variations in women’s knowledge and attitudes regarding preconception healthcare peter s....
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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