Variations In Women’s Knowledge And Attitudes Regarding Preconception Healthcare Peter S....
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Transcript of Variations In Women’s Knowledge And Attitudes Regarding Preconception Healthcare Peter S....
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: DemographicsCHC (n=105)
PCI(n=108)
p-value
Age (years)* 30.0 (7.6) 30.8 (7.8) 0.003
Race**BlackHispanicAsianCaucasianOther
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%)
<0.001
Cohabiting with partner**
49 (48%) 59 (55%) 0.273
*mean (SD)**n (percent)
Results: DemographicsCHC (n=105)
PCI(n=108)
p-value
Education<12th gradeHigh school graduateSome college/technical schoolCollege graduate Some graduate educationGraduate degree
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
Annual Income < $25,000 $26-50,000 $51-75,000$76-99,000 > $100,000
48 (52%)35 (38%)7 (7.6%)2 (2.2%)0
12 (12%)25 (25%)21 (21%)10 (9.8%)34 (33.6%)
<0.001
Note: n (percent)
Results: Reproductive Characteristics
Characteristic CHC n (percent)
PCIn (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%)
0.024
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=59b. Respondents: CHC=93; PCI=105
Results: Preconception Health Info.Item CHC
n (percent)PCIn (percent)
p-value
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
10 (11%)40 (42%)5 (5.3%)22 (23%)18 (19%)
4 (4.0%)5 (59%)2 (2.0%)21 (21%)14 (14%)
0.095
**Respondents: CHC=95; PCI=100
Results: Selected Knowledge QuestionsQuestions CHC
n (%)PCIn (%)
p-value
Review of medications prior to pregnancy 93 (89%) 103 (97%)
0.024
Talk to doctor about diseases in the family prior to getting pregnant
92 (86%) 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
57 (59%) 76 (73%) 0.041
Results: Selected Patient Attitude Items
Item CHC n (%)
PCIn (%)
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