An Analysis of Preferred Maternal Education Topics Among Prenatal and Postpartum Women Employed in an Urban Corporate Setting in North Carolina

Rebecca MerrickMPH Candidate, Spring 2010

AcknowledgementsPrimary Professor:Stephanie Jilcott, PhDBrody School of MedicineDepartment of Public Health

Content Advisor:Betsy LaForge, MPHDirector, Member Health PartnershipsBlueCross BlueShield of North Carolina

Contributing Researcher:Laura Hughes, RNBlueCross BlueShield of North Carolina

Introduction and Background

BackgroundUS ranks poorly among

industrialized nations for infant mortality

NC infant mortality and preterm birth rates higher than US average rates

United States North Carolina

Infant Mortality Rate

6.83 8.53

Preterm Birth Rate

12.8 13.6

Table 1: Comparison of US and NC Preterm Birth and Infant Mortality Rates, per 100,000 population (2005)

BackgroundCDC and HRSA – national public health

goals to improve maternal and child health care

Prenatal care potentially improves birth outcomes

Disparities due to socioeconomic factors

Lack of prenatal care creates high costsKnowledge gaps for women regarding

prenatal and postpartum care

Goal and ObjectivesIncrease adherence to standards

of prenatal care by improving the information environment among women working in an urban corporate setting in NC◦Conduct Focus Groups◦Analyze Responses◦Recommend Topics to Include or

Exclude in Education Materials

Theoretical Framework

Social Cognitive Theory as Related To Behaviors which Affect Prenatal Outcomes

Reciprocal DeterminismBehavioral CapabilityExpectationsSelf-EfficacyObservational Learning

(Modeling)Reinforcements

A Conceptual ModelDetermina

nts

Environmental

Personal Behavioral

Reciprocal Determinis

m

Increased Self-

EfficacyIncreased Behaviora

l Capability

Setting Goals and Expectati

ons

Observational

Learning

Increased Adherence to Prenatal Care

Standards

Reinforcements

Intermediate OutcomeHealth Outcome

Decrease in Preterm Birth

Rate

Research Methods and Data Analysis

MethodsTarget Population: Urban Women

in NC currently pregnant or delivered a child within the past six months

Location: Major Insurance Company, Durham, NC

Recruited participants on company intranet homepage

MethodsTwo focus groups

◦4 participants each◦1 hour

Six educational booklets, reviewed prior to focus group session

Seven-question survey to capture participant background

MethodsTwo moderators assisted

discussion with interview guideParticipants assigned number (1-

4) and responses audio-recordedModerator transcribed sessions

verbatim subsequently

Data AnalysisCodebook

◦Deductive codes from Interview Guide

◦Inductive codes from major themes and topics that emerged from the data

Transcripts uploaded and coded using NVivo 8

Double coding method◦Discussion to resolved coding

discrepancies ◦Refined codebook after first

transcript

Results

Participant Characteristics In each focus group:

◦Three women currently pregnant◦One woman recently postpartum◦Three women have one previous

childParticipant age range: 25-40

years◦Median age of 33 years

Four African American, Three Caucasian, One Asian

Education levels ranged from some college to graduate-level degrees

Chart 1: Number of Coding Referenced for Each Node, Transcriptions 1 and 2

• Using NVivo, the most common codes were -------- identified and used as a guide to selecting themes

Major ThemesVisual ContentInteractivityFather InvolvementBreast and Bottle FeedingBooklet LengthMental Health / Postpartum

Depression

Visual ContentUse of “real” people

“It does help that it has real people. And not all of them are supermodels. That’s pretty”. (33-year old African American woman currently pregnant with her first child)

Visual ContentPictures to supplement text

“I mean you can read the descriptions and everything, but I think if you had like a small picture…you know an example of what it might look like you know that would be a lot of help”. (33-year old African American woman, currently pregnant, one previous child)

Interactivity“I do have to say, these little

things about filling stuff out, I don’t even have time to fill out my baby book so I found these to be like useless”. (32-year old Caucasian woman, currently pregnant, one previous child)

Interactivity“I like the work- the workbook

format… it’s nice because I think it makes things a little more interactive and it soon becomes a reference guide down the road where you can always pick it up and go back to it”. (33-year old Asian woman, currently pregnant, one previous child)

Father InvolvementFather’s role in prenatal

education materials usually minimized

Participants highly desired more information directed to the father’s role◦Emotional support for the mother◦Need to address the father’s feelings

and concernsMother’s responsibility to relay

important information

Father InvolvementPregnancy myth number one,

father’s role does not begin until the birth of the baby”. (33-year old Asian woman, currently pregnant, one previous child)

Breast and Bottle FeedingConcerns with proper feeding

technique, schedule, storage, potential benefits/harm

Overwhelming societal pressure to breastfeed

Little information on bottle feeding

Negative perception of breastfeeding advocacy groups

Breast and Bottle Feeding“It talks about breastfeeding and

it’s really positive and then there’s this little on bottle feeding. But it’s like it’s your choice. But the thing is you feel so bad when you can’t… it would be nice if they had that in there because I was really traumatized. I cried and cried and cried”. (32-year old Caucasian woman, currently pregnant, one previous child)

Booklet LengthImpacted initial impressionBalance of informationWhat to Expect When You’re

Expecting

“But honestly the choices are a really big thick book like this thing you’re dispensing or this little thing from a doctor’s office that says nothing”. (40-year old Caucasian woman, recently delivered her first child)

Mental Health / Postpartum Depression

Need for educational materials directed at emotional stress

Postpartum Depression not directly identified as a major issue

Pediatrician, not OB/GYN, asking about mother’s emotional well-being

Mental Health / Postpartum Depression

“I just took my daughter in for her checkup and the doctor was like ‘how are you feeling? Are you having a good day?’ I was like, “Oh my gosh’”. (33-year old Asian woman currently pregnant, one previous child)

Discussion: Recommendations for Prenatal and Postpartum Education Materials

DiscussionUse of culturally appropriate

pictures to supplement textInclude, but limit, interactive

space to accommodate different learning styles

Materials directed towards the father◦Father’s knowledge gap potential

point for interventionEqual information presented on

breast and bottle feeding ◦Ultimately the mother’s choice

DiscussionMid-sized booklet with references

to more detailed sourcesAcknowledge and directly

address Postpartum Depression as an illness◦Do not minimize depressive episodes

as “baby blues”◦Pediatric visits a potential point for

intervention

Strengths and LimitationsFocus group interaction can

facilitate new discoveriesIn-depth discussion generates

data with high face validitySmall unit of analysis (n=2)Small number of participants

(n=4, n=4)Data can only be generalized to

pregnant and postpartum women working at this company

Future StudiesKnowledge gaps, educational

preferences, preferred topics for pregnancy programs

Specific to particular populationsAssess self-efficacy for behaviors

before and after educationAssess how self-efficacy for

adhering to prenatal care standards varies in response to different educational materials

Timing of educational materials

ConclusionEducation can improve self-

efficacy for behaviors that can lead to a healthy pregnancy

Results suggest mid-sized materials that depict normal women, address father’s role, present breast and bottle feeding, and include references for more sources

This pilot study can help form the basis of more in-depth, specific investigations

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Questions