1. LaToya Artis, Cape Fear Regional Coordinator
An example of a preconception health message: North Carolina Folic Acid Campaign
LaToya Artis, Cape Fear Regional Coordinator
NC Folic Acid Council
October 28, 2009

2. About the Folic Acid Campaign
The North Carolina Folic Acid Campaign is a statewide program whose mission is to improve health by promoting the benefits and consumption of folic acid

3. The goal of the Campaign
Is to reduce the number of pregnancies affected by neural tube birth defects (NTDs), such as spina bifida and anencephaly

4. Objectives
To increase women’s awareness of folic acid’s role in preventing birth defects
To increase the percentage of women of childbearing age who take a multivitamin containing folic acid every day

5. Our target audiences All women of childbearing age
Specific marketing messages around
Women ages who are not planning a pregnancy
Women ages who are planning a pregnancy
Latino/Hispanic women

6. Folic acid: A preconception message
Folic acid deficiency identified as a preconception risk factor in the CDC’s 2006 guidelines
If taken BEFORE pregnancy, folic acid can prevent up to 70% of spina bifida and anencephaly
The U.S. Public Health Service recommends that ALL women of child bearing age take 400 mcg of folic acid every day

7. Folic Acid Campaign methods
We disseminate our preconception health message through…
Media - TV, radio, print
Free materials – brochures, reminders, videos, bulletin boards, etc
Health Care Provider Education - Office Champion
Peer education- Community Ambassador Program
Latino Campaign
Integration of message into existing programs/services
Over 120 Community Ambassadors- close to 1000 community presentations in 24 counties
Over 150 private medical practices have received inservice

8. Office Champion Program
We provide an in-service about folic acid to family practice and Ob/GYN
The training for all staff includes basic folic acid facts and how and when to talk with female patients about this topic
A nurse or other staff member is appointed the “Office Champion”
The Office Champion helps remind clinicians to talk to female patients about folic acid and keeps the practice stocked with educational materials for patients
Program reaches more than 250 practices each year

9. Office Champion Program: Results
Comparing provider knowledge before and after the folic acid in-service:
Proper timing of folic acid supplementation: 87% of respondents answered correctly (at least one month before conception) before the in-service and 94% after the in-service. North Carolina providers have high knowledge about the importance of taking folic acid before pregnancy.
Correct folic acid daily dose: Improvement from 53% to 73% of respondents who correctly identified 400 mcg.
Correct recurrence prevention dose: Improvement from 24% to 45% of providers who knew that 4000 mcg before pregnancy is the correct dose to prescribe if a patient has a history of a prior NTD-affected pregnancy.
The proportion of providers who reported discussing folic acid and multivitamin use with at least half their female patients of childbearing age at annual exams jumped from 51% before the in-service to 69% afterward.
Talk about the office champion survey and it’s results: An evaluation of the Office Champion Program took place from to examine the knowledge, attitudes and recommendation behavior related to folic acid and multivitamin use among private health care providers. Evaluators randomly selected OB-GYN and family practice offices from a statewide database. Prior to the in-service, staff administered a confidential survey to those in attendance to assess the baseline knowledge and behavior of providers. Three to four months later, a second survey was sent by mail to measure how individual health care providers’ knowledge, attitudes and counseling behaviors related to folic acid and multivitamins had changed as a result of the in-service and establishment of an Office Champion.
A total of 104 respondents, including 57 nurses, 29 doctors, 14 mid-level providers and two health educators completed the survey.

10. Community Ambassador Program
Basic health promotion program
Community groups or individuals
Regional coordination
Community Ambassadors are:
Motivated individuals
High school or college students, employees at a company, members of churches, neighborhood moms, hair stylists, etc.
Individuals that represent the diversity of the community
The Community Ambassador (CA) Program is a lay health education program, in which local community members are trained about multivitamins and folic acid. Community Ambassadors give workshops and educational talks about folic acid in their local communities. This allows the North Carolina Folic Acid Campaign (NCFAC) to expand our reach on a grassroots level.
Program reaches more than 10,000 individuals each year

11. Community Ambassador Program: Results
Pre-test/ Post-test Results for Level of Importance Placed on Taking Daily Multivitamins
Survey 1: How important is it for you to take a daily multivitamin?
Survey 2: After hearing the presentation today, how important do you now think it is to take a daily multivitamin?
Very important (20.9%)
96.7% maintained very important
Important (35.7%)
80.5% shifted to very important
19.5% maintained important
Not very important (27.6%)
56.9% shifted to very important
38.2% shifted to important
Not at all (15.7%)
52.9% shifted to very important
38.6% shifted to important
Talk about the results of the program and the way participants moved across the levels in stages of change model.
Now in its eighth year, the NCFAC wanted to evaluate the effectiveness of the Community Ambassador Program. The evaluation effort sought to examine the knowledge, attitudes and behaviors of the community members who attended CA presentations. Designed by the NCFAC evaluation committee, the survey sought to capture respondents’ intent to change their behavior.
The survey was administered in two parts. Survey 1 was completed before the CA presented on folic acid to assess baseline knowledge, beliefs and behaviors, as well as to collect demographic information. Survey 2 was completed immediately following the presentation. The evaluation team will send out a third and final survey to those who have provided addresses to determine if a behavior change took place.

12. Latino Campaign
Developed in response to increased risk for NTDs among Latinas.
Health care provider education, including cultural competency workshops
Educational materials are NOT direct translations; they are modified to be culturally appropriate
Community ambassadors present to small groups of women
Statewide Spanish-language media

13. Latino Campaign: Results
From 2006 to 2008, knowledge of multivitamins and folic acid increased significantly in North Carolina Hispanic women ages 18 to 35, but overall still remains low.
Hispanic women knew that a prescription is not necessary to buy multivitamins and that the best time to start taking a multivitamin every day is when young women first get their period.
More Hispanic women knew that taking a daily multivitamin with folic acid could prevent a birth defect, but the same percent were taking a multivitamin as compared to the women surveyed in 2006.
In 2006, the NCFAC did a preliminary survey with foreign-born Hispanic women ages in 12 randomly selected counties throughout the state. Between May 2006 and May 2008, the North Carolina Folic Acid Campaign and the March of Dimes implemented a multi-faceted educational campaign to promote multivitamin use. All 12 counties participated in a paid media campaign consisting of a mix of Spanish-language television, radio and newspaper advertising and publicity. In addition, the six intervention counties received public health care provider education, cultural awareness information about Hispanics, and a lay health educator program. In 2008, the NCFAC completed a second survey to measure the success of the campaign.

14. Prevalence of Neural Tube Defects North Carolina, 1995-2005. N. C
Prevalence of Neural Tube Defects North Carolina, * N.C. Birth Defects Monitoring Program
* data are provisional

15. Lessons learned: planning
Materials development
Make sure audience participates in development and review of materials
Work with partners at all agencies involved so that process goes smoothly
Give yourself enough time for many rounds of approvals

16. Other successes
Helped to introduce and pass legislature that will provide multivitamins to low income women of childbearing potential
Received a grant from the CDC to test a “Promotora” curriculum that is much like the Latino Campaign’s model

17. Lessons learned: partnerships
Partnerships are important
Partnerships allow for leverage and expand resources beyond our capacity
Find partners with compatible messages
Partnerships can be tricky and time-consuming
Too much work for everyone to be doing their own piece alone
Eg. American Heart Assn, American Cancer Society, Diabetes group all are doing messaging together

18. Lessons learned: partnerships
Non-traditional partners are essential
Media
Difficult to measure but much broader reach than public health reaches alone
Media partners look for opportunities to work with positive messages
Community-based organizations
Schools and students
Schools: our target audience is 18-24: how to reach? Via college campuses, community colleges (pre-service students); high school classes, etc.

19. Lessons learned: women
Do not assume that women will be moved by our public health messages
Knowledge does not necessarily lead to action
Listening (and adapting) is important: women talk about competing priorities, barriers, stress, etc.

20. Lessons learned: women
Most women don’t think much about pregnancy before it happens.
So consider other ways to talk about preconception messages
Spanish-speaking women are receptive to pregnancy messages

21. Looking to the future
Partnering with other organizations and agencies (e.g. schools)
Combining the folic acid message with other preconception health messages
Funding opportunities

22. Ideas? Questions?
Contact us!

23. Join us! www.getfolic.com www.marchofdimes.com/northcarolina
Blogger:
Myspace:
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24. For more information contact:
Contact us
By spreading the word about folic acid and multivitamins…YOU can make a difference for mothers and babies!
For more information contact:
LaToya Artis Megan Whelen
Cape Fear Regional Coordinator Triad Regional Coordinator
Gina Smith Linda Morgan
Eastern Regional Coordinator Western Coordinator