1. Promoting Use of prenatal vitamins in women during childbearing years.
Andrea Autry
MPH 515
August 17th 2015

2. Why is this important?
In the United States 3,000 pregnancies result in neural tube defects of the fetus every year. These defects affect the brain and spine and result in death or lifelong disability. The most commonly known neural tube defects are spina bifida and anencephaly. (CDC, 2014) These defects occur very early in pregnancy, about the 28th day after conception. This is when the neural tube which houses the brain and spinal cord develops. When certain environmental factors are experienced by the mother, the development of this tube may not always go as planned.

3. Relationship Between Folic Acid and Birth Defects.
There is a strong association between folic acid deficiency of the mother and neural tube defects. It is there for recommended by the U.S. Public Health Service that women in childbearing years get 400 mcgs of folic acid each day. This can be gained by eating certain foods, but the only guaranteed method to ensuring the 400mcgs of folic acid is through use of prenatal vitamins. (nchpeg.org, n.d.) Prenatal vitamins contain folic acid which when taken before and during pregnancy greatly reduce the chances of the baby having defects such as anencephaly which is fatal, and spina bifida which results in serious physical disability (CDC,2015)

4. Public Health Intervention
My public health program will focus around encouraging and promoting the use of prenatal vitamins for all women during childbearing years.
I will be using the Theory of Planned Behavior to promote the use of prenatal vitamins in women of childbearing years, by addressing attitudes toward the behavior & subjective norms.
These are influenced by facilitating factors, inhibiting factors, and perceived control. These factors shape intention and thus results in the adoption or refusal of the behavior. (Diclemente & Salazar, 2013)

5. The Theory of Planned Behavior (TPB)
Much like the Theory of Reasoned Action (TRA)
Both theories believe that beliefs about the health behavior will largely shape the intent and that social norms are just as important as personal beliefs.
One added construct is added, perceived behavioral control. This construct is concerned with how people perceive the extent to which they are able to control the outcome of the health behavior. (Diclemente & Salazar, 2013)
If a person believes they should participate in a behavior but do not think they can perform, afford, or learn the behavior, than it is denied.

6. Target Population Women during childbearing years
Divided into two subgroups
Subgroup 1 women actively trying to conceive or are already pregnant
Subgroup 2 women who are not pregnant and not trying conceive
Each group will require different approaches as what factors are important to them will be quite different

7. Facilitating Factors
Facilitating factors are external factors whether actual or perceived that would increase the chances of women taking the prenatal vitamins. (Diclemente & Salazar, 2013)
Facilitating factors may be easy to determine in women who are trying to conceive or are already pregnant.
Healthcare provider issuing a prescription or samples of prenatal vitamins during a pre- conception or prenatal check-up
Through awareness of self-education when a women is learning about becoming pregnant or educating herself about her current pregnancy.

8. Facilitating Factors
Facilitating factors will be slightly more difficult to identify for those in subgroup 2, but with some research they are there
March of Dimes promotion, March for Babies. This annual walk is sponsored by various corporations such as Kmart, Macy’s, and Citi, and is promoted through various media outlets. (Marchofdimes.org, 2015)
Benefit of having better hair, skin, and nails which comes with taking prenatal vitamins could be promoted towards those in subgroup 2.
Ease of obtaining the vitamins from a local drug store, and also the ability to buy generic and often less expensive brands
Refer to them as multivitamins for those reluctant or embarrassed to say prenatal
If an unplanned pregnancy occurred, the use of prenatal vitamins would increase the chances of pregnancy resulting in a healthy baby

9. Inhibiting Factors
Inhibiting factors are any actual or perceived external factors that would deter a woman from taking prenatal vitamins (Diclemente & Salazar, 2013)
One difficulty with inhibiting factors is that perception and reality do not go hand in hand.

10. Perception is Everything!
Women who are not trying to conceive or are not currently pregnant may perceive that taking or buying prenatal vitamins may in a sorts “put it out into the universe” and have an unplanned or unwanted pregnancy.
Some may perceive that taking a prenatal vitamin may give others the wrong idea.
Parents who see their children taking vitamins saying “prenatal” may interpret the use of the vitamin incorrectly.
Significant others seeing the vitamins may also interpret the use incorrectly.
Both subgroups may feel that taking a prenatal vitamin will be a hassle or expensive to maintain.
Women who are trying to conceive or are currently pregnant spending time preparing for baby, finishing projects and may find it hard to remember.
Women with no pregnancy plans may find it hard to remember as pregnancy is not on their list of priorities.
Both may perceive that the income used on vitamins could be used towards conception aids, baby items, or other daily life expenses that would be deemed more important

11. Mail Order Starter Kits
Between 1998 and 2000 a quasi-experimental program created a direct mail pharmacy and mailed 100 “starter kits” of multivitamins to female participants between the ages of 18 to 39 years
PCPS provided education
main outcome was for the women to take the vitamins at least four times per day, had intentions to use regularly, and developed knowledge and positive attitudes towards taking the vitamins.
evaluated via telephone surveys. In the beginning, there was a sharp increase of multivitamin use, no other significant changes were observed. Was not sustained. It was suggested another program be developed and implemented. (Lawrence et al. 2013)
This example used the Informational-Motivation-Behavioral Skills Model (Diclemente & Salazar, 2013). The education provided by the primary care providers in theory should have motivated the participants to start using the multivitamins. However, not all knowledge is of equal value, and it did nothing to quell any social fears or apprehensions of the women that may be experienced.

12. Media Campagin
. In 1997 a year-long community information campaign targeted 22,500 women in their childbearing years.
television and radio PSAs, news conferences, billboards, printed materials including, flyers, banners, posters and brochures were broadcasted or distributed in a four-county area of Southwestern VA. Green ribbons to promote folic acid awareness were distributed in schools as well as folic acid teaching packets for health classes in grades 5-12 and colleges.
After the year, telephone surveys were conducted and results reported increased awareness of folic acid requirements in women during childbearing years. An increase from 52% in 1997 to 73% in There was a slight increase of actually taking the multivitamins from 28% to 32%. Television and health-care providers were listed as the top two resources for information. (MMWR, 1999)
This example used the Health Belief Model by promoting folic acid in various community settings making it appear acceptable in all layers of the model including family, recreationally, community, and socially. (Diclemente & Salazar, 2013)

13. North Carolina Campaign
. Free multivitamins can be requested by telephone or online through funding provided by the North Carolina government.
The state reports a 70% decrease in birth defects since initiating the campaign.
Many states have caught on to this low-cost program, and have resulted in a national folic acid council. (Mission-health.org, 2015)
This campaign utilized the precede-proceed model because it provided a social assessment, epidemiological assessment, educational and ecological assessment, and administrative and policy intervention. (Diclemente & Salazar, 2013)

14. My Campaign
Epidemiological data to gage the severity of the occurrence of birth defects such as spina bifida and anencephaly in the area.
Vitamin deficiencies data will be collected
Educational needs such as awareness of the importance of folic acid, where you can get folic acid and it’s relation to the prevention of birth defects.
Community based participatory research to assess for quality of life issues.

15. Get Out There
Involve more community work phone interviews aren’t as personable.
Recruit stakeholders in areas that are likely to have my target group, women of childbearing years.
college campuses, Planned Parenthood, schools, and fitness centers.
My goal will be set to increase prenatal vitamin use in my sample by 40%.

16. Execution
Utilize visuals such as boards, pamphlets, and flyers to educate participants on the benefits of using prenatal vitamins such as improved quality of hair, skin and nails as well as nutritional information and benefits during pregnancy whether planned or unplanned
Free sample packs with coupons for discounted or free vitamins, or information for state funded vitamin programs. This removes the inhibiting factor that vitamins could be expensive or hard to obtain.
Removing pictures of pregnant women would reduce the anxiety for some reason who could view taking the vitamins as a “bad omen”.
The labels could contain just the word vitamin in a decorative type, fun designs, or just a plain white bottle.
The creation and promotion of a smart phone app would set reminders for participants to take their vitamins as well as provide links to education websites about the use of prenatal vitamins.

17. Evaluation
App created earlier could link participants to a survey indicating their usage and attitude towards taking the vitamins.
Communicating via could be an acceptable way of communication.
Survey monkey site where people can create and participate in surveys anonymously; the information is tabulated and sent to the developer of the survey.
I would not use telephone surveys as women in my target range tend to be busy with school, work and social obligations.
These three outlets could be done easily from anywhere at any time via their smart phone, tablet, or computer.