An example of a preconception health message:

North Carolina Folic Acid Campaign

LaToya Artis, Cape Fear Regional Coordinator

NC Folic Acid CouncilOctober 28, 2009

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

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

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

Our target audiences

• All women of childbearing age• Specific marketing messages around

– Women ages 18-24 who are not planning a pregnancy

– Women ages 18-24 who are planning a pregnancy

– Latino/Hispanic women

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

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

Office Champion Program

Program reaches more than 250 practices each year

• 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

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.

Community Ambassador Program

Program reaches more than 10,000 individuals each year

• 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

Community Ambassador Program: Results

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

Pre-test/ Post-test Results for Level of Importance

Placed on Taking Daily Multivitamins

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

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.

Prevalence of Neural Tube Defects North Carolina, 1995-2005*

N.C. Birth Defects Monitoring Program

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pre

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len

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pe

r 1

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Anencephaly Spina Bifida Encephalocele Total NTDs

*2004-2005 data are provisional

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

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

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

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

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.

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

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

Ideas? Questions?

Contact us!

Join us!

• www.getfolic.com • www.marchofdimes.com/northcarolina• Blogger: http://getfolic.blogspot.com/• Myspace: www.myspace.com/getfolic• Facebook:

http://www.facebook.com/pages/North-Carolina-Folic-Acid-Campaign/16803568463

• Twitter: www.twitter.com/getfolic • Youtube: www.youtube.com/getfolic

For more information contact:

LaToya Artis Megan WhelenCape Fear Regional Coordinator Triad Regional Coordinator910-822-3004 336-723-4386lartis@marchofidimes.com mwhelen@marchofdimes.com

Gina Smith Linda MorganEastern Regional Coordinator Western Coordinator252-972-4900 828-213-0031 gsmith@marchofdimes.com cgclmm@msj.org

By spreading the word about folic acid and multivitamins…YOU can make a difference for mothers

and babies!

Contact us