Improving Adequacy of Prenatal Care in Utah

Laurie Baksh, MPH, Nan Streeter, MS RN, Lois Bloebaum, BSN MPA, Joanne Barley, BS,

Shaheen Hossain, PhD. Utah Department of Health

MCHEP ConferenceDecember 2005

Background• Adequacy of prenatal care (PNC) is a measure of

access to prenatal care.

• Adequacy is a measure based upon month of prenatal care entry and number of visits.

Background

• Inadequate prenatal care is a risk factor for low birth weight and other adverse pregnancy outcomes.

• Prenatal care provides an opportunity to conduct risk assessment, risk reduction, and maternal education.

• Risk reduction is particularly beneficial to medically and socio-economically high-risk women.

Background

• Utah’s prenatal care adequacy steadily declined from 1993 through 2000.

• United Health Foundation’s America’s Health: State Rankings Report puts Utah at 49th in the nation for adequacy starting in 2000.

Utah’s Prenatal Care Adequacy

1994 - 2002

0%

10%

20%

30%

40%

50%

60%

70%

80%

1994 1995 1996 1997 1998 1999 2000 2001 2002

PRAMS Data

• Using 1999 Utah PRAMS data, analysis of Utah’s prenatal care adequacy was published in 2001.

• Using the Kotelchuck index, we found that the largest contributor to poor adequacy was women missing prenatal care appointments.

Prenatal Care Adequacy – 1999 Utah PRAMS Data

62.9%12.5%

24.6%

Adequate PNC

Inadequate PNCDue to Late Entry

Inadequate PNCDue to InsufficientVisits

PRAMS Data

• The PRAMS analysis also found that 61% of women with inadequate prenatal care due to late entry reported that they received prenatal care as early as they wanted.

• It appeared that many Utah women were not aware that first trimester PNC is important.

Focus Groups• The results of the PRAMS analysis led the Utah

Department of Health (UDOH) to conduct focus groups with women who received inadequate prenatal care.

• Six focus groups were held with women who had late PNC or inadequate PNC identified and selected from birth certificate records.

Focus Groups• Focus group participants did not appear to value prenatal

care:

• “All women should have the same amount of care available to them, but whether they take advantage of it or not, that’s their choice.”

• “I don’t think it’s necessary to go to the doctor if you don’t want to…. You can’t change anything that is going to happen to the baby.”

Development of a Media Campaign

• In 2001, a media campaign was developed to target Utah’s poor prenatal care adequacy.

• The media campaign was built on the current “Baby Your Baby” program that has been in existence since 1987 and has name recognition throughout the state.

• Using PRAMS and focus group data, a new education campaign was developed with the theme “13/13” to target women getting into care late and women who do not receive adequate visits.

• Commercial spots were developed which highlighted the message to “See Your Provider By Week 13 and See Your Provider 13 Times for a Healthy Pregnancy” and that “13 is Your Lucky Number”.

Fortune Teller

Institute of Bad Luck

Award Winning - Happy Babies

Development of the Media Campaign

• Television ads began airing in March 2003 on Utah’s CBS station. Spanish ads began soon after on several local Spanish stations.

• Radio spots were aired on multiple stations.

• Billboards were hung and newspaper ads were placed periodically in various publications statewide.

Evaluation of the Campaign

• A survey was designed to determine the effectiveness of the campaign in changing women’s behavior.

• Survey began in July 2004

• Participants were chosen from a sample of mothers who had delivered a live born infant in the previous two to four months.

• We over sampled women with lower education levels

Evaluation of the Campaign

• A one page questionnaire was mailed out to • determine women’s feelings about the new ads • determine if viewing the ads changed women’s perceptions of

PNC or motivated them to seek early and continuous PNC.

• Two mailings were sent to the sample of moms.

• Included 20 minute prepaid phone card as an incentive.

Evaluation of the Campaign

• Overall response rate – 41%

• Surveys sent to 1523 women

• 621 completed surveys were returned

Knowledge About Prenatal Care

• Knowledge about prenatal care:• 94% of women said that before their pregnancy, they thought

women should start PNC in the first trimester

• Opinions regarding number of PNC visits were variable:• 3.9% said 1 to 4 visits• 7.3% said 5 to 8 visits• 31.1% said 9 to 12 visits• 43.4% said 13 to 16 visits• 12.2% said 17 or more visits

Campaign Penetration• 70.5% of women said they had seen a “13 by 13” commercial on

TV in the last year

• 34.4% said they had heard a “13 by 13” commercial on the radio in the last year

• 39.1% said they had seen a “13 by 13” Baby Your Baby billboard

• Only 22.6% of women said they had not seen a commercial on TV nor heard a radio spot

Did We Motivate Women?

• 31.9% of women said the commercials motivated them to call their health care provider for an appointment

• 32% of the women who indicated the ads didn’t motivate them said it was because they already knew or had already contacted their provider.

• 46.0% said the commercials motivated them to get prenatal care

Were There Differences in PNC?

• Did the ads work?• Comparing women who saw an ad to women who did

not hear/see ads:• Significant differences in trimester of entry• Significant differences in number of visits• Significant differences in adequacy of prenatal care.

Utah’s Prenatal Care Adequacy

2000 - 2004

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2000 2001 2002 2003 2004

+ 15.3%

Conclusions

• A targeted media campaign can be an important tool in raising level of awareness of the importance of adequate prenatal care

• Utah’s adequacy rates are at an all time high, but still require efforts to reach HP2010 goals