Download PCI n (percent) - UNC Center for Maternal & Infant Health

Variations In Women’s Knowledge
And Attitudes Regarding
Preconception Healthcare
Peter S. Bernstein, MD, MPH
Professor of Clinical Obstetrics & Gynecology and
Women’s Health
Introduction
• Women vary in their knowledge of the importance
of Preconception Care
• Frey and Files surveyed 499 women attending an
Internal Medicine/Family Medicine private practice
in AZ.
– 98% recognized the importance of improving health prior
to conception
– Responses to knowledge questions were correct 54-99%
of the time
– 39% recalled their MD speaking about Preconception
Health issues
Matern Child Health J, 2007
Introduction
• A second study of mostly Mexican-American
women (n = 305) of lower socioeconomic status
found:
– Lower levels of correct responses to knowledge
questions (range 30-94%)
– But 95% knew it was important to improve health prior to
conception
– 41% reported that an MD had spoken to them about the
importance of preconception health
Coonrod et al., Am J Obstet Gynecol 2009
Knowledge that folic acid should
be taken before pregnancy
US, 1995-2008
Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each
year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999.
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.
Daily use of folic acid among
women 18-45 years
US, 1995-2008
Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each
year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999.
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.
Knowledge that folic acid
prevents birth defects
US, 1995-2008
Nationally representative telephone surveys conducted by Gallup, targeting approximately 2000 English-speaking women ages 18-45 each
year. Margin of error is +/- 3%. Survey not conducted in 1996 and 1999.
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved June 2, 2011, from www.marchofdimes.com/peristats.
Objective
• To survey and compare non-pregnant
reproductive age women seeking care at
two different OBGYN practices that serve
differing populations:
– Larchmont Women’s Center primarily serves
women with private commercial insurance
(PCI)
– Comprehensive Family Care Center, a
Federally-qualified Community Health Center
(CHC) that primarily serves women on public
assistance.
Methods
• Self-administered survey of knowledge
and attitudes regarding preconception
care developed by Frey and colleagues
(Matern Child Health J, 2007)
– Utilized 5 point Likert scale and multiple
choice questions
– Available in English and Spanish
– Completed while waiting for visit
– Classified as “Exempt” by the IRB
Methods
• Primary outcome variable: Awareness of
the need for preconception care
• Sample size calculation:
– Assuming the PCI group had a similar belief
in the need for preconception care (98%)
– 100 patients needed in each group to detect a
5% difference in response by the CHC group
Results: Demographics
Age (years)*
Race**
Black
Hispanic
Asian
Caucasian
Other
Cohabiting
with partner**
*mean (SD)
**n (percent)
CHC
(n=105)
PCI
(n=108)
p-value
30.0 (7.6)
30.8 (7.8)
0.003
<0.001
35 (34%)
41 (40%)
4 (3.9%)
3 (2.9%)
19 (3.7%)
19 (18.3%)
10 (9.6%)
4 (3.8%)
62 (59%)
9 (19%)
49 (48%)
59 (55%)
0.273
Results: Demographics
CHC
(n=105)
Education
<12th grade
High school graduate
Some college/technical school
College graduate
Some graduate education
Graduate degree
Annual Income
< $25,000
$26-50,000
$51-75,000
$76-99,000
> $100,000
Note: n (percent)
PCI
(n=108)
p-value
<0.001
14 (14%)
22 (22%)
37 (37%)
21 (21%)
4 (4%)
3 (3%)
2 (2%)
6 (5.6%)
29 (27%)
35 (33%)
9 (8.4%)
26 (24%)
<0.001
48 (52%)
35 (38%)
7 (7.6%)
2 (2.2%)
0
12 (12%)
25 (25%)
21 (21%)
10 (9.8%)
34 (33.6%)
Results: Reproductive Characteristics
Characteristic
CHC
n (percent)
PCI
n (percent)
p-value
Pregnancy Plans
No Plans
Trying, hope to be pregnant
Hope to be pregnant in 1-2 years
Hope to be pregnant in 3-5 years
Not able to get pregnant
63 (62%)
13 (13%)
6 (5.9%)
15 (15%)
5 (4.9%)
72 (67%)
3 (2.8%)
14 (13.1%)
16 (15%)
2 (1.9%)
Ever pregnant
84 (80%)
57 (53%)
<0.001
If ever pregnant, prior unplanned
pregnancy a
59 (70%)
34 (58%)
0.119
Currently using contraception b
47 (51%)
67 (64%)
0.059
a. Respondents: CHC=84; PCI=59
b. Respondents: CHC=93; PCI=105
0.024
Results: Preconception Health Info.
Item
CHC
PCI
n (percent)
n (percent)
Has a doctor spoken to you about
“preconception health”?
61 (59%)
45 (43%) 0.015
Interested in receiving preconception
health education. (Very interested/
Somewhat interested)
67 (65%)
63 (59%) 0.329
When would you prefer to receive
preconception health education? **
1. At the time I become pregnant
2. Before I try to get pregnant
3. During pregnancy and until delivery
4. Every time I get an annual exam
5. Unsure
**Respondents: CHC=95; PCI=100
p-value
0.095
10 (11%)
40 (42%)
5 (5.3%)
22 (23%)
18 (19%)
4 (4.0%)
5 (59%)
2 (2.0%)
21 (21%)
14 (14%)
Results: Selected Knowledge Questions
Questions
CHC
n (%)
PCI
n (%)
p-value
Review of medications prior to pregnancy
93 (89%)
Talk to doctor about diseases in the family
prior to getting pregnant
92 (86%)
103
0.024
(97%)
84 (79%) 0.052
Important to be tested for infectious
diseases before getting pregnant
91 (89%)
104
(97%)
0.021
Important to be tested for infectious
diseases before getting pregnant
91 (89%)
104
(97%)
0.021
Regular exercise can harm an unborn child 69 (68%)
88 (82%) 0.015
A woman thinking about getting pregnant
should avoid some fish products
76 (73%) 0.041
57 (59%)
Results: Selected Patient Attitude Items
Item
CHC
n (%)
PCI
n (%)
p-value
A woman should improve her health if
considering getting pregnant
91 (89%)
106
(99%)
0.002
A woman has control over her health
74 (72%)
95 (88%) 0.002
A woman needs help of health
professionals to improve her health
77 (77%)
68 (68%) 0.044
Discussion
• Interest in preconception health was high
in both groups (approx. 60%)
• Responses to knowledge tended to be
>80% correct though gaps existed
• Women of lower socioeconomic status
tended to do less well on knowledge
questions
Discussion
• Providers at CHC were more likely to have
raised preconception health as a topic
(though low at both sites)
• Need apparently greater at CHC site
– Knowledge deficit greater
– Women at CHC felt less in control of their
health
– More women at CHC site felt that the help of a
health provider was needed to improve health
Thanks to my co-authors:
•
•
•
•
•
Shilpi Mehta, MD
Yves-Richard Dole, MD
Lisa Simmonds, MD
Ashlesha Dayal, MD
Setul Pardanani, MD