Gerald McGwin, Jr., M.S., Ph.D. Associate Professor Departments of Epidemiology, Surgery, and Ophthalmology University of Alabama at Birmingham

An Educational Intervention to Promote Proper Seat Belt Use During Pregnancy

Background Restraint use during pregnancy contributes to improved maternal and fetal survival after MVCs.Restraint use during pregnancy contributes to improved maternal and fetal survival after MVCs. Research suggests 25% to 50% do not follow guidelines for seatbelt use during pregnancy.Research suggests 25% to 50% do not follow guidelines for seatbelt use during pregnancy. Discomfort and concerns about harm to themselves or fetus common reasons for lack of restraint.Discomfort and concerns about harm to themselves or fetus common reasons for lack of restraint. Few interventions to improve seat belt knowledge and practices during pregnancy.Few interventions to improve seat belt knowledge and practices during pregnancy.

Purpose To evaluate an education intervention focused on increasing the proper use and knowledge regarding seat belt use during pregnancy.

Methods Phase ICollect baseline information regarding seat belt use knowledge and behaviorsPhase ICollect baseline information regarding seat belt use knowledge and behaviors Phase IIDeveloping and implementing educational interventionPhase IIDeveloping and implementing educational intervention Phase IIIEvaluating impact of educational interventionPhase IIIEvaluating impact of educational intervention

Methods – Phase I & III The Jefferson County Alabama Department of Health operates nine health centers distributed throughout the county; seven of these centers provide prenatal care.The Jefferson County Alabama Department of Health operates nine health centers distributed throughout the county; seven of these centers provide prenatal care. To qualify for services at the County health centers, patients need to be residents of Jefferson County, Alabama or have Medicaid; indigent patients also qualify for services.To qualify for services at the County health centers, patients need to be residents of Jefferson County, Alabama or have Medicaid; indigent patients also qualify for services.

Research team visited County health centers and approached all pregnant women for participation in the study (Phase I: 6-8/2001; Phase III: 10-12/2002)Research team visited County health centers and approached all pregnant women for participation in the study (Phase I: 6-8/2001; Phase III: 10-12/2002) Staff members rotated among all seven centers in a manner that provided a random sample of all women seeking prenatal care.Staff members rotated among all seven centers in a manner that provided a random sample of all women seeking prenatal care. Patients given description of study and asked if they were willing to participate.Patients given description of study and asked if they were willing to participate. Methods – Phase I & III

Self-administered questionnaire collected demographic and pregnancy information and restraint use characteristics.Self-administered questionnaire collected demographic and pregnancy information and restraint use characteristics. Information on restraint use in previous pregnancies and under different driving situations also collected.Information on restraint use in previous pregnancies and under different driving situations also collected. Patients asked whether they had received any information regarding restraint use from a variety of sources.Patients asked whether they had received any information regarding restraint use from a variety of sources. Survey available in both English and Spanish.Survey available in both English and Spanish. Methods – Phase I & III

Methods – Phase II Data from Phase 1 identified gaps in knowledge and behavior as targets for educational material.Data from Phase 1 identified gaps in knowledge and behavior as targets for educational material. Focus groups conducted with clinic patients and staff to identify barriers regarding proper seat belt use during pregnancy and techniques for addressing these issues.Focus groups conducted with clinic patients and staff to identify barriers regarding proper seat belt use during pregnancy and techniques for addressing these issues. Collectively, this information was used to create a variety of material for distribution to prenatal care clinics, patients, and staff.Collectively, this information was used to create a variety of material for distribution to prenatal care clinics, patients, and staff.

Methods – Phase II Posters depicting proper seat belt placement created and installed at prenatal care clinics.Posters depicting proper seat belt placement created and installed at prenatal care clinics. All patients given gift bag containing brochure explaining benefits and correct use of seat belts.All patients given gift bag containing brochure explaining benefits and correct use of seat belts. Clinic staff provided buttons encouraging proper seat belt use.Clinic staff provided buttons encouraging proper seat belt use. All material was available in both English and Spanish.All material was available in both English and Spanish.

Methods – Summary 6/2001 1/2002 3/ /2002 Baseline Intervention Intervention Post-Invention Survey Development Dissemination Survey Survey Development Dissemination Survey

FIGURE 2A. Knowledge of seat belt effectiveness for a non- pregnant woman among pre- and post-intervention groups. (p=0.005)

FIGURE 2B. Knowledge of seat belt effectiveness for a pregnant woman among pre- and post-intervention groups. (p<0.0001)

FIGURE 2C. Knowledge of seat belt effectiveness for a baby among pre- and post-intervention groups. (p=0.0009)

Conclusions Although frequency of seat belt use high, many not wearing seat belts properly.Although frequency of seat belt use high, many not wearing seat belts properly. This study demonstrated potential for educational tools to change knowledge and behavior.This study demonstrated potential for educational tools to change knowledge and behavior. Education regarding proper seat belt use is now a regular component of pre-natal care at county health department pre-natal care clinics.Education regarding proper seat belt use is now a regular component of pre-natal care at county health department pre-natal care clinics.

An Educational Intervention to Promote Proper Seat Belt Use During Pregnancy