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Improving Adequacy of Prenatal Care in Utah

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Improving Adequacy of Prenatal Care in Utah Laurie Baksh, MPH, Nan Streeter, MS RN, Lois Bloebaum, BSN MPA, Joanne Barley, BS, Shaheen Hossain, PhD. – PowerPoint PPT presentation

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Title: Improving Adequacy of Prenatal Care in Utah


1
Improving Adequacy of Prenatal Care in Utah
  • Laurie Baksh, MPH, Nan Streeter, MS RN,
  • Lois Bloebaum, BSN MPA, Joanne Barley, BS,
  • Shaheen Hossain, PhD.
  • Utah Department of Health
  • MCHEP Conference
  • December 2005

2
Background
  • Adequacy of prenatal care (PNC) is a measure of
    access to prenatal care.
  • Adequacy is a measure based upon month of
    prenatal care entry and number of visits.

3
Background
  • Inadequate prenatal care is a risk factor for low
    birth weight and other adverse pregnancy
    outcomes.
  • Prenatal care provides an opportunity to conduct
    risk assessment, risk reduction, and maternal
    education.
  • Risk reduction is particularly beneficial to
    medically and socio-economically high-risk women.

4
Background
  • Utahs prenatal care adequacy steadily declined
    from 1993 through 2000.
  • United Health Foundations Americas Health
    State Rankings Report puts Utah at 49th in the
    nation for adequacy starting in 2000.

5
Utahs Prenatal Care Adequacy 1994 - 2002
6
PRAMS Data
  • Using 1999 Utah PRAMS data, analysis of Utahs
    prenatal care adequacy was published in 2001.
  • Using the Kotelchuck index, we found that the
    largest contributor to poor adequacy was women
    missing prenatal care appointments.

7
Prenatal Care Adequacy 1999 Utah PRAMS Data
8
PRAMS Data
  • The PRAMS analysis also found that 61 of women
    with inadequate prenatal care due to late entry
    reported that they received prenatal care as
    early as they wanted.
  • It appeared that many Utah women were not aware
    that first trimester PNC is important.

9
Focus Groups
  • The results of the PRAMS analysis led the Utah
    Department of Health (UDOH) to conduct focus
    groups with women who received inadequate
    prenatal care.
  • Six focus groups were held with women who had
    late PNC or inadequate PNC identified and
    selected from birth certificate records.

10
Focus Groups
  • Focus group participants did not appear to value
    prenatal care
  • All women should have the same amount of care
    available to them, but whether they take
    advantage of it or not, thats their choice.
  • I dont think its necessary to go to the doctor
    if you dont want to. You cant change anything
    that is going to happen to the baby.

11
Development of a Media Campaign
  • In 2001, a media campaign was developed to target
    Utahs poor prenatal care adequacy.
  • The media campaign was built on the current Baby
    Your Baby program that has been in existence
    since 1987 and has name recognition throughout
    the state.
  • Using PRAMS and focus group data, a new education
    campaign was developed with the theme 13/13 to
    target women getting into care late and women who
    do not receive adequate visits.
  • Commercial spots were developed which highlighted
    the message to See Your Provider By Week 13 and
    See Your Provider 13 Times for a Healthy
    Pregnancy and that 13 is Your Lucky Number.

12
Fortune Teller
13
Institute of Bad Luck
14
Award Winning - Happy Babies
15
Development of the Media Campaign
  • Television ads began airing in March 2003 on
    Utahs CBS station. Spanish ads began soon after
    on several local Spanish stations.
  • Radio spots were aired on multiple stations.
  • Billboards were hung and newspaper ads were
    placed periodically in various publications
    statewide.

16
Evaluation of the Campaign
  • A survey was designed to determine the
    effectiveness of the campaign in changing womens
    behavior.
  • Survey began in July 2004
  • Participants were chosen from a sample of mothers
    who had delivered a live born infant in the
    previous two to four months.
  • We over sampled women with lower education levels

17
Evaluation of the Campaign
  • A one page questionnaire was mailed out to
  • determine womens feelings about the new ads
  • determine if viewing the ads changed womens
    perceptions of PNC or motivated them to seek
    early and continuous PNC.
  • Two mailings were sent to the sample of moms.
  • Included 20 minute prepaid phone card as an
    incentive.

18
Evaluation of the Campaign
  • Overall response rate 41
  • Surveys sent to 1523 women
  • 621 completed surveys were returned

19
Knowledge About Prenatal Care
  • Knowledge about prenatal care
  • 94 of women said that before their pregnancy,
    they thought women should start PNC in the first
    trimester
  • Opinions regarding number of PNC visits were
    variable
  • 3.9 said 1 to 4 visits
  • 7.3 said 5 to 8 visits
  • 31.1 said 9 to 12 visits
  • 43.4 said 13 to 16 visits
  • 12.2 said 17 or more visits

20
Campaign Penetration
  • 70.5 of women said they had seen a 13 by 13
    commercial on TV in the last year
  • 34.4 said they had heard a 13 by 13 commercial
    on the radio in the last year
  • 39.1 said they had seen a 13 by 13 Baby Your
    Baby billboard
  • Only 22.6 of women said they had not seen a
    commercial on TV nor heard a radio spot

21
Did We Motivate Women?
  • 31.9 of women said the commercials motivated
    them to call their health care provider for an
    appointment
  • 32 of the women who indicated the ads didnt
    motivate them said it was because they already
    knew or had already contacted their provider.
  • 46.0 said the commercials motivated them to get
    prenatal care

22
Were There Differences in PNC?
  • Did the ads work?
  • Comparing women who saw an ad to women who did
    not hear/see ads
  • Significant differences in trimester of entry
  • Significant differences in number of visits
  • Significant differences in adequacy of prenatal
    care.

23
Utahs Prenatal Care Adequacy 2000 - 2004
15.3
24
Conclusions
  • A targeted media campaign can be an important
    tool in raising level of awareness of the
    importance of adequate prenatal care
  • Utahs adequacy rates are at an all time high,
    but still require efforts to reach HP2010 goals
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