Utah Preconception Media Campaign

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                    Acknowledgements


This report was prepared for the Maternal and Infant Health Program
           Community & Family Health Services Division
                    Utah Department of Health



                  Lois Bloebaum BSN, MPA
          Manager, Maternal and Infant Health Program
          Community & Family Health Services Division
                  Utah Department of Health



                   This report was prepared by

              SUMA/Orchard Social Marketing, Inc.

                     Researchers and Authors

                         Cathy Schechter

                           Susan Poag

                        Melanie Susswein
                                                      Table of Contents
Preliminary Communications Plan .........................................................................................................1

Stakeholder Interviews .............................................................................................................................9

Women’s Focus Group ............................................................................................................................14

Provider Focus Group .............................................................................................................................25

Appendices

           Appendix A – List of Stakeholders

           Appendix B – Instruments

                       One-on-One Stakeholder’s Interview Guide

                       Young Women’s Focus Group Guide

                       One-on-One Pacific Islander Women’s Focus Group Guide

                       Young Women’s Focus Group Worksheet

                       Provider’s Focus Group Guide

                       Provider’s Focus Group Worksheet

           Appendix C – Original Reproductive Life Plan

           Appendix D – Revised Reproductive Life Plans and Pregnancy Spacing Brochure
                    PRELIMINARY COMMUNICATIONS PLAN

PROJECT SUMMARY
The Utah Department of Health contracted with SUMA/Orchard Social Marketing, Inc.
(SOSM) to conduct formative research and develop a social marketing campaign to
promote preconception health among women of childbearing age to encourage healthy
behaviors in advance of getting pregnant to reduce infant mortality and birth defects.
SOSM researchers conducted focus groups with Utah women between the ages of 18
and 34, segmenting them by whether they had children and desired more
(interconception phase), or had no children, but planned to have them in the future.
Women were also segmented according to ethnicity, with two Hispanic groups (one
English/one Spanish), an African American preconception group, two groups with
Native American women (both urban and rural), as well as in-depth interviews with
Pacific Islanders.

In addition, knowledgeable stakeholders working in allied fields that touch the lives of
these women were interviewed for their perspectives on preconception health
promotion. Four focus groups were held with health care providers, as well, to
understand what role they might play in the campaign.


CAMPAIGN CHALLENGES
1. Preconception health comprises many different components. Somewhat like a
   fruit basket contains a variety of fruit, so does the umbrella of “preconception
   health,” comprise many components, including things women should do (eat well,
   exercise, get vaccinated, plan pregnancies, get sleep) and NOT do (smoke, binge
   drink, take drugs, etc.), and resources for more information.

2. Many young women in the preconception phase of life do not have regular access
   to preventative health care. Lack of health insurance is one reason many women
   forego regular care; if they had Medicaid as children, it stopped at age 18. They may
   have aged out of insurance provided through parents, and many jobs do not offer
   health insurance. Students living away from home who customarily depended on a
   parent to prompt them for checkups are only seeking service when ill, and may use
   student health centers. Students seeking care for sexually transmitted diseases
   (STDs) or birth control may wish to do so away from any insurance coverage that
   could be seen by parents, thus, seek family planning services (along with many un-
   or underinsured women) through Planned Parenthood. Normal avenues for health
   promotion and health education can easily miss this population. Consequently,
   laser-targeted message distribution and media planning is critical for success.




                                                                                           1
3. For women in the preconception phase of life, allusions to future pregnancies or
   babies hold little (if any) appeal. Preconception health for the purpose of having
   healthy babies at some undetermined date down the road lacks relevance to many.
   The preconception issue must be couched in “well woman” messages that are age
   and life-stage appropriate to be relevant, acceptable and attractive to the audience.

4. Women in the interconception phase will be far easier to reach through theirs (or
   their children’s) health care providers, however, health care providers with strong
   ties to the LDS religion, take issue with the pregnancy spacing facts, and indicated
   they would not deliver those messages. If they are Medicaid-eligible when
   pregnant, they can be accessed through Utah Medicaid lists, as well as the
   obstetricians and gynecologists serving them when pregnant. In addition, some
   pediatricians and family physicians have expressed interest in offering pregnancy
   spacing information to women.


CAMPAIGN ASSETS
1. Information presented in the draft of the “Reproductive Life Plan” was received
   very favorably among women in focus groups. Information about vitamins, family
   history, vaccinations, relationship health, sleep and other health topics, was
   perceived as relevant to many. Women requested more information on reproductive
   health and birth control options and mental health issues. The lists of additional
   resources for information was also perceived favorably, and viewed as useful.
2. Most community-based stakeholders embrace the concept of preconception
   health, and have indicated a willingness to assist to whatever extent possible with
   the distribution of materials. To whatever extent is possible, the vast majority of
   allied professionals and community-based group leaders and influentials strongly
   acknowledge the need for this campaign, and will help with distribution to the
   extent possible.


TARGET AUDIENCES
Primary Audiences
   Preconception: Women between the ages of 18-34 who someday plan to become
   pregnant
   Interconception: Women between the ages of 18-34 who have had children and plan
   to have more

Secondary Audiences
   Mothers of women 18-34 who plan to become pregnant
   Health care providers who care for the primary audience
   Social service providers with access to the primary audience




                                                                                           2
CAMPAIGN CENTERPIECES
The centerpiece of the campaign will be the “Reproductive Life Plan,” (RLP). The
magazine-style piece (Appendix D) comprises the critical issues for women to be aware
of not only for future healthy pregnancies, but for their current and future health and
well-being. The following topics are addressed in the RLP.
    Healthy Habits (diet, nutrition, exercise, proper amounts of sleep)
    Self Knowledge (family history, vaccinations, menstrual cycles)
    Mental Health (depression, anxiety, stress)
    Things to Avoid (binge drinking, tobacco, substance abuse)
    Reproductive Health (birth control options, information about sexually transmitted
    diseases)

A secondary piece targeted specifically at interconception audiences is a brochure about
pregnancy spacing, which educates and encourages women to wait 18 to 24 months
between pregnancies.


CAMPAIGN THEMES
Concepts of “well woman exams” or “wellness,” is common among women who have
annual Pap smears, breast exams and regular health care. Among young women,
particularly the un- or underinsured populations, or extremely young women who have
only recently left home, this concept is not as familiar. Thus, the overarching campaign
theme should speak simply to the idea of wellness for life beginning at a young age. The
following concepts will be coupled with logo design to brand the overall campaign.

       Be Well
       Well Woman
       Healthy U
       Healthy Woman


CAMPAIGN SLOGANS TO TEST
The campaign slogan will be paired with the logo, and introduce the central piece of the
campaign, “The Reproductive Life Plan.”1
   Plan your health, live your life
   Start healthy, stay healthy


CALLS TO ACTION
Preconception health as a whole concept contains many small calls to action:
   Check your health (call to interactive section of the site)
   Take a daily vitamin
   Exercise regularly

1   Campaign logos/slogans, advertisements and collateral pieces will be field-tested in Utah in early 2010




                                                                                                              3
    Maintain a healthy diet
    Stay up to date on your vaccinations
    Get plenty of sleep
    Check your relationship health
    Avoid alcohol, substance abuse and tobacco
    Know your family history
    Plan for a healthy pregnancy

The overarching call to action should offer ways to get information about how to
overcome barriers to these actions, or to get more information. Final calls to action
should offer resources for finding more information:

   Call for referral
   Go to www.healthyu.com (e.g.) for information
   Seek information about how to make small changes that can make a big difference in
    the long run for better health.


CAMPAIGN TONE
   For Women: Youthful, healthy and wholesome, but realistic. Down-to-earth and
    grounded, but hopeful and forward-looking. Images should depict real people of all
    shapes, sizes and colors, acknowledge life’s challenges and demands, yet offer
    relevant answers to often unspoken questions. It must appeal to women at a core
    level, answer unspoken or unasked questions, awaken them to new information,
    provoke thought, spark small changes to create a more healthy and whole life in
    context of a woman’s larger journey through her life and the life of her family.

   For Professionals: There must be a component to introduce the issue of
    preconception and interconception health to professionals. The content should be
    factual, straight-forward, and offer ways to integrate preconception health into their
    standards of care, as well as to their practice. These messages will have to come
    from preconception professionals, like Merry K. Moos, and local experts.



CAMPAIGN COMPONENTS

Earned Media Campaign
Earned media will be a consistent part of the campaign from start to finish. Our public
relations team will develop relationships with medical reporters for daily newspapers,
television and radio outlets, and magazines to introduce them to the issue, and provide
them with story ideas, experts and other people to interview.
    1) Campaign kick-off
    2) Coverage of local events
    3) Invitation to medical reporters



                                                                                          4
   4) Identification of campus journalism students to establish a weekly column on
      women’s health issues



Paid Media Campaign
The current budget for creative development allows for the production of 2-3 spots.
Depending on the success of engaging partners/sponsors for the television campaign
(described below), we might take one of two approaches:

   1) Without partner/sponsors: Produce spots to reach target groups with a call to
      action to seek more information through the website or referral number. One
      spot each targeting:
          a. Young women (preconception) to emphasize information and referral for
              health
          b. Young mothers (interconception) to emphasize pregnancy spacing
          c. Mothers of young women, with messages to encourage mothers to
              encourage their daughters to stay healthy
   2) With partners/sponsors: Up to ten spots to emphasize the various components
      of preconception health, including:
          a. Vitamins with Folic Acid
          b. Exercise
          c. Nutrition
          d. Family history
          e. Family planning
          f. Preventive health check-ups
          g. Relationship health
          h. Readiness for baby

Corresponding Spanish-language spots will be produced to the extent the budget will
allow, and air on radio. Local affiliates of Telemundo and Univision will be engaged as
partners, as well, for earned and paid media.

Website
Because the calls to action will always promote information-seeking, it will be critical to
develop and implement a strong and detailed website with sections for both women and
professionals.
   Women’s section should be interactive, allow women to create a self-assessment or
   reproductive life plan on their own, offer information on each component of
   preconception and interconception health.
    Professional’s section should contain information, links to continuing education
   opportunities, referral sources, downloadable tools that can be used for patient
   education, or be integrated into their practice to draw patient attention to
   preconception health.




                                                                                          5
Collateral Materials
   Reproductive Life Plan (magazine format, English/Spanish)
   Pregnancy Spacing Brochure (English/Spanish)
   Wellness Prescription Pad (and/or downloadable templates for electronic medical
   record systems)
   Refrigerator magnets with Vitamin Chart
   Short videos for the website
       o Period Piece: Everything You Need to Know but Were Afraid to Ask
       o Birth control options
       o Relationship health
       o STDs: What’s My Risk Now? Later?

Micro-Campaigns
Micro-campaigns, which narrowly target specific audiences, will utilize the collateral
materials, but introduce them through trusted organizations or individuals or outlets
with more direct access. The following constitutes a list of potential markets for micro-
campaigns, based on contacts and information gathered in the formative research phase
of this project.

Community Outreach
Goal: Outreach to non-English language audiences, or audiences needing specialized
language to appeal to ethnic sensibilities.
Strategy: Person-to-person outreach to key leaders and influencers in the community to
tap into existing distribution networks to deliver RLPs.
    Communidades Unitas (Salt Lake City; has a strong presence at the Mexican
    Consulate)
    Centro Hispano (Orem)
    Tongan P.A. Kangi Langi
    Ana Birkhead, BYU
    Melissa Zito American Indian Health Advisory Board Indian Health Liaison
    Joyce Ah You - The Queen Center Pacific Islander Ethnic Network
    Harambee - Utah African American Network
    Utah Navajo Health Systems, Inc. (Blanding)

Governmental Agencies (for material distribution)
Goal: Provide Reproductive Life Plans for organizations to offer to their clients.
Strategy: Person-to-person outreach with leaders to establish a system of dissemination
to clientele.
    Medicaid
    Workforce services
    Head Start
    Juvenile Justice
    Office of Home Visiting
    WIC
    DHS



                                                                                        6
Healthcare Organizations
Goal: Offer information pertinent to professionals to raise awareness of preconception,
so that preconception health issues can be integrated into their protocols and standards
of care when working with young women.
Strategies:
    1) Campaign kick-off with professional training opportunities
    2) Web links on website for professionals
    3) Distribution of RLP and other collaterals for them to offer patients
    Intermountain Health Care
    Planned Parenthood
    University of Utah Schools of Medicine & Nursing (grand rounds)
    Local health departments (family planning, health educators and WIC)
    FQHC’s (community-based public health and indigent care clinics)
    Utah Pediatrics Society
    Outreach to other medical professional associations

Community Organizations
Goal: Cultivate relationships for distribution of RLP.
Strategy: Provide RLPs for web links, and offer downloads for them to print and
distribute.
    March of Dimes (Teddy Bear Den)
    Utahmarriage.org
    Prevent Child Abuse
    Women’s Center of Weber County
    St. Benedict’s Foundation (Catholic sisters with outreach)
    Junior League (health fair)

Universities and Colleges
Goal: Reach healthy target audiences who may not access health care on a regular basis
with pertinent information about preconception health.
Strategies:
    Establish relationships with campus newspapers for distribution in campus eateries,
    health centers, women’s centers, and student unions
    Cultivate relationships with female journalism students who may want to write
    women’s health columns
    Outreach to campus counselors and women’s dormitories with RLPs




                                                                                           7
CAMPAIGN TRAJECTORY

PHASE I: CAMPAIGN PREPARATION

   PR team to generate corporate and media sponsorships
   Distribution arrangements with free magazines in coffee shops, campus newspapers
   Outreach team to generate partnership agreements with community-based
   organizations

PHASE II: KICKOFF

   Sponsor professional preconception training event in Salt Lake City to raise
   awareness in the professional community and give them a “head’s up” about the
   new campaign
   Use the event to introduce the RLP
   Invite media for special event to include student journalists, as well as all major
   media outlets (both English/Spanish) to generate earned media
   Simultaneous distribution to begin on campuses
   Website launch with free vitamin give-away for first 500 people to complete the
   “health quiz”

PHASE III: CAMPAIGN SPOTS BEGIN TO AIR

PHASE VI: COMMUNITY-BASED OUTREACH BEGINS WITH TOP-TIER
AUDIENCES

Hispanic Community: via Spanish media, sponsor preconception health fair in SLC,
featuring health & beauty, free vitamins, RLP in English/Spanish
Governmental Agencies: Work with Medicaid, Workforce, Head Start, Office of Home
Visiting, others, to distribute RLP
Planned Parenthood: Provide PP clinics with RLPs and other collateral for distribution
in clinic waiting rooms




                                                                                         8
                            STAKEHOLDER INTERVIEWS
Stakeholders representing 27 social service agencies, health care organizations, and
community-based providers participated in one-on-one interviews to share their points
of view about the forthcoming campaign. (See Appendix A for a complete list of
participating stakeholders.)

The interviews were approximately an hour long and included the following lines of
inquiry:

       Organizational history and populations served
       Organizational efforts to promote preconception health
       Perceptions of the campaign’s target audience
       Perceptions of the types of tools stakeholders would need to promote
       preconception health
       Knowledge of and opinions about the Baby Your Baby campaign
       A review of and feedback on the original Reproductive Life Plan brochure
       developed by the State (Appendix C)
       Partnership opportunities for campaign efforts and dissemination



PRECONCEPTION HEALTH: CURRENT KNOWLEDGE AND EFFORTS

The stakeholders were enthusiastic about the opportunity to meet with the researcher
and discuss their knowledge of preconception and interconception health, and the
efforts they make to positively impact it. Stakeholders most often associated
preconception health with the health of women who are preparing to have babies, rather
than with a holistic approach for women to follow in their childbearing years. Except for
those affiliated with the March of Dimes and the Utah Birth Defect Network, the
interviewees displayed a minimal amount of knowledge and activity regarding
preconception health in general. Among these stakeholders, interconception messages
currently have more opportunities for promotion, although many were willing to
explore how their organizations might assist in communicating preconception health
messages as well.

Stakeholders who work for advocacy organizations on behalf of specific populations
(such as Native Americans, Pacific Islanders, African Americans, or Hispanics) consider
preconception health care an important topic but said it is not currently a priority focus
for their organizations. They explained that competing issues take higher priority for the
populations they represent, including basic needs, chronic illnesses such as diabetes, and
access to health care in general.

Some stakeholders work for organizations with narrowly focused missions such as child
abuse or drug rehabilitation. They typically said that imparting knowledge about
preconception health could benefit the populations they serve, but it is not currently part
of what they do.



                                                                                         9
Stakeholders who offer direct care, such as health care providers, often provide their
clients with some form of preconception care, such as discussing family planning, birth
control, or the benefits of taking folic acid. None of the direct care organizations
represented currently offers a comprehensive approach to preconception health; instead,
they focus on just one aspect. For instance, a representative of one nursing institution
said that when their patients get birth control, they are asked to let the provider know
when they start thinking about becoming pregnant so they can be advised about “the
types of vitamins they should be taking.”

The interviews did reveal a number of opportunities to promote interconception health
messages, particularly for stakeholders who are currently involved in prenatal and
postnatal care. Participants in this group had a common concern about pregnancy
spacing and an interest in receiving materials to educate clients about the importance of
spacing pregnancies for the sake of the health of both mother and baby. As one
stakeholder said, “I do think that one of the things that works to promote
interconception health is to tell women that during pregnancy the fetus really does
deplete your iron, calcium, et cetera. I think people do not take the time to talk to people
about this, but I think they get it when you do.”



PERCEPTIONS OF THE CAMPAIGN’S TARGET AUDIENCE

 When stakeholders learned that the Utah Department of Health wants to promulgate
messages about preventing birth defects and promoting healthy birth weights and
outcomes, they consistently identified young women in their teens, late teens, and early
twenties as the populations the campaign should target, with a special emphasis on low-
income women. For many stakeholders, the conviction that preconception health care
should start as early as the teen years was linked to the religious and cultural norms for
much of Utah’s population. They said the religious norms include getting married early
and having multiple children, often within a short period of time. Some stakeholders
said it is not uncommon for a 26-year-old woman to have five or six children, with
pregnancies just a few months apart.

Interviewees said access to health care is limited for many who are uninsured or
underinsured, and that many often do not seek health care unless they are sick. The lack
of access to health care, coupled with the current norm of seeking health care only when
one is already sick or pregnant, limits the current opportunities to promote
preconception health care in clinic settings.

Among this target population, stakeholders expressed special concern about
undocumented Hispanics and their access to health care. They reported that women
who are undocumented often do not receive prenatal care and frequently show up at a
hospital to give birth, but then do not participate in organized health care beyond
delivery.

       Illegals come in late or not at all … they’re so scared about the immigration status.



                                                                                               10
A notable number of stakeholders expressed concern about both drug use and eating
disorders in the target populations. Many said they frequently see women who are
obese or, less often but often enough to be a concern, anorexic or bulimic women who
are trying to maintain “a perfect body.” Use of illegal drugs, particularly
methamphetamine, and misuse of prescription drugs were also mentioned as common
problems in Utah. One drug prevention professional said Utah has the largest Prozac
prescription rate in the United States.



PERCEPTIONS OF TOOLS NEEDED TO PROMOTE PRECONCEPTION HEALTH?

Stakeholders were asked which health education programs they believe work well with
women in the proposed target audience, based on their own experience. Small group,
one-on-one, and community-based programs counted among the most popular
responses. In fact, four interviewees said their experience has led them to believe that
small group education is the most effective health education strategy. One program
described as successful and very well attended is led by a bilingual, bicultural
community volunteer at a federally qualified health center. Reported outcomes
included longer breastfeeding and higher rates of prenatal care. Another program rated
as successful, offered through the American Heart Association, brings women together
for three short, Saturday sessions at churches or schools to discuss heart health. The
stakeholder who described the program also facilitated it; she said, “I have observed
that they like to come together in a group setting and to feel the support of others in the
group. I think they work tremendously well.” The prenatal care program De Madres a
Madres, led by promotoras (community educators), was also mentioned as a model
health education program. A fourth program is in the process of being developed by the
Utah Department of Health to educate small groups of African immigrant women about
health care. Its creation was based on research in the community.

Some interviewees said they want to receive training on how to educate women on
preconception health, as well as training materials that they could use in small group
settings with women.

Interviewees also stressed the importance of having messages come from multiple
sources. Stakeholders representing specific populations stressed the importance of
strategies and materials that are culturally sensitive. For instance, for Native Americans
the materials may be more successful if they include “pan-Indian” cultural concepts
such as “protecting the circle of life” or “seven generations.” Photographs should also
reflect the diversified population of Utah.

Other suggestions pertinent to specific populations included working with the Church
of Latter Day Saints Relief Society as a way to reach the large Mormon population of
Utah; targeting college students through campus or student organizations; and making
sure all materials contain the telephone numbers of organizations referenced, as well as
websites for those who have access to the Internet.




                                                                                         11
Some stakeholders stressed the importance of including an educational component for
health care providers so that they can reinforce campaign messages or answer questions
that may arise for women as a result of the campaign. Some stakeholders suggested
attributing the findings about preconception care to the American Congress of
Obstetricians and Gynecologists (ACOG) as a possible strategy to get health care buy-in.
It is interesting to note that, although stakeholders said it is important to involve health
care providers in the campaign, they also expressed frustration with past attempts to
include providers in campaign efforts.

Stakeholders indentified a few campaigns as memorable or effective. These include a
methadone prevention campaign targeting Native Americans (more detailed
information about this campaign can be viewed at http://ncai.org/meth/); a
methadone campaign targeting Caucasian women and featuring typical women pushing
baby strollers; the State of Utah’s tobacco prevention campaign, targeted to Native
Americans; the March of Dimes’ Teddy Bear Den, which rewards women for
participating in educational programs by giving them coupons to shop with at the
Teddy Bear Den Store they can use to buy items for their children; and the Baby Your
Baby campaign, which educates women about prenatal and postnatal care.

Stakeholders who offer direct care were asked how they follow up with women who
face high-risk birth outcomes. Most of the participating organizations that work directly
with pregnant women have specific programs or protocols in place to follow up with
high-risk pregnancies. Strategies mentioned include building networks for families,
supportive websites, medical protocols, and home-based programs. The interviews
revealed that Utah has strong support for women who face high-risk birth outcomes. As
one stakeholder said, “The greater risk may be for the women who fall into the fifty to
sixty percent of women who have unintended pregnancies.”



KNOWLEDGE AND PERCEPTIONS OF BABY YOUR BABY

Most stakeholders were familiar with the Baby Your Baby campaign and spoke highly of
it. Several mentioned the advertisement promoting 13 visits to the doctor as well as the
Keepsake book. Those who were most familiar with the campaign noted that it
benefitted from its partnerships with KUTV and Intermountain Healthcare. A few
stakeholders also said the selection of spokespeople such as Christina Flores (KUTV
anchor) has helped the campaign achieve a strong following in the Hispanic community.

The following statement is reflective of the positive impression stakeholders generally
have of the Baby Your Baby campaign.

       The campaign isn’t scary. It’s been helpful. It’s built on ideas of having a healthy baby,
       here’s how we can help. When I think of the TV ads, they’ve picked wholesome news
       people with mini-celebrity status, and that has given it a positive feel. They’ve had the
       past three governors’ wives involved.




                                                                                                    12
REACTIONS TO THE REPRODUCTIVE LIFE PLAN BROCHURE

Stakeholders reviewed the Reproductive Life Plan brochure designed by the State of Utah.
Several of the participants had been on the committee involved in creating it. Most liked
the concept but agreed that the current version is too wordy, too busy, needs to be
rewritten at a lower literacy level, and should have pictures of everyday women who
reflect the diversity of Utah. As one committee member put it, “I was on the committee
that put it together. It says “you are a busy woman,” and then we give you eight pages
to read. I am going to put this in my pile, and then later never comes.”



PARTNERSHIP OPPORTUNITIES FOR MESSAGE DISSEMINATION

Stakeholders were generous in their willingness to support the campaign. Specific ideas
for partnerships or dissemination include the following.

       Post PDF versions of the Reproductive Life Plan and pregnancy spacing brochures
       on Utahmarriage.org. Also, offer a link to the campaign website.
       Provide information to distribute through Workforce Services.
       Medicaid will make its database accessible for mailing the Reproductive Life Plan
       and/or pregnancy spacing brochures to its clients.
       Make materials available to health educators at local health department offices.
       Develop a class on preconception health to offer at the March of Dimes Teddy
       Bear Den.
       Distribute materials at Native American powwows.
       Work with Tongan Physician Assistant Kangi Langi.
       Distribute both preconception and interconception materials to Medicaid
       enrollment brokers who, according to federal requirements, must educate
       participants about family planning.
       Distribute the pregnancy spacing brochure to the University of Utah School of
       Nursing.
       Partner with a Mexican-American consultant to distribute materials around the
       Hispanic community.
       Partner with Intermountain Healthcare.
       Partner with the Women’s Center at Weber State University and the St.
       Benedict’s Foundation as possible partners. Distribute materials through the
       Sisters of St. Benedict who participate in a lot of health fairs, business fairs, and
       PTA and community fairs. Train staff to talk about baby spacing and leave
       brochure behind when they do home visits.
       Partner with the Care Fair health fair sponsored by the Junior League.
       Work with Centro Hispano in Oren, Utah.
       Partner with Head Start Parent Education programs.
       Implement grand rounds for medical students and the equivalent for nurses.
       Present information on preconception care at the annual conference of the
       American College of Nurse-Midwives (ACNM).



                                                                                          13
                                     WOMEN’S FOCUS GROUP
INTRODUCTION

SUMA/Orchard Social Marketing, Inc. (SOSM) conducted research with low-income women 18
to 34 years of age to provide background information for a statewide marketing campaign to
improve preconception health among women in this group.

METHODOLOGY

Ten focus groups with women of various ethnic backgrounds, plus eight in-depth interviews
with Pacific Islanders, all identified as within the target audience (106 respondents in all)1, were
held in July 2009. SOSM worked with representatives of the State of Utah to determine the
ethnic and geographic composition of the focus groups. The focus group research took place in
Salt Lake City, Moab, and Pleasant Grove, Utah; the in-depth interviews were conducted in Salt
Lake City. The participants and locations mirror the geographic and ethnic diversity of the state
and provide representation from both interconception and preconception women. Focus groups
were conducted in both English and Spanish. Demographic details of the focus group and
interview participants are outlined in Table 1 below.

                                                Table 1

                              Focus Group/Interview Demographics

    Instrument         Location            Population          Conception Status         Number of
                                                                                         Participants

Focus Groups        Salt Lake City    Caucasian                Interconception                10

                                      English-dominant         Preconception                   9
                                      Hispanic

                                      General                  Preconception                  10
                                      population,
                                      working/tech
                                      school

                                      African American         Preconception                   9

                                      Urban American           Interconception                14
                                      Indian


1
  Since the interview instrument was consistent with the focus group instrument, the in-depth interview
findings are included within the discussion on the focus groups.



                                                                                                      14
  Instrument         Location           Population         Conception Status        Number of
                                                                                    Participants

                                    Rural American         Preconception                  4
                                    Indian

                  Moab              American Indian        Preconception                  9

                                    Rural general          Preconception                 10
                                    population

                  Pleasant          College students       Preconception                 10
                  Grove
                                    Spanish-dominant       Preconception                 13
                                    Hispanic

Interviews        Salt Lake City    Pacific Islander       Interconception               4
                                                           Preconception                 4
                                                                                     Total: 106




SOSM utilized a combination of established community liaisons and the services of a local
market research company to recruit participants. SOSM researchers conducted in-depth
interviews with the community liaisons to determine their ability to appropriately screen
potential respondents for the focus groups and interviews. Researchers trained the community
liaisons in the use of the appropriate screening techniques and monitored their recruitment
activity at scheduled intervals.

Focus group research concentrated on the state’s previously developed Reproductive Life Plan
brochure, which is the centerpiece of the current campaign. In order to present the messages of
the current version of the brochure in a more user-friendly and appealing format, SOSM
developed a magazine-style preconception life plan to field-test with the target audience as a
means of conveying essential preconception health messages, including the concept of
reproductive planning. These core preconception health messages are grounded in the Centers
for Disease Control’s report, Recommendations to Improve Preconception Health and Health Care,
dated April 21, 2006. To that end, focus group lines of inquiry included the following (See
Appendix B for the focus group guide).

       Identification of lifestyle choices and trends relevant to the overall campaign, such as
       motivators and influencers
       Identification and exploration of women’s health behaviors



                                                                                                  15
       Salience of preconception health messages
       Determination of the attractiveness and appeal of the Reproductive Life Plan magazine
       format

SOSM took a segmented approach to field-testing materials in the focus groups. We conducted
four focus groups in the first week of July, analyzed and updated materials in the middle two
weeks of July, and then conducted the remaining six focus groups and the in-depth interviews
with updated materials in the last week of July.


DATA ANALYSIS

Focus group sessions were tape-recorded and transcribed verbatim for analysis. (In this report,
italicized indented text indicates participants’ quotes. They are included to illustrate the
findings and enhance their credibility.) Transcripts were then read with an eye to common
themes and patterns of response. All interviews and focus groups fall under the rubric of
qualitative research, which means that they lack statistical validity. Therefore, all findings
contained in this report should be considered strictly directional and not definitive.



FOCUS GROUP FINDINGS AND RECOMMENDATIONS

As the Methodology section above indicates, SOSM researchers included women from different
ethnic, racial, and geographic backgrounds in the focus group research to ensure that this
campaign would represent and include Utah women from all walks of life, whether they are
African American, Pacific Islanders, American Indian, members of the Church of Latter Day
Saints, Caucasian, living in rural areas, or city dwellers. Data analysis indicates that findings
are consistent across population segments, especially those regarding health concerns and
priorities, with women from each population segment voicing similar opinions. Exceptions are
noted in the findings.



IDENTIFICATION OF LIFESTYLE CHOICES AND TRENDS RELEVANT TO THE OVERALL
CAMPAIGN, SUCH AS MOTIVATORS AND INFLUENCERS

In an icebreaker discussion at the beginning of each focus group, participants were asked to
name who they respect the most and briefly explain why. This question is designed to identify
influencers and motivators.




                                                                                               16
Finding: The vast majority of participants cited family members, especially their mothers, as the
people they respect the most; some participants mentioned friends. Most indicated that they
respect the person because he or she worked hard, persevered, and positively impacted their
lives.

       The person I respect the most is my mom. She’s been through a lot and she held it down, kept her
       strength.

       We need our friends. We can share things.

Recommendation: Campaign messages should be mindful of these influencers. Message media
should include pictures and other concepts of women with family members and with groups of
other women, to draw a connection between those they respect and healthy preconception
behavior.



IDENTIFICATION AND EXPLORATION OF WOMEN’S HEALTH BEHAVIORS AND SALIENCE OF
PRECONCEPTION HEALTH MESSAGES

Finding: The preconception health messages contained in the Reproductive Life Plan are relevant
and pertinent to the lives of Utah women.

       I felt like all of it was really relevant. A lot of times you flip through magazines and you’re like
       no, no, no, and oh, this stuff’s interesting. But as I was flipping through this, everything, I was
       like, oh yeah, that. I guess not everything, but pretty much the majority of it I was like, oh yeah,
       that’s relevant, that’s relevant. And it was interesting to me to read, the majority of it was.

To determine top-of-mind health concerns, the moderator initiated a conversation on women’s
health, unhealthy behaviors, health priorities, and barriers. The vast majority of responses echo
the preliminary preconception health messages identified for this campaign and contained in
the Reproductive Life Plan brochure. In other words, prior to reviewing the brochure, focus group
participants identified as concerns and areas of interest the key health messages covered in the
brochure.

Focus group participants mentioned many of the same messages when sharing their thoughts
on women’s health prior to seeing the Reproductive Life Plan. The most common responses were
related to eating well and exercising, with mental health, sleep, fitness, healthy relationships,
and the cost of insurance figuring into other common responses.

       Living a better and healthier life. Exercising. Eating well. Being active. I think one should set a
       goal and be aware of how we eat and what we do.




                                                                                                             17
       I think that when you are down on yourself and you’re overly stressed, and you often find an
       unhealthy outlet, and that might be partying, that might be smoking, that might be eating poorly,
       and I think that’s where a lot of health problems come from is, because you’re mentally not in a
       position where you can take care of yourself physically. So I think it all starts with how mentally
       healthy you are, and emotionally healthy.

Participants in seven of the ten focus groups spoke of a strong connection between appearance
and health. The conversations went beyond simple statements about the importance of exercise
and a well-balanced diet, revealing many women’s struggle with body image and how this
struggle impacts health.

        A lot of my friends are overly concerned with their weight. A lot of them are uncomfortable even
       if they’re a healthy weight or if they’re maybe slightly overweight or just a little bit of exercise
       and diet. But they are overly obsessed or worried about their weight or being overweight.

       I just feel like it’s bad for your self-consciousness, you know? You know, it just kind of affects
       your whole being. It affects everyone around you if you’re talking about how you’re fat or you
       need to lose weight.

The Spanish-dominant Hispanic and rural American Indian groups more often indicated that
their top-of-mind thoughts were centered around specific diseases such as diabetes and cancer,
as well as difficulties related to maintaining healthy behaviors. In offering feedback on the
Reproductive Life Plan brochure, they also expressed great interest in the family history portion
and a strong reliance on other women as their sources of health information.

       When I hear women’s health, I think of usually the bad stuff like breast cancer and cervical cancer
       … diabetes, because my mother and sister have diabetes, and most of the women in my family on
       my mom’s side have diabetes.

       [I liked] family history. The importance of baby spacing. I didn’t know about that …. Vitamins. I
       didn’t know about prenatal vitamins like folic acid. I had to look on the Internet and I did it
       because my friends told me about it. Before that, I was completely unaware.

For most women, Reproductive Life Plan’s messages regarding unhealthy behaviors were
relevant. When asked to identify unhealthy behaviors in women their age, many included
drinking, drugs, weight issues, prescription drugs, binge drinking, and smoking as the
unhealthy behaviors they observe.

       I had a friend who got pretty involved with meth, so my friend just deteriorated her whole life. So
       it’s pretty bad. That stuff is a killer.




                                                                                                            18
While most women did not mention vitamins, vaccinations, birth control, menstrual cycle, or
healthy relationships as top-of-mind thoughts about women’s health, they expressed a high
level of interest in these topics when reviewing the Reproductive Life Plan brochure. In addition,
the section on a woman’s menstrual cycle and ovulation elicited many responses and was
frequently listed as something they learned during the focus groups.

Vitamins
Although many women expressed great interest in the vitamin information, and some asked if
they could take the vitamin chart home with them, they also voiced numerous concerns about
vitamins, including not knowing which kind to take, when to take them, if they negatively
interact with other medicines or herbal remedies they may be taking, and whether they are
truly necessary or if a proper diet will provide all the vitamins a person may need.

       Respondent 1: Is it the right kind of vitamin? Are there any health risks? You know how there
       are certain vitamins that aren’t approved by the FDA, and you don’t know if you should be
       taking those. So you could ask somebody if this is the right vitamin I should be taking, how much
       I should take, because you know you get that one pill, you need more than that certain one
       vitamin in your body.

       Respondent 2: Would it cause like a growth, a weird abnormal growth if you had too much folic
       acid or something?

Moderators were sure to discuss the folic acid health message in each focus group due to its
importance to preconception health. They found that participants were often unaware of the
importance of folic acid or only vaguely articulated their knowledge of it subsequent to
discussing it in the focus group.

       Respondent: Could we add in the magazine that it helps reduce what she said [spina bifida]?
       Because I did not know that.

       Moderator: Something like, if you do not have folic acid in your body when you’re pregnant, you
       have a higher chance of having a child with a birth defect.

       Respondent: Yeah, exactly.

While the importance of folic acid was better known in the interconception groups, they too
were unable to clearly state the direct correlation between folic acid and prevention of specific
birth defects, or the importance of taking folic acid between pregnancies.

       You know, who thinks, “Oh, I’d better take folic acid today?“… You don’t really think about how
       many grams of folic acid you need every day and why, and you kind of pointed that out. This
       talks about how it helps for birth defects in children, and I think that’s really important because I
       never knew that.



                                                                                                         19
Vaccinations
Most women expressed surprise that some immunizations are needed beyond childhood. The
following focus group conversation was typical in that many participants had no idea that
women need immunizations or that this was an important health topic to consider.

       Respondent 1: Vaccinations. Something that you really don't think about for yourself.

       Moderator: Okay. Was anybody else surprised by vaccinations?

       Respondent 2: I haven’t gotten a shot since I was a little kid. I didn't know you were supposed
       to still keep getting them.

       Moderator: By a show of hands, how many of you were surprised by the vaccination? … So
       that’s about half.

Birth Control
Some respondents indicated that they would like to know more about birth control. Participants
responded positively to the suggestion of adding a birth control chart similar to the vitamin
chart as a means to learn more about various birth control options and the levels of protection
they offer.

       I think that would be helpful. I think it’s really important, just because it is not information that
       every girl in Utah has access to …

       I had friends in high school who ended up getting pregnant in high school because they were too
       nervous to talk to their mom about birth control.

Menstrual Cycle
Many respondents expressed surprise over the content of the menstrual cycle health message in
the Reproductive Life Plan brochure. They spoke of a basic lack of knowledge about how their
bodies work in regard to ovulation and whether or not their own menstrual cycle was
considered irregular.


       Moderator: What did you learn that you didn’t know before?

       Respondent 1: Almost everything.

       Respondent 2: I wasn’t sure about the six days of ovulating.

       Respondent 3: I always thought it was two days.




                                                                                                          20
       Respondent 4: Yeah, I thought it was different.

Stress
Stress was discussed in several of the focus groups as a concern that women face and that may
ultimately impact their health. It became apparent that stress is an issue with which women
struggle and that they would benefit from learning how to decrease stress by adopting healthy
lifestyle choices.

       Respondent 1: I think stress is something that a lot of women our age have a hard — not have a
       hard time with, but it’s something we face every day. I think a lot of times we have higher levels
       of stress, higher levels than is healthy.

       Respondent 2: Unnecessary too. I feel like I have stress about the dumbest stuff, but I don’t
       take the time or have the knowledge and tools to de-stress myself. Like, you don’t need to worry
       about it, but it escalates to a point where you have to deal with it.

Recommendation: Maintain the current health message topics in the Reproductive Life Plan
brochure and enhance the content by adding the following:

       resources related to eating disorders
       a birth control chart
       direct language explaining the need for folic acid
       language and visual collateral to explain ovulation and the menstrual cycle
       language and visual collateral regarding vitamin safety and food intake necessary to
       match the nutrients in a single vitamin tablet
       information on how to mitigate stress through healthy lifestyle choices
       more direct language on when annual exams are recommended

Finding: The cost of health care is a perceived barrier that women in many of the groups said
impacts their lives and medical decisions. Mentioned in almost every group, it was the most
common barrier discussed.

       I have probably more health costs than my daughter has …. Where am I going to get the
       hundreds of dollars for my prescriptions?

       Where would you get vaccinated and the cost of some of the vaccinations if you don’t have
       insurance? ... Like, HPV is like sixty or seventy dollars if you don’t have insurance.

        I just worry when I think about women’s health. I need to make sure I’m healthy, but I don’t
       know, because I have no money, I have no job.

       Even your co-pay. Like, I always weigh that I am sick enough to pay the co-pay.



                                                                                                       21
Recommendation: Special attention needs to be focused on helping women achieve healthy
lifestyles on limited incomes by providing resources for low-cost or free immunizations,
pregnancy tests, and purchasing and preparing healthy foods on a limited budget. In addition,
the campaign should include information on where women can go to obtain health care if they
do not have insurance.

Finding: Only a handful of women indicated that reproduction was a top-of-mind thought
when reflecting on women’s health. Many women indicated that pregnancy messages are not
appealing to them at this point in their lives. However, most women responded with great
interest when the moderator stated that 50% of pregnancies are unplanned.

       Being a mom is always on every woman’s mind, so it’s something that’s important. But it doesn’t
       have to be drilled into our heads. So maybe just cutting it down a little.

       You guys bring up the whole getting-pregnant thing a lot, like this is better if you’re pregnant,
       this is worse if you’re pregnant. Part of me is like, what if I don’t want to have kids, and I get this
       pamphlet and it’s all about when you get pregnant and you need to do this more, or you need to
       stop doing this …. Maybe what you could do is make a section about pregnancy and how it will
       affect everything …

Recommendation: Campaign messages should be focused on women’s health in general and
include information about pregnancy, as opposed to focusing on pregnancy with general
women’s health information added. When speaking of pregnancy, include the statistic that 50%
of pregnancies are unplanned.

Finding: Women spoke about the need to be educated on how to integrate healthy behaviors
into their daily lives. They know that exercising and eating healthy food are essential to their
well-being, as evidenced by the large number of women who provided these two responses
when asked about top-of-mind thoughts on women’s health. In addition, many women stated
that they liked learning that one can exercise in ten-minute increments. However, knowing
what one should do and actually having the tools and education to put that knowledge into
practice make the difference between practicing and not practicing healthy preconception
behaviors.

       When I buy for myself, I stood there, like, this is the most embarrassed I’ve ever felt, but I do not
       know how to get food for myself at all, like what I should buy.

       I like the [exercise message] because we are so stuck on trying to get to the gym. It says here,
       ten minutes as long as it adds up to 35 minutes.

       Or even if you are in a bind and you are in a hurry, what should you get from Wendy’s?




                                                                                                           22
       When they talk about, like, fruits and vegetables … they should even have recipes in it, like
       healthy food.

Recommendation: Campaign messages and strategies should make use of tools that provide
tips on how to adopt the healthy behaviors promoted in the campaign. These tools will bridge
the gap between knowing and doing by illustrating achievable ways to integrate behaviors into
daily life.

Finding: The amount of information in the Reproductive Life Plan brochure is appropriate, and
the magazine concept is appealing to women. Some women stated they would like to hear
stories from “real” women, again speaking of the need to show women with other women in all
campaign collateral.

       I just like how when I read it, I think, well sometimes when we talk about health, you’re like, I’m
       going to feel so bad with all these things I need to do. But I read this, and I was like, oh okay. I
       didn’t feel like I was being scolded. I was like, wow, I really am not good.

       I thought it was good so people don’t get overwhelmed. It teaches you stuff. It’s like a skirt: you
       know, short enough to keep it interesting but long enough to cover the essentials. That’s how it is.

Recommendation: Maintain the current format of providing brief health information and
probing questions, with a list of resources for accessing more in-depth information.



DETERMINATION OF THE ATTRACTIVENESS AND APPEAL OF THE REPRODUCTIVE LIFE PLAN
MAGAZINE FORMAT

Findings: Participants consistently chose the titles Start Healthy, Stay Healthy and Plan Your
Health, Live Your Life for the magazine title. In addition, they particularly liked some of the page
titles and subtitles, such as Life Is a Journey of Balance and Flow, Happy Is Healthy and Healthy Is
Happy, and Sometimes Your Journey Is Interrupted. They enjoyed the magazine-style format as a
means of communicating important and relevant health messages. It is approachable and
familiar, serving to communicate important health messages in a format with which women are
comfortable. The photographs considered to be the most favorable were those of women who
appear realistic and represent the diversity of Utah. Several women considered the photograph
cropping to be juvenile.

       Respondent 1: I feel like, for somebody that doesn’t really focus on their health or know about
       their health, this would be really cool, because it talks about tips to not just feel good for a month,
       but it’s like, know about your family history, know about what you can do for the long term. It
       gives, like, barriers, like sun on your skin, but not too much, just enough Vitamin D to be
       absorbing the really good stuff.



                                                                                                            23
      Respondent 2: Exactly. Like a lot of times you’ll see pamphlets like these where it’s just nonstop,
      monotonous crap that you don’t care about.

Recommendation: Continue with the magazine format for the Reproductive Life Plan brochure,
which is the cornerstone for campaign messages, and include more photographs of women who
are “real” Utahans. Delete the flowered cropping to give the magazine a more sophisticated
look.




                                                                                                      24
                            PROVIDER FOCUS GROUP

INTRODUCTION

Four focus groups with Utah providers were conducted in Salt Lake City (2), Ogden (1),
and Blanding (1). In addition, two Provo health care providers were interviewed at the
Student Health Center at Brigham Young University to gather information specific to
that population. Focus group participants included family physicians, internists,
obstetricians, an adolescent health physician, physicians’ assistants, and nurse
practitioners. The purpose of the focus groups was to gather information about how
providers perceive preconception health care; current practices and concerns; and ideas
about what information is important for the target audiences and how messages
conveying that information might be distributed.

Lines of inquiry covered the following general areas.

   Top-of-mind perceptions of preconception health
   Current ideas and practices vis-à-vis preconception health care
   Concerns about patients in the preconception phase of life
   Responses to potential campaign materials
   Ideas for distribution of materials




                                                                                     25
KEY FINDINGS


PERCEPTIONS OF PRECONCEPTION HEALTH

Lack of Routine Care for the Preconception Target Audience. A recurring observation
of the health care providers was that a large proportion of the preconception target
audience does not get routine care. Providers reported that they generally do not see
women in the preconception phase of life unless they come in for sports physicals,
premarital visits, birth control, or testing for sexually transmitted diseases. Very few
young women come for routine preventive health screening, which the providers
generally attribute to an overall lack of awareness of the need, either because their
parents do not know about it or did not teach them about it as young adults, or because
they do not take care of themselves.

       They’re there for their immunization years. They’re all there at the 12-year-old mark,
       and then after that, unless they’re sexually active or coming in for birth control, they
       don’t get routine care.

       They don’t tend to think of prevention the way an adult thinks of prevention.

Young women in college, in particular, may not yet have learned to take care of
themselves.

       There is the factor of shyness, without mom or aunt or somebody there to walk them
       through, a grown-up; you know, that transition into womanhood or self-care is daunting;
       they’re unsure what to do.

Providers also noted gaps in insurance coverage, whether it is Medicaid or their parent’s
health insurance plan.

       Medicaid will not pay for a physical on an adult female patient. If they’re over eighteen,
       they don’t get a physical. They can have a Pap test, they get their pills, but they cannot
       have a physical with the screenings. The regular things aren’t gone over.

       I will say I’ve had privately insured patients’ kids that are still on their parents’
       [insurance], who will come into student health so they can pay out of pocket. They’re
       worried about some kind of traceable evidence.




                                                                                                  26
Young LDS Women Tend to Have Particular Assets and Challenges. Providers in Salt
Lake City and Provo pointed out that young LDS women who are planning to be
married often come in for a “premarital exam.” The Provo providers offer an
educational program at the Student Health Center in which they actually teach a course
about preconception health and sexuality. However, the Salt Lake City providers in
both focus groups discussed the lack of protocol for such visits, and expressed varying
levels of uncertainty about what to do when these young women come in. Many
agreed that they had low-risk behaviors and were fairly well-educated about health.

       The majority are virgins, well-educated about smoking, alcohol use …. Like if they’re
       twenty, they’re basically planning for pregnancy, they don’t smoke. They don’t drink.
       They’re taking prenatal vitamins. They exercise. They’re normal body weight. I mean,
       they’re doing everything right, basically. So there’s not a lot of education that needs to
       go on necessarily in that group.

However, after one provider who is not native to Utah expressed concern about these
young women, others began to share their concerns as well. She noted that the women
were at low risk for contracting sexually transmitted diseases, but from an
educational/emotional perspective many young LDS women had anxieties about their
sexuality. Others shared their own perplexity about the “premarital exams,” noting that
there is no protocol for them.

       Am I big enough? Do I need to use dilators? What about birth control? … A lot of
       times if the exam is too uncomfortable, I won’t even do the exam because I’ll have them go
       out, have their honeymoon, have some sexual activity and then come back.

       They’re terrified … they don’t know what to expect.


Overall, most providers agreed that they do not see these women very often, certainly
not for preventative screenings, and that “the people at the highest risk for
complications from not planning are generally least interested in it.”

Current Ideas and Practices for Preconception Health Care
When asked what top-of-mind associations they make with the term “preconception
health care,” providers presented a series of topical headings: prenatal vitamins, birth
control, weight control, pregnancy planning, alcohol and drug prevention, healthy
relationships, and abstinence. The unanimity of the responses indicates a tendency
among providers to think less of the relational cluster of preventative or healthy
behaviors under one banner—preconception health—than of a hit-or-miss series of
issues young women may have, largely relating to reproduction or sexuality.

       I have to admit, unless it’s a medication I know is a pregnancy issue, it doesn’t pop into
       my head.




                                                                                                27
A few providers mentioned that, when treating sexually active young women who do
not use birth control, they point out that they must, in effect, be planning a pregnancy.

       Before I give them any medications, I say, “Are you planning on becoming pregnant?”
       “No.” “Are you on birth control?” “No.” “Are you sexually active?” “Yes.” So what
       I say a little less bluntly is, “Do you want to go on prenatal vitamins, or do you want to
       take birth control? At this point in time, those are your options.” So prenatal vitamins is
       what I picture as preconception, and just talking about drinking and alcohol and drugs
       and things that can harm a baby if you decide to become pregnant.

Providers noted almost unanimously that they have never received any training about
preconception health, either as students or through professional development. One
exception was a nurse who specifically treats women with diabetes. Beyond that, not
even the several medical residents in both Salt Lake City and Ogden had received
training about preconception health.

       We get bits and pieces everywhere. I mean, when the studies on folic came out, I think we
       all got it from all different sources on that. In medical school, of course family planning
       is big. We’ve got plenty of lectures on that in residency. But I think as far as having a
       dedicated course on that, probably not, it’s just bits and pieces, and we decide what to put
       into our little query.

Although the topics may be interrelated under the banner of preconception health,
providers noted that they lack time to focus on all the various issues at play. Many
discussed their “algorithm of asking questions” based on the patient’s history, but they
often admitted that it was difficult to introduce new routines during a visit for a specific
ailment. The recurring question in at least two groups became “How will I work all of
this into my practice?” At least one resident concluded that generating awareness of the
cluster of topics and incorporating them into visits for other purposes might be his only
recourse.

       Rarely are women coming in and saying, “Hey, six months from now I think I’m going
       to have a baby.” But if you can … get in their physicals or they come in for depression
       and anxiety, I think that’s the key, to encompass it into all of women’s health, and
       incorporate it into the visit, even if it’s just for a cough or cold. If you can somehow
       incorporate this, then I think we will have better outcomes.




                                                                                                28
Discussions about how providers educate their patients about their conditions led many
to report that if they had not already converted to electronic record keeping, they were
in the process of doing so or expected to do so in the near future. As they described it, if
they wish to generate patient education pieces, the electronic system usually has
prepared pieces that can be printed out, along with prescriptions or other instructions.
In some cases, such as that of Intermountain Healthcare, pieces can be added to the
entire system. Other systems allow individual physicians to integrate “hot text,” or text
they want to place into the system, under certain categories in their files. Younger
providers seemed more adept at using these innovations than older ones.

       Essentially, you have the ability to create a template for whatever you’d like. … [For
       example] In my hot text for “sore throat, bronchitis, sinusitis,” I have a history of
       asthma, smoking. I put it there. Do you smoke? It’s actually for adults or kids. If they
       smoke, I’m more likely to give them an antibiotic … It’s mine, but built into the system.


PROVIDER CONCERNS ABOUT PATIENTS AND PRECONCEPTION

When asked what concerns they had about their patients and preconception health,
providers brought a wide variety of issues into the discussion. Generally, these fell into
several categories.

Timing of Visits. As mentioned above, health care providers rarely see women
preconception unless they are ill or need birth control. The concerns about illnesses
most commonly expressed by patients are those that the providers most often see, such
as sexually transmitted infections and obesity. Because of this, they are not likely to
have opportunities to present patients with information about issues such as taking folic
acid or pregnancy spacing until the patients are already pregnant.

       I think one of the only opportunities I have—and that I have recognized in the very high-
       risk demographic, socioeconomic status, unplanned pregnancies, single moms, that type
       of thing—is their postpartum visit. So I might not have seen them before they came in
       pregnant the first time, but at their postpartum visit you deal with their anxiety and
       depression. It’s hard, but it’s one of those things where I talk about the difference it will
       make for her and her baby if there’s space between her kids.

Ignorance and Lack of Awareness Among Patients. Some providers lamented the fact
that most parents lack education about well-child checkups beyond the immunization
years, which translates into not passing the importance of prevention on to their
children.

       If the parents don’t have that understanding, then they can’t pass it on to their children.
       They can’t educate their teenagers about responsibility of taking care of yourself, being
       careful, using contraception, using protection. If they don’t get that message at home,
       they don’t get it at school, and they don’t get it here, then they just don’t get it anywhere,
       because they’re not going to think about it on their own.



                                                                                                  29
Providers in all groups expressed a sense that patients do not understand their own
anatomy, reproductive functions such as ovulation, or adult vaccination schedules.
They do not believe patients know why they are receiving a Pap smear. For these
reasons, many said they thought the Reproductive Life Plan brochure, which was field-
tested later in the group sessions, was generally too difficult for their patients to
understand or even to read.

       … the hook used to be the Pap smear, but really what they need to know is that if they are
       sexually active, they still need to come in for health care. But it’s not a “Pap smear.”
       They equate Pap smear and pelvic exam as the same thing, so teaching them the
       difference.

Limited Time During Visits. Time is a critical issue for all health care providers, and
across the board (with the exception of the Provo student health providers) they agreed
they have very little time to assess or discuss preconception issues with patients when
they see them for sick visits. As will be shown in subsequent sections of this report,
while they agreed that patients need this information, they also did not think they were
the ones to provide detailed information such as that presented in the magazine.
Instead, they prefer short, “bulleted” messages that they can disseminate easily.

Access to Services for Uninsured or Underinsured Patients. Providers in community
clinics in particular expressed awareness of the great number of undocumented,
uninsured, and underinsured patients they see.

       You have a huge undocumented, noninsured population who doesn’t come in because
       they can’t afford it. Then they end up kind of a disaster in the emergency room … I think
       Baby Your Baby misses the mark a little bit because it doesn’t provide a huge population
       in Utah with prenatal care, and they end up having to pay for it themselves, which is at a
       much-reduced rate, but it happens a lot.

Providers see many unmet needs among their patients, particularly in the arena of
mental health. Mental health came up repeatedly in discussions, since they perceive that
depression, low self-esteem, abuse, and other issues influencing relationship choices
cause trouble for young women who are least likely to plan for pregnancy.

       Mental health is huge … like depression, anxiety, bipolar. Major. Which leads a lot of
       those people to substance abuse.

       You’ll hear them say, “I’m having this baby for him,” and [they] talk about feeling like
       they’re possessed.




                                                                                                  30
Perceived Lack of Referral Resources. In all groups, providers stated that there was a
scarcity of mental health resources to which to refer patients. In a few groups, providers
spontaneously entered into discussions about whether or not the referral aids they use
are adequate or up to date. One Salt Lake City provider thought he was well-educated
about preconception issues but not about what he described as “the real world, when
you get out into practice.”

       I think the education was there in what should be done. I think what wasn’t there is what
       you do when this patient can’t afford this. What do you do if this patient has this barrier,
       because there are programs, you know, many of you work in them? There are programs
       out there, and a lot of that is not talked about with formal education … like community
       access, government-funded programs, privately funded programs.

       If there was a website that was comprehensive or had everything on it. Our care manager
       hands us papers all the time. It’s like, well, I can’t keep track of papers, you know?
       There’s no one area that you can go to and get everything you need, and that’s what we
       need.


RESPONSES TO POTENTIAL CAMPAIGN MATERIALS

Providers reviewed three drafts of materials: one general preconception magazine-style
brochure, one brochure about pregnancy spacing, and one wellness prescription pad.
Overall, the providers expressed reticence about distributing the magazine and had a
number of suggestions for more effective ways to offer them to the target audience. They
responded more favorably to the idea of giving the pregnancy spacing brochure to
patients.

Preconception Magazine. Providers generally gave the preconception magazine mixed
reviews. While they tended to agree that providing basic information and resources for
finding more information is positive, they had varying opinions as to how the
information should be presented. Blanding providers were very positive about the
publication, pointing out that their patients rarely receive such nice presentations of
information. Salt Lake City providers, on the other hand, expressed doubt that many
women would actually read it. Some said it was too “wordy” and thought that shorter,
more targeted messages would be more effective. They also thought more dollars
should be invested in short messages via billboard, media, or small giveaways such as
magnets.

Some providers suggested that more information be presented about basic anatomy, to
give a context to the messages. Some Salt Lake City providers also indicated they would
like to see more information on sexually transmitted diseases, mental health issues (such
as that presented in the article about “the blues”), and menstrual cycles. A few
providers did not like the word “preconception” and preferred the term “healthy
woman.”




                                                                                                31
Blanding participants thought the theme of “life’s journey of balance and flow” would
be more appropriate for their audiences if it included the concept of “the circle of life” or
“generation to generation.” Ogden providers, on the other hand, wanted to see the “life
journey” theme carried on every page more conspicuously than in the current design.
They also thought that the “Health IQ” questions should be placed more prominently, at
the front of the publication rather than towards the back. Participants in all of the Salt
Lake City and Ogden groups requested the publication in Spanish.

Providers suggested that the publication would not likely be useful to them in their
practices, largely because it is long and the referral information is scattered throughout.
Overall, they suggested that shorter, checklist types of publications are more useful to
them.

Despite their misgivings about the usefulness of the publication in their own practices,
many providers did say that they saw the information it provides as good for women to
have. They suggested a number of alternative places where it could be distributed,
including the following.

       Campuses                                           Native American chapter
       Workforce                                          meetings
       ESL Classes                                        Girl’s Night Out events
       Peer to Peer in neighborhoods                      Online
       Schools                                            Put signs on computers at public
       Churches                                           libraries to advertise the site
       Job Corps                                          Abortion clinics
       Planned Parenthood

Interconception Brochure. With the exception of the Provo providers, who said they
could not distribute the brochure at all, providers generally responded more favorably
to the interconception pregnancy spacing brochure than to the preconception magazine.
A few Salt Lake City providers felt that the brochure should be targeted more to men,
and suggested designing it in such a way that men as well as women would find it
relevant. Ogden providers were more forceful in their opinion that the piece should
reflect positively on motherhood, and not show “women looking exhausted.” A few
providers suggested that since many mothers do not return for postpartum visits, the
brochure should be included in the after-birth package they give patients upon
discharge from the hospital. Overall, the size of the brochure and the clarity of the
information appealed to the providers, and more of them expressed a willingness to use
the brochure than the preconception magazine.




                                                                                          32
Wellness Prescription Pad. Providers generally liked the wellness prescription pad.
Some expressed approval for applying the “Pass It On” slogan (from the magazine) to
the pad. They saw a wellness prescription pad with a call to “pass it on” as something
they might use as an aid in promoting well-woman checkups for preconception stage
women. Others liked the pad and saw it as something they could easily integrate into
the many sports physicals they conduct for young women. Many suggested that if it
had more white space, they would frequently use it like a pad of paper, to write the
names of over-the-counter drugs or other patient information.

As much as they liked the pad, however, a major barrier to implementing its use in
practice has to do with the growing use of electronic records. Many physicians keep
“hot text” in their records to prompt them to offer certain instructions to patients, while
others use patient education materials provided in the electronic system itself. Both can
be printed easily during the visit, precluding the need for a pad of paper. One Blanding
provider noted that it would be “painful” to add to the patient visit regimen a piece of
paper on which to write or check off a traditional prescription. A Salt Lake City provider
noted that the promoters of some health cause offered pads such as these during the
Olympics and “no one used them.”

Ogden providers liked the pads and suggested putting health tips at the top, such as
information about using certain over-the-counter drugs during preconception or the
dangers of combining smoking and birth control pills. They also recommended that the
website be prominently displayed on the pad. Other suggestions included making a
chart of the characteristics of different STDs, such as genital warts versus HPV.


RECOMMENDATIONS FOR DISTRIBUTING MATERIALS

As demonstrated by their assessments of the materials described above, providers
expressed an overall need for short and engaging messages that will give their patients a
greater understanding of their bodies, empowering them to make healthier choices.
They cautioned that the limits of a busy practice would prevent them from reviewing
information from the proposed Reproductive Life Plan brochure in its current iteration,
and asked instead for “one-pagers.” The following recommendations address provider
needs and preferences within the parameters of the current campaign.

Checklists. Providers in all groups stated that they prefer “one-pagers” or checklists,
simple pieces that they can easily review with a patient on the patient’s way out the
door.

The main reason they liked the wellness prescription pad concept was because it was
short, to the point, and would help them remember to talk with women about
preconception health (that is, if they had time or could remember to use it). There was
frequent mention, however, of wanting a checklist they can hand out. A few suggested
that the pad could be used to address frequently asked questions or to provide a “What
to do if …” checklist.


                                                                                          33
Electronic Resources. A major barrier to the use of materials such as the wellness
prescription pad is the growing reliance on electronic records. Insertion of “hot text”
into electronic records may be an alternative or preferred solution for many providers.
Web-based solutions such as these should also integrate the providers’ request for up-to-
date referral information.

Educational Tools. Providers also expressed a need for educational tools to explain
human anatomy to patients. Several providers mentioned that new rules of engagement
with drug companies prohibit them from receiving the giveaways they formerly relied
upon for such displays. A few said they would prefer anatomical models or posters to
use with their patients. More isolated recommendations included providing patients
with calendars or “cycle beads” to chart fertility, or quizzes that might spark patient
interest.

Pregnancy Spacing. Most participants considered the brochure in its current iteration to
be a useful tool, something they would distribute to patients at the appropriate time—
after the birth of a new baby, during a postpartum visit, or even at a pediatric visit.
Most providers considered the length of the brochure and the information presented
ideal for the amount of time they have to review materials with their patients.


A NOTE SPECIFIC TO THE BLANDING FOCUS GROUP

Blanding providers have seen their community education efforts succeed in the form of
educational events. Much of the discussion of recommendations in Blanding revolved
around the desire to organize educational activities for the community, including a
professional development event for health care providers and social activities for young
women and their mothers.




                                                                                      34
                 APPENDIX A: LIST OF STAKEHOLDERS

1. Heather Borksi - UDOH Bureau of Health Promotions Program
2. Luis Garza, Sabrina Morales - Comunidades Unidas
3. Amy Muti, Probation Officer - Second District Juvenile Court
4. Audrey Stevenson, Division Director of Family Health - Salt Lake Valley Health
   Department
5. Julia Robertson - Observing Pregnancy Risk Line
6. Gail Rapp, Patti Fuhriman, - UDOH Medicaid Bureau of Managed Health Care
7. Owen Quiñonez, Dulce Diez - UDOH Center for Multicultural Health
8. Joyce Ah You - The Queen Center Pacific Islander Ethnic Network
9. Karrie Galloway, CEO - Planned Parenthood
10. Janie Wilson (Director, W&N Clinical Programs), Amy Lovato (W&N
   Administrative Assistant) - Intermountain Healthcare
11. Ana Birkhead - Brigham Young University College of Nursing
12. Steve McDonald - March of Dimes
13. Catherine Hoelscher - Baby Watch Early Intervention Program
14. Penny Davies - Planned Parenthood of Ogden
15. Melissa Zito - Health Systems Improvement
16. Shirley Stevens – Utah School Nurse Association Board
17. Betty Sawyer did not attend; instead, 2 coworkers were interviewed – Harambee
   Utah African American Network (Ogden)
18. Leissa Roberts - College of Nursing University of Utah
19. Elizabeth Smith, MPH - Perinatal Education Department
20. Ann Freimuth - Prevent Child Abuse Utah
21. Marie Nagata - Baby Your Baby, UDOH Building
22. Frank Wojtech - Utah State Office of Education – Health Curriculum
23. Ed Napia - Indian Walk-In Center: Networking to Keep Tobacco Sacred in Utah
24. Lynn Tanner, Davis Family Advocacy Program
25. Anna Erickson - FQHC (Discussion about partnership in our campaign)
26. Becky Barnet - Human Services Division of Substance Abuse & Mental Health
27. Melanie Reese – Healthy Marriage Initiative
                          ONE-ON-ONE INTERVIEW GUIDE WITH
                     UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                                  STAKEHOLDERS



                                      Name, Location, and Organization
                                           Name of Interviewer

INTRODUCTION TO INTERVIEWS: SOSM has been contracted by the Utah Department
of Health to develop a social marketing campaign around preconception health messages.
The goal of this interview is to get your opinion and thoughts on how to achieve this
throughout Utah.

A LITTLE BIT ABOUT US: We are a social marketing company based in Austin, Texas. In
our 15 years in business, we have learned that the most beautiful outreach campaigns will
not work unless there is support and consideration from stakeholders, such as you. This
interview will take an hour, and is completely confidential.
Before we begin do you have any questions or concerns? If not … commence.

I. Background

    1. Tell me about the history of your organization.

         Probe: The mission and main activities?

         Probe: The number of volunteers and employees?

    2. Tell me about the populations that you serve.

         Probe: What is their ethnicity?

         Probe: What areas of Utah do they reside in?

    3. How does your organization impact or follow-up with women who have high risk birth
       outcomes?

    II. Preconception

    4. What have you heard about the preconception strategy that Utah is pursuing?

         If little or nothing: “The Utah Department of Health want to promulgate messages that
         promote healthy birth weight, prevent birth defects and promote healthy birth outcomes
         throughout Utah in particular to the Medicaid population.”


SUMA/Orchard Social Marketing, Inc.
Stakeholder Interview Guide
                                                                                                  1
    5. With these goals in mind, who do you think are priority target audiences for this
       campaign?

    6. What role do you and your organization currently play in educating people about
       preconception issues?

         Probe: What works?

         Probe: What doesn’t?

         Probe: What kind of tools and materials do you have?

    7. Who doesn’t seem to get the messages about preconception health?

         Probe: What challenges do people face in having healthy babies?

         Probe: What do you think they have difficulty understanding?

    8. What causes it to be difficult to understand or deliver these messages?


III. Field Test: Reproductive Health Plan
         Ask participant to review the Reproductive Health Plan

    9. Have you seen anything like this before?

         Probe: Where? How was it being used?

    10. What kinds of opportunities do people in your organization have to review something
        like this face-to-face with clients?

    11. When you review this, what, if anything, do you think might be missing?

    12. Thinking now about how to get this out to people, how would you suggest this be
        distributed?

IV. Baby Your Baby

    13. What role have you or your organization taken in the BYB campaign?

    14. What is your opinion of BYB?

    15. What have you heard about it?

    16. What is your opinion about how it has been advertised?

    17. What, if anything, would you change about it?

SUMA/Orchard Social Marketing, Inc.
Stakeholder Interview Guide
                                                                                              2
    18. What are your thoughts about integrating the preconception campaign messages into
        the BYB campaign/service?

V. For Health Care Providers:

    In a recent strategic planning document on promoting preconception health, one of the
    recommendations made by the CDC is increased distribution and usage by health care
    providers of patient self-assessment tools.


    19. When you think of chronic disease education issues like for asthma or diabetes, what
        has been your experience in using these kinds of tools?

    20. What kinds of assessment tools have you seen or used that may be helpful to this effort,
        either as a model or something that could be incorporated into the campaign for health
        care providers?

    VI. Concluding Questions

    21. What is the most innovative or memorable tool or practice that you have seen or heard
        about it in educating this target audience?

    22. If you could design the perfect preconception campaign what would it look like?

         Probe: Who would be your priority target audiences?

         What kind of tools would you like to have in your hands to educate your patients?

    23. What other partner organizations, agencies or individuals would you want to engage for
        this campaign?

    24. In terms of this campaign, how do you see your organization contributing to this effort?


         Probe: How do you think your organization could play a role in distributing the
         Reproductive Life Plan?

    25. How would you describe the level of involvement you and your organization would
        want to have in this effort?

    26. Do you want us to stay in touch with you as this campaign progresses? What is the best
        way to stay in touch?




SUMA/Orchard Social Marketing, Inc.
Stakeholder Interview Guide
                                                                                                   3
                                FOCUS GROUP GUIDE WITH
                       UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                                    YOUNG WOMEN

Pre-Group Activity: Worksheet #1. Participants will enter the session with their answers already
recorded.
      I.    Introduction

      Moderator begins by introducing the concept, process, and purpose of the focus group.

            Lay ground rules for the discussion (no right or wrong answers, speak one at a time, etc.)
            Explain the purpose of the tape recording equipment
            Assure participants that their remarks are confidential in the sense that their names will never be
            attached to their statements.

  Introduce purpose of group: The purpose of this group is to discuss information related to the concerns
  of women your age when it comes to health.

  Objective One: To identify lifestyle trends and choices relevant to campaign strategy –
  heroes/mentors motivators, media habits

      II.       ICEBREAKER

              Please introduce yourself and tell us a little about yourself (your family, your job or
              school), and what you wrote on your worksheet on the question that says, “The person
              I respect the most is…” Then tell us what you respect about that person.
              We don’t have to go around the table now. Let’s just discuss how you answered the
              question about what you do in your spare time.

        Objective Two: To identify motivators (predisposing, enabling, and reinforcing factors)
        for young women’s personal health behaviors.

                What do we think of when we think of “our health?”

                Probe: What do you think are priorities for women your age when it comes to good
      health?

                Among your female friends, what are some unhealthy habits you see?
                What type of things do you do to keep healthy?
                What gets in the way of you doing some of these things?
                Who or what influence your decisions about how you take care of your health?

                Probe: Media? Other?



  SUMA/Orchard Social Marketing, Inc.
  Young Women’s Focus Group Guide
                                                                                                          1
             Probe: When you think about your mom’s influence on your health decisions, what
             kinds of conversations have you had with her about health issues? What about the
             men in your life, how do they influence your health?



Objective Three: To determine the salience of preconception health messages to participants.

MODERATOR SAYS: We are now going to look at and discuss various pieces of health information
important to women your age. The information is going to be on pages that look something like a
magazine. Before we look at those pages, I’d like to get your opinion about some titles. Before we get
started, I want to assure you that we did not create these materials. They were done by an artist in
another state. So if you like them or don’t like them, it will not hurt my feelings. What I really need is for
you to give your honest opinion.

(Show the group the picture from the mag. rack at Planned Parenthood as you hand out
worksheet).

Moderator writes each title on a board

                 In the Pink
                 Ready, Set, Go Healthy
                 Good Health is in Your Hands
                 Good Health: Pass it On
                 What’s Your Healthstyle?
                 Utah Women. Your Life. Your Health
                 Start Healthy, Stay Healthy
                 Plan you Health. Live Your Life
                 Your Life. Your Health. You Are Utah Women

Moderator passes out worksheet and says: I’d like you to think about each title and then rank them in the
order that you like best. A one means it is your first choice and a 7 means it is your last choice.

Moderator: Go through the worksheet and ask in detail how they rated each title. For instance
how many people rated In the Pink a number 1, which means it is your favorite.. Then go on to
number 2, 3,

Moderator: Consensus Building: This group chose the following as the top three titles: Let’s
vote to see which one you like the best out of these top three: SAY NUMBER OUT LOUD FOR
RECORDING

             Based on the titles, what do you think the information going with this title will be
             about?


SUMA/Orchard Social Marketing, Inc.
Young Women’s Focus Group Guide
                                                                                                        2
Moderator: I am going to hand out some different pages. Take a moment to look at this and
then we will have a brief discussion about it.

             FOR EACH DOUBLE PAGE SPREAD, ASK THE FOLLOWING QUESTIONS:
               o What is your opinion about this information?
               o What did you learn that you didn’t know before? What surprised you?
               o What questions come up for you after reading it? (If the expert of the world
                  on these topics came in, what would you want to ask about this?)
               o What do we like or dislike about the way the piece looks.
               o What do you think it wants you to do?
               o What information is missing? Is there any other information you feel like you
                  need to know about your health.

Interconception Group Only
          Baby Spacing Content
              o What did you learn that you didn’t know before? What surprised you?
              o What questions come up after reading it?
              o What does this want you to do?
              o What is your opinion about this advice?


For the Spanish-dominant group only

Show the Spanish card.
            o What is your opinion about this information?
            o What did you learn that you didn’t know before? What surprised you?
            o What questions come up after reading it?
            o What do we like or dislike about the way the piece looks.

             By a show of hands, who thinks they might make a change to what you would
             ordinarily do after reading these? What would it be?
             Moderator says: All of these messages are part of a package to encourage young women who
             have not yet had children to consider the kind of health they should have before they do get
             pregnant. We have seen messages about mental, physical, and reproductive health as
             well as about relationships Let’s take a minute to rank them in order of importance.

Moderator: Explain ranking exercise on the worksheet and ask participants to complete it.

         Probe: Discuss why you ranked as you did. MODERATOR: VERBALIZE THE
         RANKING SO IT IS ON THE RECORDING.

             How does all this relate to you at this time in your life?
SUMA/Orchard Social Marketing, Inc.
Young Women’s Focus Group Guide
                                                                                                   3
             By a show of hands, how many of you plan to have children someday? (Do Not Ask
             This Question of the Interconception Group)
             Based on what you have seen here so far, what would you think you would need to
             do (or stop doing) to ensure you would have a healthy baby when you’re ready?

Objective Three: To determine participants’ reactions to concepts and graphics

         Moderator: Show the clinic pamphlet picture again and say: This picture was recently taken
         in a clinic. As you can see, there are many pamphlets and messages competing for your
         attention. If you saw this (HOLD UP COVER PAGE) in your mailbox, or in a display of
         pamphlets in your doctor’s office or clinic, how many of you would find it interesting
         enough to pick up?
         Thinking back to the titles we discussed at the beginning of the material review. This
         group picked A and B as your favorites. Now that you see what we plan on putting
         inside the magazine do you think those titles are appropriate?
              Would you change your mind on which title you like best?
              Do you have any suggestions of another title?

         Moderator: Show the Merck “My Voice” mp3 and explain what it is.

                  What do you think of this concept?
                  If you saw this in your mailbox, or in a display of pamphlets in your doctor’s
                  office or clinic, how many of you would find it interesting enough to pick up?
                  If you had to choose between getting information this way, or with the magazine
                  we’ve looked at, what would you choose? What makes you think it’s better?

Distribution

                  Generally speaking, where do you usually get health messages like these that are
                  important to you?
                  Where would you and the people you know like to receive messages like these, if
                  you had a choice? (RECORD ANSWERS ON FLIP CHART)
                  By a show of hands, how many of you have used a social networking site this
                  week? By social networking, I mean Facebook, My Space, or something like that.

                  Moderator: Probe heavily
                  Probe: Have you ever used it for health care information?
                  Probe: Would you use it to get information about health care?

                  Many young women who have not had children don’t have a regular health care
                  provider, or health insurance. If the state was going to provide an information
                  resource center for young women like yourselves, what would be the best way to
                  do it?
SUMA/Orchard Social Marketing, Inc.
Young Women’s Focus Group Guide
                                                                                              4
                          (IF NOT MENTIONED, PROBE) Internet website? Telephone hotline?
                           Local events or meetings? Combination of both? Other?

Familiarity with “Baby Your Baby.”
            How many people have heard of the Baby Your Baby campaign?
            The creators of Baby Your Baby would like to do a campaign on what they call
              “preconception.” What does that term mean to you?
            What about the term, “reproductive life plan?” What does that mean to you?
              What words would you use to explain this to other people?
            Let’s brainstorm what the name of this campaign might be. If we put all these
              pieces together into a magazine, for example, or ran television or radio
              advertisements with some of these health messages, what would we name this
              campaign? (RECORD ANSWERS ON FLIP CHART)

Familiarity with Pregnancy Risk Hotline.”

             o    Pregnancy Risk Hotline.
                      Based on the name, “Pregnancy Risk Hotline,” what do you think
                        happens when you call this number?

Moderator explains that women and their doctors can call the hotline to get information about things
that might affect a pregnancy. For example, someone who is pregnant may have had alcohol before they
knew they were pregnant; someone else may be taking a medication they’re concerned about.

                          Based on that description, what would be a better name for this hotline?



Conclusion

About half, 50% of pregnancies are unintentional. Many people may get pregnant by accident
and are still doing unhealthy things. Our clients want to get messages out to young women who
have not yet had babies about the importance of being healthy BEFORE you ever get pregnant.
They want to prevent women from the heartbreak of having a premature baby, a child with
birth defects, or a baby with low birth weight; they want everyone to be healthy from the day
they are born. How would you get these messages out to women who aren’t thinking about
pregnancy? Let’s go around the circle one last time before we say goodnight. If you could give
them one piece of advice about the very best way to get these messages out, what would it be?



Thank you for your time!

SUMA/Orchard Social Marketing, Inc.
Young Women’s Focus Group Guide
                                                                                                 5
                          ONE-ON-ONE INTERVIEW GUIDE WITH
                     UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                              PACIFIC ISLANDER WOMEN

                                       Conception Status
                                           Name:
                                         Interviewer

    I.        Introduction
              Moderator explains the purpose of the interview and introduces herself.


1. Please tell me a little about yourself (your family, your job or school),

         Objective Two: To identify motivators (predisposing, enabling, and reinforcing factors)
         for young women’s personal health behaviors.

          2. What is the first image or thought that comes to mind when you think about your
             health?

              Probe: What do you think are priorities for women your age when it comes to good
              health?

          3. Among your female friends, what are some of the most unhealthy habits you see?

          4. What type of things do you do to keep healthy?
          5. What gets in the way of you doing some of these things?
          6. What influence your decisions about how you take care of your health?

              Probe: Media? Other?

7. Who influences your health decisions?

              Probe: When you think about your mom’s influence on your health decisions, what
              kinds of conversations have you had with her about health issues? What about the
              men in your life, how do they influence your health?




SUMA/Orchard Social Marketing, Inc.
Pacific Islander Women’s Interview
                                                                                                   1
Objective Three: To determine the salience of preconception health messages to participants.

MODERATOR SAYS: We are now going to look at and discuss various pieces of health information
important to women your age. The information is going to be on pages that look something like a
magazine. Our client is working on a campaign for women about their health. Your input will help us
with that campaign. Before we look at those pages, I’d like to get your opinion about some titles. Before
we get started, I want to assure you that we did not create these materials. They were done by an artist in
another state. So if you like them or don’t like them, it will not hurt my feelings. What I really need is for
you to give your honest opinion.

Moderator hands out the ranking sheet, which has the titles listed on it and asks the person to
pick the one they like the best.

8. Why did you pick that one?

       Moderator: Lay out the 2 magazines. Please pick the one that appeals to you the most.
9. Why did you pick that one?

            Ask the following questions after they have read everything.

10. What is your opinion about this information?
11. What did you learn that you didn’t know before? What surprised you?
12. What questions come up for you after reading it? (If the expert of the world on these topics
    came in, what would you want to ask about this?)
13. What do we like or dislike about the way the piece looks.
14. What do you think it wants you to do?
15. What information is missing? Is there any other information you feel like you need to know
    about your health.


All of these messages are part of a package to encourage young women who have not yet had children to
consider the kind of health they should have before they do get pregnant. We have seen messages
about mental, physical, relationship, and reproductive health.

16. Which do you think is the most important message? Why?
17. How does all this relate to you at this time in your life?
18. Based on what you have seen here so far, what would you think you would need to do (or
    stop doing) to ensure you would have a healthy baby when you’re ready?




SUMA/Orchard Social Marketing, Inc.
Pacific Islander Women’s Interview
                                                                                                            2
Objective Three: To determine participants’ reactions to concepts, graphics and potential titles
for Life Plan

19.   Which bit of information is most likely to grab your attention?
20.   What do you like about it?
21.   Are there any that you dislike?        Why?
22.   What kinds of colors or fonts or styles do you think are most attention grabbing?
23.   If you saw this in your mailbox, or in a display of pamphlets in your doctor’s office or clinic,
      how many of you would find it interesting enough to pick up?

         Moderator: Ask participant to look at the message ranking page of the worksheet and to please
         complete it.

         Moderator: Show the Merck “My Voice” mp3 and explain what it is.

24. What do you think of this concept?
25. If you saw this in your mailbox, or in a display of pamphlets in your doctor’s office or clinic,
    how many of you would find it interesting enough to pick up?
26. If you had to choose between getting information this way, or with the magazine we’ve
    looked at, what would you choose? What makes you think it’s better?



Distribution

27. Generally speaking, where do you usually get health messages like these that are important
    to you?
    Probe: Where do you get your health care?
    Probe: Have any of the doctors or nurses there ever spoken to you about these message?
    What did they say?
28. Where would you and the people you know like to receive messages like these, if you had a
    choice?
29. Have you used a social networking site this week? By social networking, I mean Facebook,
    My Space, or something like that.

                  Moderator: Probe heavily
                  Probe: Have you ever used it for health care information?
                  Probe: Would you use it to get information about health care?




SUMA/Orchard Social Marketing, Inc.
Pacific Islander Women’s Interview
                                                                                                         3
30. Many young women who have not had children don’t have a regular health care provider,
    or health insurance. If the state was going to provide an information resource center for
    young women like yourselves, what would be the best way to do it?
    (IF NOT MENTIONED, PROBE) Internet website? Telephone hotline? Local events or
    meetings? Combination of both? Other?

Familiarity with “Baby Your Baby.”
31. How many people have heard of the Baby Your Baby campaign?
32. The creators of Baby Your Baby would like to do a campaign on what they call
    “preconception.” What does that term mean to you?
33. What about the term, “reproductive life plan?” What does that mean to you? What words
    would you use to explain this to other people?



Conclusion

About half, 50% of pregnancies are unintentional. Many people may get pregnant by accident
and are still doing unhealthy things. Our clients want to get messages out to young women who
have not yet had babies about the importance of being healthy BEFORE you ever get pregnant.
They want to prevent women from the heartbreak of having a premature baby, a child with
birth defects, or a baby with low birth weight; they want Utahans to be healthy from the day
they are born. How would you get these messages out to women who aren’t thinking about
pregnancy? Let’s go around the circle one last time before we say goodnight. If you could give
them one piece of advice about the very best way to get these messages out, what would it be?



Thank you for your time!




SUMA/Orchard Social Marketing, Inc.
Pacific Islander Women’s Interview
                                                                                                4
                 UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                           Young Women’s Focus Group
                                 Worksheet #1

Please complete the following sentences with the word(s) or feelings that first pop into
your head. There are no right or wrong answers, only your opinion. You do not need to
put your name on this paper. Your answers are confidential and anonymous.

1) The thing I like best about being this age is
    ___________________________________________________________________________
    ___________________________________________________________________________


2) The thing I like least about being this age
    ___________________________________________________________________________
    ___________________________________________________________________________


3) The one person I would most like to meet is
    _____________________________because_______________________________________
    ___________________________________________________________________________


4) The funniest thing I have seen or heard lately is
    ___________________________________________________________________________
    ___________________________________________________________________________


5) The thing that makes me most nervous or scared is _____________________________
    ___________________________________________________________________________


6) The person I respect most is __________________________________________________
    ___________________________________________________________________________


7) My favorite thing to do in my spare time is_____________________________________
    ___________________________________________________________________________




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Women’s Focus Group Worksheet
                                                                                       1
8) My favorite thing to do when I am alone is _____________________________________
    ___________________________________________________________________________


9) When I want to take care of myself, I __________________________________________
    ___________________________________________________________________________


10) The first thing that comes to mind when I think of my health is
    ___________________________________________________________________________
    ___________________________________________________________________________


11) Do you have a computer at home?                 Yes               No


12) Do you have access to the Internet?             Yes               No


13) If so, where do you have access…

                  Home

                  Work

                  Library

                  School

           Other (Explain: _______________________________________________)?




SUMA/Orchard Social Marketing, Inc.
Women’s Focus Group Worksheet
                                                                                  2
                             FOCUS GROUP GUIDE WITH
                    UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                                   PROVIDERS


 I. Introduction

       Moderator begins by introducing the concept, process, and purpose of the focus group.
          Lay ground rules for the discussion (no right or wrong answers, speak one at a time, etc.)
          Explain the purpose of the tape recording equipment
          Assure participants that their remarks are confidential in the sense that their names will
          never be attached to their statements.

   Introduce purpose of group: The purpose of this group is to discuss information related to the
   concerns of women between 18 -27, when it comes to health.

II. Icebreaker

            Let’s go around the room and introduce ourselves, tell us a bit about where you
            work, the demographics of your patients, and how long you have been working
            in this field?

            I am going to read you a quote we heard from a provider who works with
            young, uninsured women who have not yet had children. As we go around the
            table, please share your thoughts about this quote.
            The problem I see is a gap between the teenaged phase to the pre or interconception phase.
            That is where I see the big old gap and it is not the providers fault….I mean there is
            nothing.


III. Attitudes and Activities Related To Preconception Health


            What are some of the health issues you see in your practice with women between
            the ages of 18 and 34? Moderator: Record on Flip Chart
            Probe: If they have not identified issues that pertain to women who do NOT
            have children say: OK, Let’s now focus on issues related to women who do not
            have children.” Moderator: Record on Flip Chart.

            When you hear the term, “preconception health,” what does that mean to you?
            What about the term, “interconception health?”

            What concerns do you have about the uninsured or Medicaid population when it
            comes to preconception health care?

            What did you learn about preconception health in medical school?

   SUMA/Orchard Social Marketing, Inc.
   Provider Focus Group Guide
                                                                                                     1
           As you know, the purpose of the group is to inform the development of a
           preconception campaign targeted to women between the ages of 18 and 34. In
           your opinion, what are the most important things this campaign should
           emphasize about preconception health with women who have not yet had
           children?

           Probe: Folic acid & vitamins? Nutrition and exercise? Smoking? Substance
           abuse? Alcohol abuse? Relationship health? Mental health? Other?


IV. Providers Needs to Educate the Public

           What educational or campaign tools do you need or think will work to help you
           educate or disseminate preconception information to this population?

           What kinds of educational or health promotions strategies have you tried that
           have worked for you in the past with this audience?

           Probe: What has not worked? What would you like to try that may be new?

           How important do you think it is that your patients are educated on these topics?
           Probe: Whose job is it to educate them on these topics?

           Distribute handout on means and topics of training and ask participants to
           complete the two exercises

           What do you want or need to learn that will better help you serve this
           population?(Generate list on flip chart)

           Moderator describes personal prescription pad and asks: What do you think of this? Is
           this something that you would use in your practice?

           How does your practice or clinic use electronic documentation?

V. Reproductive Life Plan Moderator distributes Reproductive Life Plan and asks participants
   to read and review it.

           What are you top of mind impressions of this?

           How would you envision this being used in your practice or clinic?

           Do you have any ideas about where else this should be distributed?

           Is there anything that you would like to see added to this? Any topic? Let’s
           compare this to our list of what falls under the rubric of preconception health. Is
           there anything missing?

  SUMA/Orchard Social Marketing, Inc.
  Provider Focus Group Guide
                                                                                                 2
         Tell Dairy Queen story: a state health commissioner traveled the state and noticed that as
         diverse as communities may be, there was still a Dairy Queen in every town, so he asked
         health educators to partner with the Dairy Queens.) Who are some of the community
         partners outside of the health care arena that may be involved with?

         Is there any place that you can think of where we should consider having a
         campaign message that would reach large numbers of young women that is
         unique to Utah or to your community?

Baby Spacing Brochure Moderator distributes brochure and asks participants to read and
review it

         What are you top of mind impressions of this?

         How would you envision this being used in your practice or clinic?

         Do you have any ideas about where else this should be distributed?

         Is there anything that you would like to see added to this?

Conclusion

         Of all of the things we have discussed today, the ideas you have heard or things
         that have been mentioned, what strikes you as the most important thing we
         should remember or consider as we try to develop an educational and awareness
         campaign that you will be able to endorse and participate in wholeheartedly?

Thank you for your time!




SUMA/Orchard Social Marketing, Inc.
Provider Focus Group Guide
                                                                                                 3
                     UTAH PRECONCEPTION HEALTH MEDIA CAMPAIGN
                                 Provider Focus Group
                                      Worksheet

On a scale of 1-5, with 1 being “Not at All,” and a 5 being “Extremely      1   2   3   4   5
interested,” how interested would you be in attending CME events about:
1. Preconception Care: What It Is and What It Isn't
2. Integrating Health Promotion Into Primary Care
3. Maximizing Prevention: Targeted Care for Those with High Risk
    Conditions
4. In Between Time: Interconceptional Care for Those with Previous Poor
    Outcomes
5. Babies to Adolescents: Incorporating Preconception Health Promotion
    into the Pediatric Visit
6. Cultural Sensitivity


On a scale of 1-5, how do you like to receive CME training? (Interviewer:   1   2   3   4   5
check all that apply)
1. Conferences
2. Online (tutorial style)
3. Webinar
4. Local face to face workshops
5. Publications
6. Other (Name)




SUMA/Orchard Social Marketing, Inc.
Provider Focus Group Worksheet
                                                                                            1
       Work             Relationships            Dreams


               Health                   School




 You have a lot of important things going on in your life
      right now and a lot to plan for your future.

 Maybe you want to be a mom someday….Or maybe you
don’t.... Or maybe you’re already a mom— either way, it is
  important for you to make a Reproductive Life Plan.


         What is a Reproductive Life Plan?
           Why is it Important for You?
      How to Create Your Reproductive Life Plan
                     What is a Reproductive Life Plan and
                        why is it important for you?
A Reproductive Life Plan is a set of goals that you make about having or not
having children (even if being a mom is years away for you). It includes how many
children you want to have, and when you want to have them. It also helps you
plan the spacing of your pregnancies, or prevent getting pregnant when you are
not ready. Part of your Reproductive Life Plan includes goals to improve your
personal health.
Most women end up having at least one baby sometime in their life, even if they don’t plan on it.
Once you become sexually active, you may get pregnant even if you are using birth control. One of the
best things you can do to have a healthy baby is to make sure you lead a healthy life long before you
get pregnant. If you wait, it could be too late to protect your baby from the effects of unhealthy
habits.

If you choose to have children you should discuss your Reproductive Life Plan with your partner, and
decide together how you both want to plan your family. Your Reproductive Life Plan is not set in
stone and can change, but the important thing is to start thinking about it now.


 Here is a guide for you to make your Reproductive Life Plan
 Read and answer the following questions


Do you want to be a mom someday?                      __YES        __NO          __DON’T KNOW

      If you answered YES:
           How old do you want to be when you have your first or next baby? _____
           How many kids do you want to have? _____
           How far apart do you want your kids to be? _____

What is your plan to prevent pregnancies that you are not ready for?


What will you do if you end up getting pregnant when you are not ready?


      If you answered NO or DON’T KNOW:

             What is your plan to prevent yourself from ever getting pregnant?


                 What will you do if you end up getting pregnant anyway?


                For more questions go to http://www.marchofdimes.com/pnhec/173_14001.asp
                                                                                                        2
 Here are some other things to consider in your Reproductive Life Plan

Personal Habits
                       These behaviors could harm you and your future babies and it
                       is best to avoid them. Check any of the behaviors that apply
                       to you:
                              __ Smoking
                              __ Drinking or binge drinking (drinking 5 or more drinks with
                                 alcohol in one sitting)
                              __ Using illegal drugs (marijuana, cocaine, meth, heroin etc.)
                              __ Unhealthy dieting or overeating
                             For more info: www.slcosubstanceabuse.org
                             SL County Health Dept 468-2009 for evaluation and referral
               Outside of Salt Lake County call 1-866-633-4673 or go to: www.hsdsa.utah.gov

Below are healthy habits to maintain no matter what your future plans are. Check any
of the behaviors that apply to you or your partner:
__   Eating plenty of fruits, vegetables and whole grains
__   Exercising regularly
__   Taking a multivitamin that contains folic acid everyday
__   Getting regular checkups with your doctor and dentist
__   Getting enough sleep
__   Using condoms to protect yourself from infection when you are sexually active
__   Managing stress

               For more info: www.cdc.gov/nccdphp/dnpa/bmi
               www.mypyramid.gov/global_nav/sitehelp.html
              http://www.cdc.gov/ncbddd/folicacid/index.htm

Health Problems
Your health will affect the health of your future babies; make sure your health
problems are under control before you ever get pregnant. Do you have any of the
following? Check any that apply to you:
                         __ Diabetes
                         __ Problems with your thyroid
                         __ Too skinny or too heavy
                         __ Asthma
                         __ Mental health concerns, including depression
                         __ Heart defect
                         __ Blood clotting problems
                         __ Seizures
                         __ Medication for acne
                         __ Exposure to chemicals
                         __ Exposure to cat litter
                         __ Any infections: Which one(s)? __________________________
                         __ Any diseases: Which one(s)? ___________________________
                         __ Other _________________________________________

Note: Once you become sexually active you may want to be tested for sexually transmitted
diseases (STDs) including HIV/AIDS. Some STDs can cause serious pregnancy problems.
                                     For more info: www.4woman.gov

                                                                                               3
Your Reproductive Cycle
Ask your health care provider questions about how to have a healthy pregnancy even if you don’t
plan on becoming pregnant in the near future. When you are ready to have a baby, visit your
provider at least 3 months before you want to get pregnant. This gives your provider a chance to
make sure you are in good health before pregnancy. For the best chance for a healthy pregnancy
and baby, it is recommended to wait 24 months between the birth of your last child and conception
of the next.
Do you want to be pregnant now?                  YES               No
If you answered “NO”, you may want to use some type of birth control. For information on
different types of birth control, go to: http:/www.plannedparenthood.org/utah
Information on low cost family planning clinics in Utah can be found at:
http://www.health.utah.gov/rhp/familyplanning/familyplan.htm

 Do you know when in your menstrual cycle you are most likely to get pregnant?
                                YES                       NO
If you answered “NO”, go to www.health.utah.gov/rhp and click on “Public Info”. Under
“Preconception/Women’s Health” take the “Menstrual Cycle Knowledge Quiz”.

Whether you plan to get pregnant or not, track your periods using a calendar. When you see
your provider, you will probably be asked: What was the first day of your last period; was it
normal for you; how long do your periods last; and do you have pain or other problems with
your periods?
                            For more info: www.4woman.gov


Vaccines/Immunizations
Vaccines (or immunizations) help protect you from certain diseases and illnesses such as the ones
mentioned below. Staying current on your immunizations will also help protect your baby from
diseases after birth. Infants should begin their series of immunizations by two months of age and
complete them by two years of age. The important thing is to make sure that your vaccines are up to
date before you get pregnant. Some vaccines must not be given during pregnancy. Check with
your doctor six months prior to pregnancy to find out which vaccines or boosters you may need.

                      Are your vaccines up to date?
                      Have you been vaccinated for the following:

                           __   Tetanus (Td)        __   Varicella (Chicken Pox)
                           __   Pertussis (Tdap)    __   Measles, Mumps, Rubella
                           __   Hepatitis A         __   Influenza (Flu)
                           __   Hepatitis B         __   HPV vaccine



Even if you are not planning a pregnancy, as an adult you need to receive a booster dose of tetanus
every ten years and yearly flu vaccine.

           For more info call toll-free: 1-800-275-0659 or www.immunize-utah.org

                                                                                                      4
Medications
Some medications are not safe to take during pregnancy. Always make sure your
doctor knows the prescriptions or over-the-counter
medications that you are taking.

What medications are you taking?
Prescriptions:



Over-the-counter drugs, supplements, or herbs:




Family Health History
Health problems can sometimes run in families. Some of the health problems
mentioned below have to do with pregnancy and others have to do with general health.

Have you or anyone in your family had any of the following:
−   A baby born too early (premature baby)                −   Depression
−   A baby who weighed less than 5 ½ pounds (low          −   Asthma
    birthweight baby)
                                                          −   Obesity
−   Preeclampsia/eclampsia (toxemia, high blood
                                                          −   Heart disease
    pressure, seizures, PIH)
−   Diabetes that started during pregnancy (gestational   −   Heart defect
    diabetes)                                             −   Stroke
−   Problems getting pregnant                             −   Other___________________
−   Two or more miscarriages
−   Stillborn baby (a baby born dead)
−   A baby born with birth defects. If so, what kind of
    defects? ____________________________


Talk with your doctor about any health problems your family members have had.
Ask how you can lower your chances of having the same problems happen to you.

Your partner’s health habits and family history will also affect your health and that of
your child. Get as much information on this as possible.

                              For more info: www.modimes.org
    Utah Birth Defect Network 866-818-7096 toll free or www.health.utah.gov/birthdefect

                                                                                           5
Personal Safety
Some women are abused by people who are close to them. Abuse is NEVER okay and
creates an unsafe place to live. Your safety is important for your own health and any
children you may have in the future. Are any of the things below happening to you?
−   Is there anyone in your life who physically hurts you (for example, pushes, hits, slaps, kicks,
    strangles, etc)?
−   Is there anyone in your life who says mean or hurtful things to you a lot?
−   Is there anyone in your life who forces you to take part in any sexual activities (including
    touch) that make you feel uncomfortable?
−   Is there anyone in your life who tries to control you or your activities?

If you answered YES to any of these questions there is help available.
Please call Utah Domestic Violence Info Line.
                               1-800-897-LINK (5465)

Personal Development
It takes a lot of work, commitment and energy to be a mom. Here are some questions
to ask yourself as you plan for your future. Think about how being a mom will affect
your other goals.

Future Goals:
Where do you see yourself in the next 5 years? The next 10 years?
(Married? Single? In school? Working? Living in a home or apartment? etc...)




How much education do you want to complete? (Do you want to go to college or technical
school? Where? When?)




Do you plan on having a career? (What kind of work do you want to do? Where do you want to
work?)




Do you plan to be a stay-at-home mom? (How will you prepare for that?)



                                                                                                      6
Emotional Health
                           Being able to handle stressful situations can affect your
                           health as well as the health and safety of your future kids.
                           Ask yourself these questions to learn more about your own
                           emotional health.




When you feel sad do you usually bounce back quickly or do you stay sad for a long time (2 weeks or
more)?


How often do you find yourself feeling overly nervous, anxious, or worried? What sort of things
make you feel that way?



What do you do when you are in a stressful situation or if you feel overwhelmed?



Do you get angry easily? What types of things make you angry?



When you get angry what do you do to calm yourself down?



How do you generally treat people who are close to you?



What do you do if someone says or does something that you don’t like?



Are there any areas of your emotional health that you want to improve in preparation
for having kids someday? If there is anything, write your goals here:



NOTE: It is always helpful to let your doctor know how you are doing and feeling.
Don’t be embarrassed to talk to him or her about any problems you may be having
with your emotional health.

                  For more info and resources: www.utah.networkofcare.org

                                                                                                      7
Financial Security
Life can be very expensive and having a baby will make it even more expensive. It is a
good idea to make a financial plan for basic needs in life whether you plan to have
kids when you’re older or not. Here are some things to think about in preparing for
your future.
−   A place to live
−   Money to pay for groceries for your family
−   A way to get around (car, bus, etc)
−   Health, dental, and auto insurance
−   Baby supplies (diapers, furniture, clothes)
−   Child care for when you go out



              Future mom or not—
        A Reproductive Life Plan gives you
       more control in planning your future.




                                        This message brought to you by:

                                   Planned Parenthood Association of Utah
                                           University Health Care
                                       Utah Chapter of March of Dimes
                                         Utah Department of Health




References:
Recommendations to Improve Preconceptional Health and Health Care- United States. Department of Health and
Human Services, Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. April 21, 2006/
Vol.55/No. RR-6 Preconception Health and Care, 2006. Department of Health and Human Services, Centers for
Disease Control and Prevention                                                                                       8
                      ADDITIONAL RESOURCES
            Women’s Health Government Resources (800) 994-9662
                      http://www.womenshealth.gov/
This website contains numerous tools for maintaining all topics related to women’s health.


                       Network of Care (415) 458-5900
       http://networkofcare.org/home_state2.cfm?productid=2&stateid=52
 General resources for a variety of topics concerning family planning, health, and safety.


          March of Dimes – Pregnancy and Newborns (914) 997-4488
             http://www.marchofdimes.com/pnhec/173_14001.asp
        Presentation of a list of questions to be covered if preparing for an
                                upcoming pregnancy.


Utah Department of Health – Reproduction Health Program (801) 538-9970
                    http://www.health.utah.gov/rhp/
      RHP intends to improve the health of women and babies all over Utah.


  Utah Department of Human Services – Substance Abuse (801) 538- 3939
                      http://www.hsdsa.utah.gov/
 Organization helpful for controlling personal drug habits which may harm future
   babies or parents; aimed for those needing aid outside of Salt Lake County.
Life is a journey
   made of balance and flow...

                         hen we talk about good health, we’re really
                       talking about preparing for a long and
                      happy life. A life full of good relationships,
                     healthy children, and plenty of energy to do
                    the things you want to do. And it’s a fact that
       the better you feel, the better you look. Good health means
       options, and rewards – studies show that healthy people
       are often more successful. Just as important, when you
       live a healthy life, you set an example for your friends, your
       family, and someday, if you decide to become a mom, for
       your children. And it just makes sense that healthier women
       have healthier children.

       In the following pages you’ll find some guidelines to be the
       healthiest you possible. Chances are you’re doing many of
       these things right now, but if not, there’s no time like the
       present! First, let’s get an idea of what you already know
       about good health.
                                  DID YOU KNOW...
Some diseases run in families. And the sooner you know, the better your health!
                                                                                       Should you be taking a daily vitamin?
                                                                                             Women, especially women of child-bearing age need a good amount of folic acid
                                                                                             built up in their bodies in order to prevent birth defects in future children. And
                                                                                             even though having a baby may be the furthest thing from your mind right now,
                                                                                             the fact is, 50% of pregnancies are not planned! Folic acid is found in lots of fruits,
                                                                                             vegetables and beans, but it’s almost impossible to eat enough of these things to
                                                                                             get the recommended daily dose of 400 micrograms. You’d have to eat a whole loaf
                                                   Why should you know your                  of bread, or drink half a gallon of orange juice every day to get enough. So much
                                                   family history?                           easier to take a little pill.

                                                 Family history” is not just about
                                                 where your family comes from.
                                                                                                          BENEFITS                                            SOURCE
                                                  It’s important to know what kinds
                                                  of illnesses they might have had                        Prevents eye problems, keeps skin and immune        Milk, eggs, liver, fortified cereals, darkly colored
                                                   too. Chronic conditions such as            A           system healthy.                                     orange or green vegetables (such as carrots,
                                                    diabetes, high blood pressure,                                                                            sweet potatoes,pumpkin, and kale), and orange
                                                    heart disease, and cancer often                                                                           fruits such as cantaloupe, apricots, peaches,
                                                                                                                                                              papayas, and mangos.
                                          run in families and can be inherited. Talk
                   to your family. If these or other conditions run in your family,                       Essential for healthy bones, teeth, gums, and       Red berries, kiwi, red and green bell peppers,
                   tell your doctor and learn how you, and your future children,                          blood vessels. Helps the body absorb iron and       tomatoes, broccoli, spinach, and juices made
                                                                                             C            calcium, helps brain function, healing, and to      from guava, grapefruit, and orange.
                   can lower our chances of having the same problems.                   (ascorbic acid)
                                                                                                          form collagen to hold cells together,
                                                                                                          and contributes to brain function.

       Are vaccinations just for kids?                                                       D            Strengthens bones because it helps the body         Sunlight on your skin! Also, from egg yolks, fish
                                                                                                          absorb bone-building calcium.                       oils, and fortified foods like milk.
                     Vaccines aren’t just for kids. Women
                     need vaccines all the way into their                                                 An antioxidant that helps protect cells from        Vegetable oils, nuts, green leafy vegetables,
                     fifties. If you’re in college or living in a                             E           damage. Important for the health of red blood       avocados, wheat germ, and whole grains.
                     communal situation, Meningococcal                                                    cells.
                     vaccine is incredibly important. Other
                                                                                                          Helps to make red blood cells, and is important     Fish, red meat, poultry, milk, cheese, and eggs.
                     important vaccines include Tetanus,                                   B12
                                                                                                          for nerve cell function.                            Also added to some breakfast cereals.
                     diphtheria and pertussis (Tdap);
                     measles, mumps and rubella (MMR);                                                    Important for normal brain and nerve function.      Potatoes, bananas, beans, seeds, nuts, red meat,
                     Hepatitis A&B; and, HPV. If you can’t                                  B6            Helps the body break down proteins and make         poultry, fish, eggs, spinach, and fortified cereals.
                     find your shot record, ask your health                                               red blood cells.
                     care provider if you’re current. If you’re                                           Helps the body convert carbohydrates into           Fortified breads, cereals, and pasta; meat and
                     not, be prepared to roll up your sleeve!                          THIAMIN energy. Necessary for the heart, muscles, and                  fish; dried beans, soy foods, and peas; and whole
                                                                                         (B1)  nervous system to function properly.                           grains like wheat germ.
                          Utah Department of Health – Immunization (800) 275-0659
                                                                                         RIBO-            Essential for turning carbohydrates into energy     Meat, eggs, legumes (like peas and lentils), nuts,
                          http://www.immunize-utah.org/index.html                                         and producing red blood cells. Also important for   dairy products, green leafy vegetables, broccoli,
                                                                                        FLAVIN
                                                                                                          vision.                                             asparagus, and fortified cereals.
                                                                                          (B2)

                                                                                        NIACIN            Helps the body turn food into energy, maintain      Red meat, poultry, fish, fortified hot and
                                                                                          (B3)            healthy skin and is important for nerve function.   cold cereals, and peanuts.

                                                          DID YOU KNOW...                                 Helps the body make red blood cells. Also           Dried beans and other legumes, green leafy
                                                                                       FOLATE             needed to make DNA. Young women need FOLIC          vegetables, asparagus, oranges and other citrus
                                              One Tetanus shot lasts for 10 years!      (B9, folic        ACID whether they plan a pregnancy or not.          fruits, and poultry; fortified or enriched bread,
                                                                                         acid, or                                                             noodles, and cereals.
                                                                                         folacin)
                         How much exercise is enough?                                            Do you know what is meant by a
                                      One of the best habits of all is daily exercise, and you     “healthy” relationship?
                                      don’t need to join a gym to get the benefits. Go for a
                                                                                                      A loving relationship is one of life’s greatest
                                      brisk walk, ride a bike, mow the lawn, vacuum the
                                                                                                      pleasures. It fills you with happiness and
                                      house! Do 10 minutes worth of exercise at a time, if
                                                                                                      energy, makes you feel secure, respected
                                      that’s all the time you have – as long as it adds up to
                                                                                                      and cared for.
                                      at east 35 minutes a day, you’re doing your body a
                                      favor. Exercise relieves stress, helps you maintain a
                                                                                                      Occasionally though, what starts out
                                      healthy weight, and builds strong bones. Oh yes,
                                                                                                      feeling like love can turn into something
                                      and it can be fun!
                                                                                                      very different, and a partner can become
                                      WHAT IS A HEALTHY WEIGHT?                                       overly possessive, jealous, threatening or
                                                                                                      abusive. If you have any doubts, or if
                                      Centers for Disease Control and Prevention –                    something about your relationship makes
                                       Healthy Weight                                                 you feel uncomfortable or scared, talk to
                                      800-CDC-INFO (800-232-4636)
                                                                                                      someone. True love should never hurt.
                                      www.cdc.gov/healthyweight/assessing/bmi/index.html
                                                                                                      Utah Domestic Violence Info Line
                                                                                                      (800) 897-LINK (5465)
Why are fruits and vegetables so important?
    Looking and feeling your best starts with eating right and drinking
    plenty of water. A healthy diet is high in fruits, vegetables, whole
    grains, and beans. Besides being low in calories these foods fill you
    up quickly and are packed with nutrients that help reduce your
    chances of obesity, type-2 diabetes, and even some cancers. Think
    of red meat as a special treat, and remember that fish is delish.

    My Pyramid - USDA       (888)-7-PYRAMID
    www.mypyramid.gov/global_nav/sitehelp.html




HAPPY IS HEALTHY...
  ...HEALTHY IS HAPPY
Are you getting enough sleep?                                                                     Why are regular health checkups important?
   Ever heard the old wives tale that you can “catch up” on your sleep?                               Your health care provider – especially one who knows your family
   Guess what: You can’t. Once it’s gone, it’s gone. Going without the                                history – can make sure you’re doing what you need to do in order
   proper amount of rest takes a toll very quickly, so getting enough                                 to be at your best. It’s the way to minimize health problems before
   sleep is not a luxury! At least eight hours a night, every night, keeps                            they arise, and it’s especially important if you are planning to have a
   you at your best mentally and physically, and gives you the energy                                 baby. Always be open and honest with your health care provider;
   you need to work and play.                                                                         they’ll return the favor by guiding you and your future family on the
                                                                                                      road to good health!
SOMETIMES YOUR JOURNEY IS INTERRUPTED...

         How often do you have the blues?
           Nobody is happy all the time, and everybody is
           stressed out part of the time. But it’s important to                                   Are there some drugs it’s okay to take?
           know the difference between “having the blues” and
                                                                                                           Illegal drugs like heroin, cocaine, methamphetamine, prescription
           being depressed. If you’ve lost interest in things you
                                                                                                           painkillers and marijuana can have very damaging effects on your
           normally enjoy, if you cry all the time, sleep too much
                                                                                                                                    health, your finances, your future and even
           or too little, if your appetite changes, if you have a
                                                                                                                                    your freedom. But if you are pregnant, taking
           feeling of worthlessness, and especially if you have
                                                                                                                                    drugs can permanently harm your baby. And that includes
           a desire to harm yourself or others, you need to
                                                                                                                                    over-the-counter drugs. If you’re thinking of getting pregnant,
           seek help. Help is available, and there is no shame in
                                                                                                                                    ask your pharmacist before taking drugs of any kind.
           asking for it.
                                                                                                                                  Salt Lake County
 What’s the latest information on STDs?                                                                                           Substance Abuse
                         If you are sexually active, chances are                                                                  (801) 468-2009
                                                                                                                                 www.slcosubstanceabuse.org
                         you have been exposed to one or more STDs. You might not
                         experience symptoms, but the fact is, having an untreated STD
                         can harm you, your partner, and even your future children. Her-
                         pes can be a nuisance for life, but Chlamydia and gonorrhea can
                         cause infertility. If you have a new partner, and especially if you
                         have had unprotected intercourse, get tested.
                                                                                               Is it okay to smoke cigarettes
                                                       Drinking: How much is                      sometimes?
                                                         too much?                               There is simply nothing good to say about smoking. We all know
                                                                                                 it causes cancer, gives you wrinkles and bad breath, makes your
                                                             Binge drinking is defined as
                                                                                                 teeth yellow and your hair dull, can cause strokes and heart
                                                           having 5 or more drinks in a
                                                                                                 attacks, and make you look older than you are. Here’s more
                                                    sitting, and it’s dangerous. Alcohol,
                                                                                                 bad news: smoking and birth control is a bad mix! The
                                             even in moderation, can have irreversible
                                                                                                 combination increases your risk for earlier heart disease.
                                             effects on your health. And if you happen
                                                                                                 Health care providers won’t even prescribe birth
                                             to be, or are planning to become pregnant,
                                                                                                 control pills for women in their 30s who are
                                             no amount of alcohol is safe.
                                                                                                 heavy smokers. While it’s hard to quit, it’s not
                                                                                                 impossible. Going for it now can reduce and
                                                      Pregnancy Risk Line
                                                                                                 eventually erase any damage you’ve done.
                                                        800-822-2229


 Life is full of ups and downs. The good news:
                            When you’re down, there’s no place to go
                                                                but                                                                        up!
HEY BABY! WHAT’S YOUR PLAN?
                                                                                What about birth control?
How much do you                                                                    What is your plan for having a family? If
 know about your                                                                   you’re not ready to have a baby, crossing
 period?                                                                            your fingers and hoping for the best are
                                                                                     not reliable methods. You should be
Did you now that half of all                                                          using some form of birth control –
women don’t have “regular”                                                            Talk to your health care provider and
periods? Whatever is normal                                                            decide what works best for you.
for you is normal. It’s a good                                                          Having a baby is a wonderful blessing,
idea to keep track of your                                                             especially if it happens when you want it to.
periods on a calendar,
especially if you are sexually                                                            Planned Parenthood – Utah
active and not using birth                                                                   Local (801) 532-1586 or
control. By keeping track of                                                                   National (800) 230-PLAN
your periods on a calendar,                                                                      www.plannedparenthood.org/utah/
you can know when you are
ovulating. When you ovulate,                                                                       Utah Department of Health –
you are fertile, and that’s                                                                         Family Planning Services
                                                                                                     (801) 538-9970
about six days in each cycle,
                                                                                                     www.health.utah.gov/rhp/familyplanning/
usually 10 days or two weeks                                                                          familyplan.html
after your period. But that
six-day “window” can change
from one month to the
next. If you want to avoid a
pregnancy, know when you
ovulate or else use some
method of birth control.




                                                             Why should you know your family history?
                                                             Are vaccinations just for kids?
                                                             How much exercise is enough?
           Everybody has a Health IQ.                        Should you be taking a daily vitamin?
                                                             Why are regular health checkups important?
                       What’s yours?                         Are you getting enough sleep?
                                                             Do you know what is meant by a “healthy” relationship?
                                                             How often do you have the blues?
                      Think about the following questions.   What’s the latest information on STDs?
                    Would your answers be different if you   Drinking: How much is too much?
                                                             Are there some drugs it’s okay to take?
                     had not read the magazine? Let’s see!   Is it okay to smoke cigarettes sometimes?
                                                             How much do you know about your period?
                                                             What about birth control?

				
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