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Formative Research among Women of Childbearing Age on Various Preconception Health Topics
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Formative Research among Women of Childbearing Age on
Various Preconception Health Topics
Prepared by Christine E. Prue, MSPH, Ph.D.1
for the Consumer Work Group of the Preconception Care Implementation Group
This information is distributed solely for the purpose of pre-dissemination peer review. It has not
been disseminated formally by the Centers for Disease Control and Prevention. It does not
represent and should not be construed to represent any agency determination or policy.
1ChristineE. Prue is the Chief of the Prevention Research Branch in the Division of Birth Defects and
Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Coordinating
Center for Health Promotion, Centers for Disease Control and Prevention.
Formative Research among Women of Childbearing Age on
Various Preconception Health Topics
In June 2006, the Consumer Work Group of the Preconception Care Implementation Group, called
for the gathering of formative research among women of childbearing age on various preconception
health topics.
In August 2006, a call for research (see appendix A) was distributed via numerous listservs.
Information was requested by September 15, 2006 so that it could be compiled and distributed to
members of the consumer work group by early December. Responses were received between
September through December. This document is a summary of the information and materials
received in response to the invitation.
Ten responses were received which included 3 research summaries, 6 Powerpoint presentations, 1
meeting abstract, and 2 assessment tools. The topic areas covered in the responses included folic
acid qualitative research, preconception care and prematurity, fetal alcohol syndrome prevention,
interconception care, perinatal screening, multivitamin distribution programs, qualitative and ad
concept testing research on multivitamin promotion, prenatal care, and survey research on a variety
of health topics (tobacco, alcohol, dietary supplements, sexual behavior, STD/HIV, contraception,
body weight, folic acid, and intimate violence).
Conclusions:
Despite wide and broad distribution of the call for research, few submissions were received.
This could mean several things: that there is not a lot of consumer research currently under
way or completed on any of the topics included in preconception health and/or that our
invitation did not make it to the right groups who have something to share and/or that our
invitation did make it to the right groups, but there was a reluctance to share their work.
Of the information received, only four submissions provided details of the research that was
conducted. The research topics covered: folic acid, preconception care and prematurity, and
multivitamin consumption (as a means to get folic acid). Despite the limited number of
topics covered in what was received, they all offer unique insights that have particular
relevance to talking with women about pregnancy and babies even when pregnancies and
babies are not desired (truly ―preconception‖ communication).
There is a need for a more comprehensive and systematic search and review of the published
literature. The literature appears to be ripe with consumer research among pregnant women
and/or moms about prenatal care, etc. However, there appears to be considerably less
research among non-pregnant women on health topics that may have particular relevance
for them and/or a future baby.
2
The research that was shared offers insights on the challenges of communicating with
women preconceptionally, in particular –
o Promoting the health of women in order to promote the health of a baby offends
many who receive these types of messages as ―vessel‖ communications (e.g., ―I am
NOT just a vessel or carrier of a baby‖)
o While many women WANT a healthy baby at some time in their life, the notion of
performing a wide variety of behaviors throughout their childbearing years ―just in
case‖ they get pregnant seems like a lot to ask. Women want to know what the
benefits of these behaviors are for them NOW…not just for a potential baby.
o Some women are concerned about how their performance of these behaviors might
be perceived by others. If I take folic acid, am I directly or indirectly disclosing to
others that I‘m sexually active and/or trying to get pregnant. Women really want
non-pregnancy-related reasons for performing many preconception health behaviors.
There is a need for more communications research that looks at multiple preconception
health topics simultaneously. Most of the research received focused on one topic (e.g. folic
acid, preconception care, and prematurity). In particular, research needs to understand how
messages could or could not be bundled to address the many facets of preconception health
and preconception health care.
3
Submission #1
Source: Ortho-McNeil Pharmaceutical, Inc
Topic/Inquiry Focus: Folic Acid
Objectives were to:
1. Better understand women‘s awareness, knowledge, and attitudes towards folic acid and folic acid
supplementation
2. Educate women about the need for/role of folic acid and understand how motivating this
message is, especially if/when using OC
3. Elicit reactions to the ideas of a combination pill and co-packing folic acid with OC
Audience
Women 18-39
Not currently tyring to get pregnant
Want to have a/another baby someday
Sexually active with male partner
Pre-menopausal
Fertile and able to bear children
Have not been through fertilization/conception clinic or process
Research Method
Consumer Qualitative Research - 6 focus group discussion in Morristown, NJ and Dallas TX in
April 2004
2 groups – Oral contraceptive users who have never given birth, at least 3 in each group very likely
or somewhat likely to conceive in the next 3 years, and currently using birth control pills
2 groups – New Starts
Have never given birth, currently use some form of birth control (good mix in groups), have never
used birth control pills, and likely to use birth control pills in the next 6 months
2 groups – Moms
Have given birth to at least one child (max. 3 children), took pre-natal vitamins or supplements
during pregnancy, currently use some form of birth control, and likely to use birth control pills in
the next 6 months
Key Findings
There was a high level of recognition of the term ―folic acid,‖ but only a few knew much
about it.
Vitamin B9, however, was unfamiliar and no one was aware of its connection with ―folic
acid.‖
For many, folic acid was somehow linked to ―women‖ and/or ―pregnancy,‖ but they were
not sure how.
4
Those most knowledgeable tended to have consulted their doctors when trying to become
pregnant and had been told at that time to start taking folic acid and why.
Many of these women read anything they could about having a healthy pregnancy while
actively involved in the conception process.
Most of these women understood the relationship between folic acid and birth defects and
knew that it should be in their systems at time of conception. Therefore, they started taking
folic acid as soon as they started trying/planning to become pregnant.
Implications-
Since the term ―folic acid‖ has gained recognition and has some connection to women
and pregnancy, there appears to be no reasons to confuse the communication by
focusing on the term ―vitamin B9.‖
Women welcomed more information/education about folic acid.
Communication about folic acid needs to call out the need for ALL women of
childbearing age to take folic acid because women using contraceptives will WANT to
assume that the message is irrelevant to them (despite contraceptive failures; ineffective
use of contraception, etc.)
5
Submission #2
Source: March of Dimes & Margaret Mark Strategic Insight
Topic/Inquiry Focus: Women, Pregnancy, and Prematurity
Objectives:
To explore reactions to messages intended to encourage women of childbearing age to consider a
pre-conception medical visit and to build awareness of the risks of prematurity, overall. Concepts
explored included, locus of control, stages of ―readiness‖ to assume control, wish for the ―good
mother,‖ and setting priorities
Audience
No specific information is offered about the audience involved in this research other than that it
includes women of childbearing age.
Research Method
Focus group sessions with women in different socioeconomic, racial/ethnic and health insurance
situations
Middle SES
Low SES with insurance
Low SES without insurance
Key Findings
Four key concepts were explored across all groups: (1) Locus of control; (2) Stages of ―readiness‖
to assume control; (3) Wish for the ―good mother‖ and (4) Setting priorities for targeting
communications.
Locus of Control
The women in these focus groups seemed to reflect real differences on a continuum of locus of
control, ranging from internal to external with the Middle SES expressing strong internal locus of
control, Low SES with insurance group expressing some internal locus of control, and Low SES
without insurance expressing very strong external locus of control.
Middle SES with insurance participants believed that their health is at leas partially dependent upon
their choices and efforts to stay healthy. They also know that their own health effects the health of
their future baby and appreciate confirmation from experts that they are doing the right things to
stay healthy. Most are not looking to become pregnant now, but are not opposed to the idea of
becoming pregnant in the future. Although pregnancy would not be ideal right now, they appreciate
pregnancy from afar.
Low SES with insurance participants reported going to the doctor regularly but were less proactive
about their health. They also understood that their efforts to stay healthy can have a direct impact
on their future baby‘s health, and for the most part, are willing to do what it takes. A few had
experienced the difference between private doctors and public clinics. Most women in this group
6
felt like they had control of ―if and when‖ they became pregnant. Several of the women were
currently trying to become pregnant.
Low SES without insurance participants were of a mindset that they felt they were not in control of
their health-or of whether they become pregnant. They seemed to reflect an attitude that their own
actions do not always influence future outcomes. Economic realities seemed to reinforce these
attitudes. Because they do not have health insurance, they go to the doctor only when they‘re sick.
Most have had children and went to the doctor after they discovered they were pregnant.
Stages of Readiness regarding a preconception check-up
The most challenging stage group: Low SES without Insurance. The first steps these women can
take is to go from the precontemplation stage to the contemplation stage.
Wish for the ―Good Mother‖
Even women who panic at the prospect of an unwanted pregnancy feel that if they MUST see a
message about pregnancy, they want cues and signals that the mother is happy and loving. In spite
of this wish for the ―perfect, happy Mom‖ images of maternal bliss are not relevant (or appealing) to
women who don‘t want to become pregnant…they do appeal to women who want to be pregnant.
Targeting: Setting Priorities
Pregnancy contemplators are well along in terms of both attitudes and behavior. You don‘t have to
work hard to reach this group – they are motivated and will find what they are looking for.
Women at the other end of the spectrum are much more in need of support, encouragement and
information.
Mastering this complex task in printed messages for low-SES women will not interfere with March
of Dimes‘ ability to inoculate the culture with the pre-pregnancy visit concept.
7
Submission #3
Source: The University of South Dakota
Topic/Inquiry Focus: Fetal Alcohol Syndrome
Audience
Women who are a part of the Northern Plains American Indian Tribes
Research Method
Research not provided.
Brochure – The Yuonihan Project Respect
Key Findings
Not applicable
Submission #4
Source: Office of Women‘s Health, California Dept. of Health Services
Topic/Inquiry Focus: Multiple topics: Tobacco, Alcohol, Dietary supplement use, Sexual
Behavior, STD/HIV, Contraception, Folic Acid, Body Weight, and Intimate Violence
Audience
A randomly selected sample of women, 18 years of age and older residing in California.
Research Method
California Women‘s Health Survey findings from 1997-2003. The CWHS is an annual household-
based telephone survey. Surveys are conducted in English and Spanish.
Key Findings
This report summarizes survey findings on a variety of health topics and offers prevalence of various
behaviors as compared to Healthy People 2010 targets.
8
Submission #5
Source: Pinellas County Health Department, St. Petersburg, Florida
Topic/Inquiry Focus: Inter-conception Care
Audience
Mothers who bring their newborns to a pediatrician for well-baby care, especially focusing on
African American women of childbearing age, their infants and families in four zip code areas in St.
Petersburg, FL
Research Method
Research not provided.
Powerpoint presentation describes the program.
Key Findings
Not applicable
Submission #6
Source: California Department of Health Services
Topic/Inquiry Focus: Comprehensive Perinatal Services Program
Audience
Pregnant women in California receiving Medi-Cal or services from a Comprehensive Perinatal Services Program
Provider
Research Method
Not applicable
Key Findings
Not applicable
9
Submission #7
Source: North Carolina Public Health
Topic/Inquiry Focus: Multivitamin Distribution to ensure adequate folic acid consumption
Audience
24 mostly rural counties of North Carolina with historically high rates of neural tube defects.
Research Method
Evaluation of multivitamin distribution; Surveys completed with 322 women.
Key Findings
Vitamin use went from 25.5% prior to first free bottle of vitamins to 82.4%
10
Submission #8
Source: CDC Foundation and CDC
Topic/Inquiry Focus: Optimal Nutrition Initiative – multivitamins as a source of folic acid
Audience
Women between 18-34 with incomes less than $50,000 who were either multivitamin users or non-users.
Research Method
Qualitative behavioral analysis f 18-34 year old women consisting of 24 focus group discussions held
in four U.S. cities: Sacramento, CA; Atlanta, GA; Calverton, MD; and Detroit, MI. Three focus
group discussions were conducted for each of 8 audience segments, as follows:
18-24 year olds, household income less than $25K, multivitamin user
18-24 year olds, household income less than $25K, multivitamin non-user
18-24 year olds, household income between 25-50K, multivitamin user
18-24 year olds, household income between 25-50K, multivitamin non-user
25-34 year olds, household income less than $25K, multivitamin user
25-34 year olds, household income less than $25K, multivitamin non-user
25-34 year olds, household incomes between $25-50K, multivitamin user
25-34 year olds, household incomes between $25-34K, multivitamin non-user
Key Findings
1. Some commonalities were present among all women participating in the focus groups.
Benefits of Vitamin Use
General
Lack of knowledge about the benefits – common perceptions were preventing
disease (especially colds or the flu) and increasing energy levels
Believed that women‘s vitamins were made specifically for them
Specific Vitamins and Minerals
Listed prenatal vitamins, multivitamins, iron, folic acid, calcium, vitamin B, and
vitamin C as important for their age group, before pregnancy, and during
pregnancy
Vitamin C was believed to prevent sickness
Calcium was thought to be good for bones—specifically, health and strength of
bones
Iron
Beneficial for the blood and was recommended for people who were anemic or
who had ‗low blood‘
Women needed iron because of blood loss during menstruation and child delivery
Iron deficiency would result in people bruising more easily and being tired and
cold
Reasons not to take iron included constipation, pill size, and bad taste
Folic Acid
Very little knowledge of folic acid and its benefits
11
Women who did know about folic acid were generally well-informed about
vitamins or had been pregnant (or someone they knew had been pregnant)
Did not know folic acid is needed before pregnancy – knew it was important for
women but not necessarily before pregnancy
Some women knew that folic acid was in multivitamins and prenatal vitamins
The term folic acid was confusing – associated it with citrus fruits or with acid
Some women believed folic acid enhanced fertility and prevented miscarriages
Prenatal Vitamins
Had heard of prenatal vitamins and believed they were important for pregnant
women—most women took prenatal vitamins during pregnancy (regardless of
current vitamin use status)
Believed prenatal vitamins were beneficial for skin, nails, and hair – some took
prenatals for these reasons
Believed prenatal vitamins had more of something that was specific to pregnant
women (in comparison to multivitamins)
Multivitamin Use in Childhood
Multivitamin Use in Childhood
Most reported taking Flintstones as children with very positive responses
regarding this experience
Flintstones tasted good and were like candy
Most reported they stopped taking multivitamin in their teens
Healthy Lifestyle
Healthy Lifestyle
Believed being healthy was exercising and eating healthy foods – also listed getting
enough sleep, taking vitamins, drinking water, medical check-ups, good mental
health, and no smoking/drinking
Lack of money and time were major barriers to a healthy lifestyle
Other barriers included, bad health habits, negative influences from
friends/family, and lack of motivation, self-control, and health insurance
2. Some differences were based on age and income.
Differences Based on Age
18-24 25-34
Talked more about beauty and Talked more openly about pregnancy
appearance in relation to multivitamins and having children
Lives were less stable Lives were generally more stable
Were not convinced of benefits from Were more easily convinced of benefits
vitamins/folic acid from vitamins/folic acid
Did not want to hear about folic acid in Were more open to hearing about folic
relation to children and pregnancy acid and its benefits in preventing birth
because they were not planning a defects
pregnancy
Would start taking vitamins when they Started taking vitamins as they became
got older and had more stable lives older
12
Differences Based on Household Income
Less than $25K HHI $25K-$50K HHI
Multivitamin non-users mentioned Multivitamin non-users mentioned time
money as the biggest barrier to taking a as the biggest barrier to taking a
multivitamin multivitamin
3. Most differences were seen between women who reported using a multivitamin every day
and those who did not.
Daily Habits
Users of Multivitamins Non-Users of Multivitamins
Taking a multivitamin is an automatic Taking a multivitamin is not a regular
and regular behavior behavior
Creatures of habit – take multivitamins Do not have regular habits – some take
as a part of a regular repertoire of daily birth control daily, most mentioned
habits brushing teeth and showering daily as
their only regular daily habits
Linked habits – taking multivitamin
linked with other daily routines such as Do not have habits that they can link to
taking birth control, allergy medicine, multivitamin use
when eating breakfast or drinking water
Keep vitamins in a variety of places to Those who owned multivitamins kept
avoid missing daily use (e.g., kitchen them either in kitchen cupboard or
counter, bathroom, nightstand, purse, bathroom medicine cabinet
car, desk at work)
Diet
Users of Multivitamins Non-Users of Multivitamins
Have balanced diets in general, planning No planning (forethought) of every day
(forethought) their diet diet
Too busy to pay close attention to what
Pay close attention to what they eat they eat (eating on the go, eating fast
food and frozen dinners frequently)
Believe that it is difficult to get all Believe that they can get the vitamins
needed vitamins from diet they need from a healthy diet (even
though they often have a poor diet)
Believe there is a need to supplement Some desire to eat better/healthier –
diet with vitamins to ensure they get minority did not care about this
what they need every day
13
Motivators/Barriers to Taking Multivitamins
Users of Multivitamins Non-Users of Multivitamins
Perceive benefits of taking Do not perceive any visible, tangible
multivitamins (promotes well being, benefits of taking multivitamins
increases immunity – prevents sickness,
gives more energy)
Look for long-term benefits of taking Expect immediate benefits of taking
multivitamins multivitamins
Reactive – would take vitamins when
Take multivitamins as a preventative something goes wrong with health (to
measure to avoid sickness ―fix‖ a problem); time-limited use (once
―fixed‖ they will stop behavior)
Regard taking multivitamin as a part of Do not perceive a link between eating
a healthy lifestyle – accompanied by poorly and taking multivitamin
exercise, getting enough sleep, etc.
Take multivitamins based upon advice Women say they do not take
from a trusted information source (e.g., multivitamins because they are not
media, nutritionists, chiropractors, prescribed by doctor – even those
family members, doctors) women whose doctor recommended
vitamins, they do not adhere to the
recommendation
Follow the example provided by female Do not follow the example of family
figure (mother, aunt) who used to members (moms, husbands) who take
encourage/continuously encourages multivitamins themselves and buy
multivitamin use multivitamins for these women
See daily multivitamin use as a priority Do not perceive it as priority at all
See a generalized benefit of taking Need specific benefits from
multivitamins multivitamins
Believe a general multivitamin has Want a vitamin ―targeted‖ to them as
everything they need women or their age group
Consider taking multivitamin as the
least time-consuming action to maintain Use excuses such as lack of time or
good health (compared to eating forgetfulness for not using multivitamin
healthy and exercise)
Accept a pill form of multivitamin Require alternative forms of
(even though often complain about size multivitamin other than a pill
and smell) (chewable, a patch, a shot, or in birth
control pills)
Use multivitamins to prevent To use multivitamins they say they must
consequences distant in time such as be in a ―life or death‖ situation – need
osteoporosis (believed to be a condition to know specific consequences of not
of older age) taking
Often takes multivitamin at the same Do not take multivitamin but make sure
time with children their children take theirs
14
Perceptions of Multivitamins
Users of Multivitamins Non-Users of Multivitamins
Claim to know general benefits of
multivitamin use Skeptical about the benefits of
Believe in long term positive effects of multivitamin use
multivitamin use (e.g., more energy)
Believe in preventative effects of Do not believe in preventative effects
multivitamin use (e.g., preventing of multivitamin use
osteoporosis)
Believe that multivitamins complement Believe that vitamins cannot replace
diets healthy diet
Believe that extraordinary amounts of Sometimes have aversion to synthetic
food would need to be eaten in order to vitamins
get amounts needed daily
Believe that multivitamin use helps Multivitamin use does not provide any
sustain good health and well being in visible, tangible benefits – based on
general (e.g., gives more energy) experience with MV use and beliefs
Know where to buy discounted price Believe that vitamins are very expensive
multivitamins
Have ―the least I can do‖ attitude – take Have ―all or nothing‖ attitude – do not
multivitamins because of not eating take multivitamins because of not eating
right and not exercising right and not exercising
Conclusions
Concept Map
Seven themes emerged from the data: lifestyle, health perceptions, health behaviors, diet and
vitamin balance, knowledge, motivators, and barriers. Based on these themes and on the detailed
results, a concept map was created to better visualize and understand multivitamin non-users and their
behavior/perceptions toward multivitamin use.
Women perceived their lives as chaotic, spontaneous, and noted that they lived in the
―now.‖ Women also had an ―all or nothing‖ attitude toward their health (e.g., ―If I‘m not eating
right, not exercising, then I‘m not going to take a vitamin‖). Their lifestyle and ―all or nothing‖
attitude were linked to many other perceptions and behaviors, especially their lack of emphasis on
prevention. Multivitamin non-users were not prevention oriented. Because prevention is not
important to them, it makes the need for immediate, tangible benefits of multivitamins very
important (e.g., they will not take multivitamins for preventative measures, but they will take
multivitamins if they see specific benefits now). Because multivitamin non-users do not perceive
immediate benefits from multivitamins, and because they are ―reactive‖ to their health and lack the
time to take care of themselves, multivitamins are not a priority in their lives. One should note from
the map that many other relationships exist among these concepts and that multivitamin non-users‘
vitamin behavior is complex.
15
Recommendations
Problem statement. Despite the success of food fortification, most women are not consuming
adequate amounts of folic acid. According to the 2004 Gallup Poll conducted by the March of
Dimes, only 40% of women ages 18 to 45 reported consuming a multivitamin containing folic acid
daily. Although this represents a positive step toward meeting the Healthy People 2010 objective of
80% of childbearing age women consuming 400 micrograms of folic acid daily, a substantial amount
of work remains in order to reach this goal. Public health recommendations, food fortification, and
education efforts have resulted in a partial decline of neural tube defect (NTD) rates for all women;
however, not all NTDs that can be prevented by folic acid use have been averted. Future declines
need to come from creative and compelling programs that will modify voluntary behavior among
women of childbearing age, namely, an increase in the use of supplements containing folic acid.
Key issues and concepts. Several key issues and concepts must be addressed in a
communication intervention in order to impact women‘s multivitamin behavior:
- Need for immediate benefits (women want beauty outcomes, but we must identify other,
true, tangible outcomes)
- Make vitamins a priority
- Increase perceptions of need – change perception that multivitamins are for children
or older individuals
- Perceived cost of vitamins
- Show how to fit vitamin-taking behaviors into their lives – creating or linking
routines, even when their lives are chaotic
- Perceived lack of control
- Increase self-efficacy (e.g., show them easy ways to buy, remember, and take
multivitamins – alternative forms of mv are key)
- Lack of knowledge regarding vitamins
- Make clear how difficult it is to get all vitamins/nutrients from food alone
- Focus more generally on multivitamins, not folic acid (FA may be included with
older age group)
- The need for a tailored vs. a general multivitamin
- Nostalgia related to childhood vitamin use
- Availability of different forms of vitamins
- Address the perception of ―all or nothing‖
Some key issues and concepts must be addressed by manufacturers in order to impact
women‘s multivitamin behavior:
- Negative pill attributes (i.e., size, taste, smell)
o Alternative forms needed (e.g., chewable, dissolve, patch, birth control, shots,
something enjoyable – chocolate?)
o Perceived and actual cost
- Alternative packaging (e.g., single-serving packets easy to carry in purse, color,
tailored)
Some key issues and concepts should be addressed by an educational intervention:
16
- Increasing awareness of and knowledge about vitamins (e.g., need, outcomes,
benefits, forms)
- Misperceptions of vitamins (e.g., where to buy, costs, effectiveness, risks)
Audience identification. The following two multivitamin non-user groups have been identified
as possible target audiences for an educational and communication campaign:
- 18-24 year olds
- 25-34 year olds
- some issues cross over and messages might be used for both age groups – this will
vary
- cost issues were similar for all women, although more severe for lowest income
17
Submission #9
Source: CDC Foundation and CDC
Topic/Inquiry Focus: Optimal Nutrition Initiative – multivitamins as a source of folic acid
Audience
Female college students between the ages of 18-24 with personal incomes less than $50,000 or
household incomes less than $75,000
Research Method
Quantitative message concept testing (using an experimental design; N=1200)
Qualitative message testing - 8 focus group discussions in four cities during September 2005
Key Findings
A message testing experiment was performed to assess the potential effectiveness of four
experimental messages designed to convince women to take a multivitamin regularly, as was
as one control message.
The target audience was women age 18 to 24 who did not take a multivitamin regularly, who
had an annual personal income of less than $50,000, who were not pregnant, and who wer
enrolled in a college or university.
Data were collected at four sites: Sacramento, CA; Washington, D.C.; Gainesville, FL; and
East Lansing, MI.
The dimensions employed to measure message effectiveness included the evaluation of the
message, attitude, beliefs, normative pressures, perceived behavioral control, and behavioral
intention.
The evaluation of the messages on all measured dimensions was generally favorable towards
multivitamin use.
The responses of California participants were les favorable and more variable than the
responses of the participants from Florida, Michigan, or Washington, D.C.
Although ratings of the favorability of the experimental message, No Excuses emerged as
the most effective of the experiemental messages and VitaGoGirl emerged as the least
effective.
A relatively consistent racial identification effect emerged such that Asian participants were
generally less favorable on the measured dimensions of multivitamin use than were other
racial groups.
A very consistent effect of living arrangement emerged such that those living in dormitories
tended to be more favorable on the measured dimensions of multivitamin use than those
with off-campus living arrangements of varying kinds.
Measures of CDC credibility correlated positively and substantially with all of the criterion
variables, so that the more credible participants perceived the CDC to be, the more
favorably they evaluated the messages, the more positive their attitudes toward multivitamin
use, the more strongly they endorsed multivitamin favorable beliefs, the more strongly the
perceived normative pressures to take a multivitamin, the more strongly they perceived
themselves to have the requisite self-efficacy to take a multivitamin regularly, and the
stronger their intention to take a multivitamin regularly.
18
Submission #10
Source: Three presentations made at the Association of Maternal and Child Health Programs
(AMCHP) Conference
Topic/Inquiry Focus: Three presentations made at a recent AMCHP conference – one from
March of Dimes Headquarters and two from state chapters – Texas and Maryland
Audience
AMCHP conference attendees
Research Method
Research was not presented. Each presentation described a program activity.
1. March of Dimes Headquarters – Prematurity campaign and 9 questions for preconception
health
2. Maryland – Pregnancy testing and 9 questions (Thalia); Creative outreach to Spanish-
speaking audiences via bus driver education opportunities
3. Texas – Prenatal education/incentives; Stork‘s Nest
Key Findings
Not applicable
19
Appendix A: Call for consumer research
Looking for consumer research among women of reproductive age on 14
preconception topics
On April 21, 2006, CDC, in conjunction with national partners and the select panel on preconception care,
published ―National Recommendations to Improve Preconception Health and Health Care – United States‖
(http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm) and launched a website with other
information about preconception care (http://www.cdc.gov/ncbddd/preconception/default.htm).
Preconception Care (PCC) is a set of interventions that identify and modify biomedical, behavioral, and social
risks to a woman‘s health that have particular relevance to pregnancy outcomes. It includes both prevention
and management, emphasizing health issues that require action before conception or very early in pregnancy
for maximal impact. The primary target population for preconception care is women of reproductive age.
The overarching goal of preconception care is to provide:
screening for risks
health promotion and education
interventions to address identified risks
Currently, fourteen preconception interventions show clear, evidence-based effectiveness in improving
pregnancy outcomes: (1) folic acid supplementation; (2) rubella vaccination; (3) diabetes management; (4)
hypothyroidism management; (5) Hepatitis B vaccination; (6) HIV/AIDS screening and treatment; (7) STD
screening and treatment; (8) maternal PKU management; (9) Oral anticoagulant use management; (10)
Antiepileptic drug use management; (11) Accutane use management; (12) Smoking cessation counseling;
(13) Eliminating alcohol use; and (14) Obesity control.
The organizations that collaborated on developing and publishing the recommendations are currently
working on developing plans for moving the recommendations from published words to practical actions.
One work group, focusing on consumer awareness of preconception care and health, is looking for any
consumer research among women of reproductive age that has been done on any of the fourteen intervention
areas listed above.
If you have conducted research or know of someone who has conducted research with women of
reproductive age on any of the topics listed above, please share your work and/or encourage them to share
their work with the group.
If your work is published in a journal that is accessible to all, please send an abstract and/or full
reference citation to: jbiermann@marchofdimes.com
If your work is in a report format that is not readily accessible, please send a copy to:
Janis Biermann
March of Dimes Birth Defects Foundation
1275 Mamaroneck Ave.
White Plains, NY 10605
The work group is also interested in gathering all known ―self-assessment tools‖ (either print or web-based)
used by women to identify their own risk and/or readiness for pregnancy. Please share any tools you are
aware of and/or use to: jbiermann@marchofdimes.com (or mail to: 1275 Mamaroneck Ave., White Plains,
NY 10605.)
The work group desires to develop a compilation of PCC-relevant consumer research and self-assessment
tools that will be used to shape its action plan. Please send references and/or reports by September 15,
2006. The work group is delighted to share the compilation with all who submit publications for inclusion.
The work group plans to have a draft of the compilation report completed by December 1, 2006. If you
would like more information about the Consumer Work Group on Improving Preconception Health and
Health Care, please contact Christine E. Prue, Ph.D., at the Centers for Disease Control and Prevention, via
e-mail cprue@cdc.gov or phone (404) 498-3837. THANK YOU!
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