Examining knowledge change associated with prenatal education programs in Ontario:

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1 Examining knowledge change associated with prenatal education programs in Ontario: A Locally Driven Collaborative Project Katelyn Godin, PhD (Cand.) School of Public Health and Health Systems University of Waterloo Harshani Gangodawilage, MPH (Cand.) Population Medicine University of Guelph September 25, 2014

2 This project is supported through the Locally Driven Collaborative Project program at Public Health Ontario Views expressed in the presentation are the views of the LDCP Healthy Pregnancies team members and do not necessarily reflect those of Public Health Ontario

3 Overview Introduction Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Part 2: The Healthy Pregnancies Knowledge Questionnaire Part 3: Findings Part 4: Implications Questions

4 Prenatal education programs in Ontario What we know: Attended by 1/3 of women and 2/3 of first-time mothers in Canada (PHAC, 2009) Widely recommended Often accessed through local public health units Public Health Agency of Canada. (2009). What mothers say: The Canadian maternity experiences survey. Ottawa, ON: Government of Canada..

5 Prenatal education programs in Ontario What we know: Highly variable, evolving Shift to online format

6 Prenatal education programs in Ontario Many research gaps

7 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Part 2: The Healthy Pregnancies Knowledge Questionnaire Part 3: Findings Part 4: Implications

8 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Locally Driven Collaborative Project (LDCP) Brings together representatives from health units so they can collaboratively develop and implement applied research or program evaluation projects that explore a topic, intervention, or program related to an important public health issue.

9 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Objectives To develop and test a tool that assesses knowledge change among women participating in prenatal education programs in Ontario Examine the knowledge change associated with participation in prenatal programs delivered by Ontario public health units Examine the characteristics of women participating in these programs Assess women s satisfaction with their program

10 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Who are we? Brant County Health Unit Best Start Resource Centre Chatham-Kent Public Health Unit Durham Region Health Department Halton Region Health Department North Bay Parry Sound District Health Unit Leeds, Grenville and Lanark District Health Unit Oxford County Public Health & Emergency Services Peel Public Health Toronto Public Health Wellington-Dufferin-Guelph Public Health York Region Community and Health Services

11 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Study design Quasi-experimental study Sample size: 511 pregnant women Pre- and post-program surveys will measure knowledge change related to: o o o Healthy pregnancies Healthy lifestyles Breastfeeding

12 Screening Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Participants who registered for prenatal programs at recruiting public health units Included Eligibility Participants who completed the preprogram questionnaire Participants who completed the postprogram questionnaire

13 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Part 2: The Healthy Pregnancies Knowledge Questionnaire Part 3: Findings Part 4: Implications

14 Part 2: The Healthy Pregnancies Knowledge Questionnaire A) Environmental scan n % # clients served annually (mean = , median= 270, 30 health units (83% response rate) Estimated 17,612 clients served in % offered online & inperson programs Best Start program most popular range= ) Modes of delivery available Online only In-person only Both online and in-person Curriculum used 1 Best Start Resource Centre Canada Prenatal Nutrition Program Gift of Motherhood (online) A New Life (online) Injoy Birth & Parenting Education Own curriculum Other/unnamed Values do not add up to 100%, as some public health units >1 curricula 2 Or adapted version

15 Part 2: The Healthy Pregnancies Knowledge Questionnaire B) Literature review Numerous existing tools for assessing pregnancy and early parenthood-related knowledge and practices were identified. 4, 7, 8, Many of the tools used a multiple choice format Questions were simple, concise, and addressed one specific subject at a time Provided examples of overall design and questions

16 Part 2: The Healthy Pregnancies Knowledge Questionnaire C) Question development & review Key Message Regular prenatal care that starts as early as possible in pregnancy is preferred. However, seeking out care at any point in pregnancy is beneficial for the health of pregnant women and their developing babies. Priority Low Med High It is important that pregnant women have a health care provider they can both trust and feel comfortable asking questions and/or raising concerns with Preterm labour is labour occurring before 37 weeks Signs and symptoms of preterm labour may include: cramps or abdominal pain that does not go away; blood or fluid from vagina; lower back pressure/pain; feeling like infant is pushing down; contractions or changes in strength of contractions; increase in amount of vaginal discharge; a feeling that "something is not right". If experiencing signs and symptoms of preterm labour, proceed immediately to hospital for further assessment It is not always possible to prevent preterm labour; some activities may be helpful, such as seeking early prenatal care, avoiding/reducing tobacco use, avoiding prolonged standing, eating a balanced diet, and reducing stress

17 Part 2: The Healthy Pregnancies Knowledge Questionnaire D) Pilot testing July 2013 Relatively small public health unit, serves ~290 clients annually through its prenatal program. Eligibility: English speaking women, enrolled in the health unit s prenatal program, first-time mothers. Recruitment for the pilot study took place during program registration by public health unit staff. Ethics approval granted

18 Part 2: The Healthy Pregnancies Knowledge Questionnaire D) Pilot testing Nine participants 6 online version, 3 via telephone Findings: Means to improve their knowledge on their pregnancy Liked MC format, difficult, wording, consistency with their program, convenience of online Feedback on how to improve question clarity

19 Part 2: The Healthy Pregnancies Knowledge Questionnaire Online version

20 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Part 2: The Healthy Pregnancies Knowledge Questionnaire Part 3: Findings Part 4: Implications

21 Screening Part 3: Findings Participants who registered for prenatal programs at recruiting public health units (n = 1108) Excluded: Did not want to participate (n = 288) Participants interested in taking part in study (n = 820) Excluded (n = 114): Eligibility criteria not met (n = 38) Pre-survey incomplete (n = 76) Included Eligibility Participants who completed the pre-program questionnaire (n = 741) Participants who completed the postprogram questionnaire (n = 511) Participants who completed their program in-person (n= 261, 51.1%) Lost to follow up (n = 230) Participants who completed their program online (n= 250, 48.9%)

22 Part 3: Findings Study Population Characteristics Age Range: 20 to 45 yrs old Mean: 30.2 yrs old Ethnicity 64% Caucasian 23% Asian First pregnancy 90% primiparous Trimester 57% in the 3 rd trimester (29-40 weeks) Education 89% completed post-secondary school

23 Part 3: Findings Knowledge change associated with in-person vs. online programs Total Knowledge Scores *(%) P-value Program Type Pre-program Post-program In-person 21 (65.6) 25 (78.1) <0.01 Online 22 (68.8) 24 (75.0) <0.01 * Maximum score = 32 Are the programs equally effective?

24 Part 3: Findings Knowledge change associated with in-person vs. online programs Statistical Modeling Program Type Post-Knowledge Score * Variables assessed: Trimester First pregnancy Public health unit Education level Income Age Residency * Adjusted for pre-knowledge score

25 Part 3: Findings Knowledge change associated with in-person vs. online programs Causal Diagram Residency Program Type Post-Knowledge Score * Public health unit

26 Part 3: Findings Participant Preferences: In-Person vs. Online When given the choice, the majority of women (60.1%) chose to take an in-person program over the online program. Majority of primiparous women (62.4%) chose to take the in-person prenatal classes. Majority of women in their 1 st and 2 nd trimester (56.2%) preferred to take the online prenatal program.

27 Part 1: The Healthy Pregnancies Locally Driven Collaborative Project Part 2: The Healthy Pregnancies Knowledge Questionnaire Part 3: Findings Part 4: Implications

28 Part 3: Implications Uses of the Healthy Pregnancy Knowledge Questionnaire Enhance local capacity to evaluate knowledge gain in prenatal education programs and improve service delivery Standardized tool will allow for the pooling of data across public health units Aid in strengthening an under-developed and highly relevant evidence base on the effectiveness of prenatal education programs

29 Part 4: Implications Program planning/development Online programs are an effective alternative for PHUs with limited resources Online programs may be a way to engage with a diverse group of women early in their pregnancy Prudent to offer both types of programs to account for varying learning styles/preferences of clients Limitations

30 Acknowledgements The LDCP Healthy Pregnancies team would like to thank Public Health Ontario for its support of this project. The team gratefully acknowledges funding received from PHO through the Locally Driven Collaborative Projects Program

31 Questions