preconception w.h.e.e.l.s
DESCRIPTION
Preconception W.H.E.E.L.S. Rhonda Freeman, MPH Maternal, Child, and Adolescent Health Coordinator County of San Diego, Health and Human Services Agency Maternal, Child and Family Health Services . W orking to H elp E ducate and E mpower healthy L ife S tyles. - PowerPoint PPT PresentationTRANSCRIPT
PRECONCEPTION W.H.E.E.L.S
Working to Help Educate and Empower healthy Life Styles
3rd National Summit on Preconception Health
Tampa, FL
June 12-14, 2011
Rhonda Freeman, MPHMaternal, Child, and Adolescent Health Coordinator
County of San Diego, Health and Human Services Agency Maternal, Child and Family Health Services
TIMING IS EVERYTHING!
SAN DIEGO, CALIFORNIAGeography
White50%
Hispanic31%
Asian10%
Black 6%
Other2%
Population
Source: United States Census Bureau, American Community Survey 2009
Race/Ethnicity0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
6.5
14.1
4.3
7.05.9
All African-American Asian Hispanic White
Deat
hs p
er 1
,000
birt
hs
Race/ethnic groups not shown: Native American, Pacific-Islander, Other (due to small numbers) and Two or More Races and Unknown.
INFANT MORTALITY RATE, 2005-2008SAN DIEGO COUNTY RESIDENTS
Race/Ethnicity0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
8.8
15.1
10.7
7.7
9.3 9.38.0
All African-American Asian Hispanic Native Amer./Alaskan Pacific-Islander White
Perc
ent
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
PERCENT OF LOW BIRTH WEIGHT BIRTHS, 2006-2009SAN DIEGO COUNTY RESIDENTS
Race/Ethnicity0.0
5.0
10.0
15.0
20.0
25.0
13.7
19.2
15.0
12.7
16.917.9
12.7
All African-American Asian Hispanic Native Amer./Alaskan Pacific-Islander White
Perc
ent
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
PECENT OF PRETERM BIRTHS, 2006-2009SAN DIEGO COUNTY RESIDENTS
Race/Ethnicity0.0
2.0
4.0
6.0
8.0
10.0
12.0
5.5
7.7
2.9
7.1
8.9
10.9
3.2
All African-American Asian Hispanic Native Amer./Alaskan Pacific-Islander White
Perc
ent
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
PERCENT OF BIRTHS WITH LATE OR NO PRENATAL CARE, 2007-2009, SAN DIEGO COUNTY RESIDENTS
HISTORYCounty's Fetal Infant Mortality Review (FIMR) Program
Conducted Case Reviews
Convened Community Action Teams
Utilized Perinatal Periods of Risk (PPOR) Analysis
Focus on African American women
FIMR FINDINGS
• 77% of deaths caused by pregnancy or delivery complications
• 55% were very low birth weight (under 1500g)
• 77% preterm
Fetal Deaths - 31
• 36% of deaths caused by pregnancy or delivery complications
• 43% caused by prematurity or its complications
• 66% born preterm
Infant Deaths - 61
FIMR FINDINGS
Contributing Factors
• Negative life course experiences• Serious stressors during pregnancy• Moms with significant pre-existing medical conditions before pregnancy• Moms with prior pregnancies
• Infant or fetal loss• Pregnancy or delivery complications
Recommendations
• Provider opportunities• Family planning counseling• Referrals to genetic counseling, support programs, etc.• Follow-up after birth and infant death
• Education to women, parents, and community• Policy
A LIFE COURSE PERSPECTIVE: RACIAL AND ETHNIC DISPARITIES IN BIRTH OUTCOMES
Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30.
Individual
Interpersonal
Society/Public Policy
Community Environment
OrganizationsTH
E FA
CTors
OF
LIFE
A CALL TO ACTION Create an interactive user-friendly tool to increase knowledge
and change behavior among women to take action to improve health and lifestyle choices
Build partnerships with organizations and providers in moving the concept of "waiting until pregnancy to think about being healthy is too late" to the forefront
Ensure resources are available for women to access and utilize
Improve maternal health and birth outcomes
EXPANSIONMarch of Dimes Received Community Services Grant for Preconception
Health Awareness Project
Expansion of wheels to other ethnic groups for women of childbearing age
Partner with non-clinical organizations
METHODOLOGY Data analysis and recommendations of local FIMR
case review findings
Identification of clinics and organizations in high risk geographic areas
Solicit input from key community stakeholders
KEY STRATEGIES Strategy #1: Develop culturally and linguistically
appropriate educational tools Designed an eye-catching and interactive tool
African American, Spanish, and Multi-Cultural
Developed specialized messages Translated into Spanish
Selected culturally appropriate images
Conducted focus groups
Created preconception toolkit
PRECONCEPTION WHEELHealthy Women Have Healthy Babies
Nutrition Weight and Exercise Stress Management Family Planning Medical and Dental Check-ups Communicating with Your Healthcare Provider Smoking, Alcohol, Drug Use and Environmental Exposure Resources
KEY STRATEGIES Strategy #2: Identify and engage community
participation Utilize existing task force partners in promoting project
Establish relationships with community clinics and organizations
Outreach and recruit to non-traditional agencies
Develop distribution plan Conduct educational trainings Provide follow-up and technical assistance
KEY STRATEGIES Strategy #3: Develop evaluation process and tools
Create database for tracking project activities Contact information Organization profile Material distribution
Administer surveys Client Staff
Conduct focus groups
RESULTS Project Period: March 2008 – November 2009
Partners Clinics – 18 Organizations – 26
Total surveys – 321 surveys completed
Focus groups - 8 conducted
Wheels – 8,000 distributed
RESULTSFocus Groups 59% reported using tips from the wheel 77% learned something new
Staff Survey 91% stated it was easy to incorporate into their routine and facilitated
healthy behavior discussions with clients
Client Survey 88% learned new information and wheel was easy-to-use 83% would use the wheel more than once Most helpful sections:
Eat right (63%) Manage stress (52%)
Take care (52%) Get moving (47%)
CONCLUSIONS Realistic time frames need to be set when developing new
materials
Creating a tool with target population input is critical for acceptance
Routine follow-up is key in keeping partners motivated in delivering preconception messages
Partner buy-in is instrumental for sustainability of project
Tailor intervention to organization’s infrastructure
FUTURE DIRECTIONA Look Ahead… Adapt wheel for other target populations Incorporate preconception wheels into other settings Institutionalize preconception education with existing
partners Serve as an example for other counties to replicate Connect and integrate with other initiatives A LIFETIME OF GOOD HEALTH
THANK YOU Community clinics and organizations FIMR task force County staff:
Sutida Jariangprasert, MPH Shukri Adam, PHN Cindy Tso, MPH Amethyst Cureg, MD, MPH, FAAP
Preconception Health Awareness Project funded by March of Dimes California Chapter
CONTACT INFORMATION
Rhonda Freeman, MPHMaternal, Child, and Adolescent Health Coordinator
County of San Diego, Health and Human Services Agency Maternal, Child, and Family Health Services
Phone: 619.542.4039Email: [email protected]
Website: www.sdmcfhs.org