New Parent Initiative / First Time Motherhood Grant
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1 New Parent Initiative / First Time Motherhood Grant Tools for Engagement: Finding the Right RLP Tools that Start the Conversation, Inform, Educate, and Reach Our Target Audiences North Carolina Preconception Taskforce 1 UNC Sheps Center for Health Services Research 2 NC DHHS Division of Public Health Women s Health Branch
2 NC Preconception Taskforce: CommiXees Request Tool Providers: We need something to use that will help us cover PCH issues and start the conversation with our patients. We have about 5 minutes. Consumers: Give us something that helps us know what we can ask about when we see our providers. We want it in advance, so we can think about it before our clinic time. Need tool that is: Inviting to consumer, available in advance Practical for clinician Useable in multiple sexings Applicable to range of clients across lifespan (age and parity)
3 Focus for PCH primarily been during clinic visits Post-partum visit, after a delivery Contraceptive supply visit Annual check-up Limited time (short time allotted for each patient) Protocols mainly involve physical measures: BMI, BP, Labs, Physical exam Unfamiliarity with ancillary topics (both provider and patient/client) Discomfort discussing How to bring up? Where to start? Are clinic visits the best time to discuss? Which clinics? Which providers? Who else should be part of the process?
4 Add- on to NC Healthy Start Baby Love Plus* in Northeastern NC Northeastern NC very rural, high poverty, high risks Awareness campaign: consumers (FTP), providers, community Collaborative effort Women s and Children s Health Section, NC Division of Public Health Local county HDs, existing outreach, case management, regional consortium Faith- community Local community colleges * See Session IN2 Results from the First Time Motherhood / New Parents Initiative for more information about NPI Program in North Carolina * See Session PH5 Improving Birth Outcomes through Healthy Start for more information about our North Carolina Healthy Start Projects (Baby Love Plus)
5 Six- county NPI Project Healthy Start Program Area Social Marketing and Health Promotion/Public Awareness Campaign Alleghany Northampton Ashe Surry Stokes Caswell Gates Camden Rockingham Person Vance Warren Hertford Pasquotank Watauga Granville Halifax Wilkes Perquimans Currituck Yadkin Avery Forsyth Chowan Guilford Orange Alamance Franklin Durham Bertie Mitchell Caldwell Nash Alexander Davie Edgecombe Madison Yancey Martin Washington Iredell Burke Davidson Wake Tyrrell McDowell Dare Catawba Randolph Chatham Wilson Rowan Buncombe Pitt Haywood Johnston Swain Greene Hyde Rutherford Lincoln Lee Beaufort Graham Cleveland Harnett Henderson Cabarrus Wayne Polk Montgomery Jackson Gaston Mecklenburg Stanly Moore Transylvania Lenoir Cherokee Macon Pamlico Craven Clay Union Cumberland Anson Richmond Hoke Jones Sampson Duplin Carteret Scotland NPI Project Counties n=6! Onslow Robeson Bladen NPI Comparison Counties n=6! Pender Mostly Rural Areas Poverty, Unemployment, Isolation Limited Health Care options (mainly public clinics) IMR over 16 per 1,000 for Minorities; (> 3 x White rate) High Medicaid (70-80% of deliveries) High Prevalence Co- Morbidities: diabetes, obesity, hypertension Columbus Brunswick New Hanover * See Session IN2 Results from the First Time Motherhood / New Parents Initiative for more information about NPI Program in North Carolina
6 Intervention: Utilization of the Title V hotline Promotion of FP Waiver (Medicaid) Billboards along major rural routes Radio spots TV ads Clinician updates / training in RLP Community outreach worker training Lay Health Advisors in faith community Target population: year olds First time mothers New Parents ü At- risk for adverse pregnancy outcomes ü Including racial/ethnic minorities Media Design and Toolkit: Training modules on PCH / RLP for clinical staff Curriculum for community workers / consumers Flipchart and Toolkit for Health Coaches in Churches Materials targeting men Website links, NC Medical Journal Starting the Conversation Booklet: Provider / Consumer Crosswalk
7 We included over 250 providers, consumers, and community outreach staff in surveys, focus groups, and feedback sessions at three different stages during 2- year project to develop and assess RLP media and materials, their popularity and use across different clinical and community sexings. Six Focus Group Sessions Developing the Tool Total 54 participants : 70% consumers, 30% staff at local HD Mainly women (90%), all childbearing age, sexually active Reactions to overall look, wording, layout, messages Advice: when to use it, who should give it out Community Feedback Survey Consumers Awareness of health risks Information sources guide decisions about family planning Most trusted sources for health knowledge Popular media: TV, Radio, Texting, Internet, other (movies, billboards) Systems Survey Providers Assess trainings, knowledge increase re: PCH Feedback on experiences with different tools, including booklet Receptiveness of patients/clients re: RLP Increased comfort to start the conversation
8 Starting the Conversation Cross- walk Booklet What Do You Want? What s your plan? Are You Ready? Designed to help patients consider: Ready to think about if children fit into your future? Not sure you re ready to plan, but willing to talk about it? Whether or not you want to have children, ever? How many children do you want to have? When do you want to have them? Preventing a pregnancy until you are ready Your goals to improve your personal health
9 Starting the Conversation Cross- walk Booklet What Do You Want? What s your plan? Are You Ready? Designed to help clinicians: Know where is their patient in terms of RLP? How much have they already thought about it? What do they need today? Where do they need to be referred? What discussions should they be having w/ their patient? What are their patient s personal health goals? Tool for: Screening Counseling Referring
10 Starting the Conversation Cross- walk Booklet What Do You Want? What s your plan? Are You Ready? Designed to help community workers: Have something in hand in informal sexings Focus a conversation around RLP process Determine where a client is in their thinking Articulate the next step in the process Identify where client can go for information Help client navigate system to find appropriate service or where they can make an appointment Complement information given in small groups and health education events (Take- home worksheet)
11 Majority like it Pictures, colors are eye- catching The word SEX gets your axention! Sex, both as a word and concept, is used to sell everything else, so it is a good idea to use it to promote health Keep sex in the title, both as an indicator of what the book covers and to grab readers axention One younger participant shared that this was the only reason she would be likely to continue reading the pamphlet Resonated with young and olders Broad appeal: those ready to start family, those sexually active but not ready for kids those who were done Male feedback: too focused on female issues Rearrange pictures: so don t see a pregnant woman when they first open the book.
12 Starting the Thought Process Awareness about: Desire for Children Timing and Spacing Pregnancies Childbearing Readiness Social / Financial Supports Relationship status Educational goals Career / job Parenting vision
13 Helping to Articulate Intentions Awareness about: Surprise Pregnancies Advantage of having BC on hand Condom use Negotiating BC with partner STDs and HIV protection Takes into account: Different relationship scenarios
14 Screening for health risks and current lifestyle issues Possible problem markers : Personal habits / lifestyle Diet Substance use Risky sexual behavior Violence / abuse Chronic conditions Self- assessment or with provider
15 Promoting Importance of Addressing Previous Perinatal Risks Awareness about: Pregnancy loss / miscarriage/abortion Chronic conditions Depression Pre- term delivery Low birth weight Fetal death, stillbirth, infant death Birth defects
16 Promoting Action, CommiXing to Behavior Change Next Steps in Process Conversation with Partner Commit to Condom Use Explore Familial Health Histories Go for check- up Address Smoking, Substance use Exercise, Healthy Weight, Nutrition Vitamin Use
17 Resource Page Referral Information: Outreach workers can direct client Clinician can recommend at visit Self- referrals if pick up booklet Can be locally adapted
18 Back Page: Notes to Record Advice I heard from clinician Ideas I shared with Outreach Worker Thoughts I had while reading Items I want to remember to ask about
19 Feedback from Consumers This booklet is like your mama talking to you! It makes you think a lixle deeper about things you usually overlook. I d give it to my 14 year- old sister who s boy- crazy already. The teens need to see this booklet because they aren t looking at the future or protecting themselves I like the part that asks you what you want and where you see yourself in the next 5 years. It makes me realize that I want to finish school, I don t want to be a stay- at- home parent, and I don t want to live in Tarboro! It makes me realize I have to be more careful about birth control! I like the questions the booklet raises. I like the sections that let you know what you can do and what steps you should take. The way it s worded, it sounds very achievable. Writing out the answers to these questions is empowering. You are making decisions about your future. You re not just waiting for the doctor tell you what to do. I like the illustrations on the cover. Everyone can see themselves somewhere here. The booklet gives you focus. It helps you ask your doctor questions you might otherwise be too nervous to talk about.
20 Please tell us about your experience with this booklet 85% These are fine for the Family Planning Clinic as well as other practice sexings 88% I think it s a useful tool and make time to use it in my practice 9% I ve had patients bring it to an appointment to discuss with me 76% I give it to clients and patients and ask them to return with it for discussion 42% I use it with every client or patient of reproductive age 69% It s been a useful tool to start conversations on RLP topics 91% This is fine for teenagers as well as clients or patients who are in their 20s 85% This booklet is realistic for clients or patients who already have children Source: NPI Evaluation Systems Survey, 2010 (n=33 providers, 6- county project area clinics)
21 Providers Endorse Progress and Continuation of Efforts This has provided an awesome learning experience and an opportunity to engage our clients in conversation with the hope of gexing them to take ownership for their overall health and well being especially their reproductive health. Thanks for providing the training I have been heavily involved in the promotion of this project in Hertford County and have enjoyed seeing the progression of preconception initiatives that the project has yielded for our area. I am eager to see how the program will continue, and how we can be involved with it in the near future.
22 Evaluation results demonstrated: increased utilization of health services increased knowledge, awareness and skills related to preconception health among consumers community leaders and health care providers The reach of both the social marketing campaign and the North Carolina Medical Journal indicate that the messages for consumers and the health care providers reached the intended audiences Broad- based messaging that included mass media as well as person- to- person venues resulted in broader acceptance and continuity of messaging Outreach and faith- based staff were not just message reinforcers, but often conversation starters, enabling the dialogue to continue when patients came to clinic visits
23 Strategies that Led to Success Taking the time to research: Community information needs Religious values related to RLP Consumer interest and preferences for learning styles All ensured that we ended up with an effective and appealing curriculum Involving consumers in the development: Enhanced message delivery Led to demand for continued utilization (outreach and clinic sexings)
24 Clinicians Confirm Importance of Linkage with Outreach It is very wise to put the information in the hands of people in the community to reach those who may not show up at the health departments or doctors' offices, until it's too late. Together we can accomplish more and reach those who may otherwise be unreachable. Sustainability through Community Partnerships Faith Community - local churches and NPI- trained Health Coaches Lay Health Advisors Healthy Start Outreach - Community Health Advocates (CHAs) Led to Availability of new Toolkit and strategies on a statewide basis Spanish cultural adaptations Requests from consumers, providers, community and faith- based leaders Inventory records indicate broad distribution statewide, just in first 12 months
25 Findings 1. Use of mass media is nearly universal, even in rural NC However, not the most trusted or popular source for pregnancy- life planning- reproductive health 2. Person- to- person information sharing is more popular for RLP than standard media messaging Family members, partners, clergy, and close friends Outreach and community health workers, local clinic staff, case managers, and social services workers 3. Outreach is key linkage between consumers, families, and clinical providers 4. Having a tool that can be used across continuum of community / clinic providers starts the RLP conversation, and keeps it going: it s all about process 5. Information campaigns should invest in human networks as much as mass media or electronic messaging
26 Thank you! Questions? For more information on the NPI Toolkit or any of the tools Please contact: Alvina Long Valentin (919) Or Julie DeClerque (919) To access a downloadable copy of the booklet or other NC PCH tools hap://whb.ncpublichealth.com/provpart/pubmanbro.htm
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