Gerald McGwin, Jr., M.S., Ph.D.Gerald McGwin, Jr., M.S., Ph.D.

Associate ProfessorAssociate Professor

Departments of Epidemiology, Surgery, and Departments of Epidemiology, Surgery, and OphthalmologyOphthalmology

University of Alabama at BirminghamUniversity of Alabama at Birmingham

An Educational Intervention to An Educational Intervention to Promote Proper Seat Belt Use Promote Proper Seat Belt Use

During Pregnancy During Pregnancy

BackgroundBackground• Restraint use during pregnancy contributes to Restraint use during pregnancy contributes to

improved maternal and fetal survival after MVCs.improved maternal and fetal survival after MVCs.

• Research suggests 25% to 50% do not follow Research suggests 25% to 50% do not follow guidelines for seatbelt use during pregnancy.guidelines for seatbelt use during pregnancy.

• Discomfort and concerns about harm to Discomfort and concerns about harm to themselves or fetus common reasons for lack of themselves or fetus common reasons for lack of restraint.restraint.

• Few interventions to improve seat belt Few interventions to improve seat belt knowledge and practices during pregnancy.knowledge and practices during pregnancy.

PurposePurpose

To evaluate an education intervention To evaluate an education intervention

focused on increasing the proper use and focused on increasing the proper use and

knowledge regarding seat belt use during knowledge regarding seat belt use during

pregnancy. pregnancy.

MethodsMethods

• Phase IPhase I Collect baseline information regarding Collect baseline information regarding seat belt use knowledge and behaviorsseat belt use knowledge and behaviors

• Phase IIPhase II Developing and implementing Developing and implementing educational interventioneducational intervention

• Phase IIIPhase III Evaluating impact of educational Evaluating impact of educational interventionintervention

Methods – Phase I & IIIMethods – Phase I & III

• The Jefferson County Alabama Department of The Jefferson County Alabama Department of Health operates nine health centers distributed Health operates nine health centers distributed throughout the county; seven of these centers throughout the county; seven of these centers provide prenatal care. provide prenatal care.

• To qualify for services at the County health To qualify for services at the County health centers, patients need to be residents of centers, patients need to be residents of Jefferson County, Alabama or have Medicaid; Jefferson County, Alabama or have Medicaid; indigent patients also qualify for services. indigent patients also qualify for services.

• Research team visited County health centers Research team visited County health centers and approached all pregnant women for and approached all pregnant women for participation in the study (participation in the study (Phase I: 6-8/2001; Phase I: 6-8/2001; Phase III: 10-12/2002Phase III: 10-12/2002))

• Staff members rotated among all seven centers Staff members rotated among all seven centers in a manner that provided a random sample of in a manner that provided a random sample of all women seeking prenatal care. all women seeking prenatal care.

• Patients given description of study and asked if Patients given description of study and asked if they were willing to participate. they were willing to participate.

Methods – Phase I & IIIMethods – Phase I & III

• Self-administered questionnaire collected Self-administered questionnaire collected demographicdemographic and and pregnancy informationpregnancy information and and restraint use characteristics. restraint use characteristics.

• Information on restraint use in Information on restraint use in previous pregnanciesprevious pregnancies and under different and under different driving situationsdriving situations also collected. also collected.

• Patients asked whether they had received any Patients asked whether they had received any information regarding restraint useinformation regarding restraint use from a variety of from a variety of sources. sources.

• Survey available in both English and Spanish. Survey available in both English and Spanish.

Methods – Phase I & IIIMethods – Phase I & III

Methods – Phase IIMethods – Phase II

• Data from Phase 1 identified gaps in knowledge Data from Phase 1 identified gaps in knowledge and behavior as targets for educational material.and behavior as targets for educational material.

• Focus groups conducted with clinic patients and Focus groups conducted with clinic patients and staff to identify barriers regarding proper seat staff to identify barriers regarding proper seat belt use during pregnancy and techniques for belt use during pregnancy and techniques for addressing these issues.addressing these issues.

• Collectively, this information was used to create Collectively, this information was used to create a variety of material for distribution to prenatal a variety of material for distribution to prenatal care clinics, patients, and staff.care clinics, patients, and staff.

Methods – Phase IIMethods – Phase II

• Posters depicting proper seat belt placement Posters depicting proper seat belt placement created and installed at prenatal care clinics.created and installed at prenatal care clinics.

• All patients given gift bag containing brochure All patients given gift bag containing brochure explaining benefits and correct use of seat belts.explaining benefits and correct use of seat belts.

• Clinic staff provided buttons encouraging proper Clinic staff provided buttons encouraging proper seat belt use.seat belt use.

• All material was available in both English and All material was available in both English and Spanish.Spanish.

Methods – SummaryMethods – Summary

6/2001 1/20026/2001 1/2002 3/2002 10/2002 3/2002 10/2002

Baseline Intervention Intervention Post-InventionBaseline Intervention Intervention Post-Invention Survey Development Dissemination SurveySurvey Development Dissemination Survey

0

10

20

30

40

50

60

70

80

Positive effect Negative effect Don't know

FIGURE 2A. Knowledge of seat belt effectiveness for a FIGURE 2A. Knowledge of seat belt effectiveness for a non-non-pregnant womanpregnant woman among pre- and post-intervention groups. among pre- and post-intervention groups.

(p=0.005)

0

10

20

30

40

50

60

70

80

Positive effect Negative effect Don't know

FIGURE 2B. Knowledge of seat belt effectiveness for a FIGURE 2B. Knowledge of seat belt effectiveness for a pregnant womanpregnant woman among pre- and post-intervention groups. among pre- and post-intervention groups.

(p<0.0001)

0

10

20

30

40

50

60

70

80

Positive effect Negative effect Don't know

Pre-Intervention Post-Intervention

FIGURE 2C. Knowledge of seat belt effectiveness for a FIGURE 2C. Knowledge of seat belt effectiveness for a babybaby among pre- and post-intervention groups.among pre- and post-intervention groups.

(p=0.0009)

ConclusionsConclusions

• Although frequency of seat belt use high, many Although frequency of seat belt use high, many not wearing seat belts properly. not wearing seat belts properly.

• This study demonstrated potential for This study demonstrated potential for educational tools to change knowledge and educational tools to change knowledge and behavior.behavior.

• Education regarding proper seat belt use is now Education regarding proper seat belt use is now a regular component of pre-natal care at county a regular component of pre-natal care at county health department pre-natal care clinics.health department pre-natal care clinics.

An Educational Intervention to An Educational Intervention to Promote Proper Seat Belt Use Promote Proper Seat Belt Use

During Pregnancy During Pregnancy