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: Rhonda.freeman@sdcounty.ca.gov

Website: www.sdmcfhs.org