Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial

Abstract

Objective: To test the hypothesis that a concise intervention to promote the preconception use of folic acid (FA) supplements among mothers who visit a wellbaby clinic (WBC) for the 6-month check-up of their youngest child is effective. Effectiveness was measured as intention to use or actual use of FA supplements before a next pregnancy among women who expected to be pregnant within 0-12 months. Design: Controlled intervention study with independent samples of intervention and control mothers. The intervention took place at the 6-month visit. A postintervention measurement was done in the intervention group and a comparable measurement in the control group at the 11-month check-up visit. Setting: The intervention, verbal and in writing, was implemented in four Dutch WBC and given by the WBC physician to the mothers who visited the WBC. Subjects: All mothers visiting the WBC were eligible for inclusion, unless they were unable to complete a questionnaire. The intervention group consisted of 198 (68 %) mothers recruited from 291 6-month intervention visits and the control group of 215 (84 %) mothers recruited from 255 11-month normal visits. Results: In mothers who expected to be pregnant within 0-12 months, the proportion using or intending to use FA was 65 % in the intervention group (n 49) v. 42 % in the control group (n 43; difference 23 %, 95 % CI 4, 43 %, P < 0·05). Conclusions: Health education intervention at the 6-month WBC visit is an effective means to promote the use of FA supplements or the intention to do so. Keywords Health promotion Folic acid supplements Preconception careMore than 20 years ago it was proved that the intake of folic acid (FA) in the periconceptional period protects against neural tube defects (NTD). In many countries policy was developed to increase FA intake, including the advice to use FA supplements before conception, and to fortify staple foods. Nine years after the first one-off mass media campaign in the Netherlands in 1994, which was followed by a number of smaller initiatives mainly directed to supposed intermediaries like general practitioners, midwives and obstetricians/gynaecologists (1) , the percentage of women using FA in the periconceptional period had increased to approximately 43 % in 2003 (2) . The Dutch Ministry of Health decided in 2004 to allocate funds for the development and implementation of additional strategies to achieve a 70 % adequate FA intake by 2010. The focus was on the development and implementation of interventions and channels through which the target group of women who would become pregnant could be educated effectively and in time. Two channels were identified as specifically appropriate: community pharmacies and wellbaby clinics (WBC). Through these channels it would be possible to deliver information and advice by so-called 'important others', in this case highly appreciated medical professionals, who are part of the social influence, one of the determinants of behavioural intentions in the ASE model (3) . Community pharmacies had s...

Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands

“…This potential role for PCHC services in delivering interconception care has been recognized in a Dutch governmental advisory report on preconception care [8]. In addition, two recent studies acknowledged this opportunity and aimed at reaching women for advice on interconception care in well-baby clinics [2, 19]. Nevertheless, interconception care has not become standard care within PCHC services.…”

Results of a Dutch national and subsequent international expert meeting on interconception care

“…Few studies have specifically assessed the effectiveness of an ICC intervention on improved pregnancy outcomes or proxy outcomes such as behavior change (see Supplementary addendum table) [17]. Only two studies have shown a positive impact; suggesting improved folic acid use and suggesting increased pregnancy intervals and less adverse outcomes in a high-risk population [18,19]. Many ICC programs have been described without reporting on effectiveness or only providing feasibility and process evaluations [20][21][22][23][24][25][26][27][28].…”

“…In the Netherlands, a single visit around 6 weeks postpartum is recommended, but Lu et al have recommended expanding the number of visits to apply ICC [3]. The role of maternity care providers in postpartum care and ICC has been described [11,73,74], but also other healthcare providers have been suggested to take part in ICC such a pediatric care providers [19,23,75,76], internists [61], sexually transmitted disease clinics [77], general practitioners and genetic counselors [78]. Actually, every office visit is an opportunity for ICC [9].…”

Preconception counselling for low health literate women: an exploration of determinants in the Netherlands

“…In the Netherlands, individual counselling can be provided through general practices, municipal health services, or midwives and gynaecologists [ 8 ]. Preconception care has shown to be effective in improving maternal health behaviour, such as folic acid use, smoking and alcohol cessation, diabetic control and obesity prevention before pregnancy, and preventing congenital disorders [ 12 – 15 ]. Women with a lower socioeconomic background are at greatest risk of complications during and after pregnancy, yet they are least likely to participate in preconception screening, risk assessment and counselling [ 15 – 17 ].…”