Increasing Folic Acid Awareness Increasing Folic Acid Awareness and Knowledge of Future Health and Knowledge of Future Health

Care Providers to Reduce the Care Providers to Reduce the Incidence of Neural Tube Birth Incidence of Neural Tube Birth

DefectsDefects

Diane Zipley, State Director of Program Services,

March of Dimes Arizona Chapter August 26, 2007

Folic Acid Folic Acid AwarenessAwareness

Research now shows that adequate intake of folic acid

before conception can prevent the incidence of neural tube

birth defects by 70%1

However, less than 50% of women are being informed about

the importance of folic acid by their health care provider2

To address this knowledge gap, the March of Dimes has developed various materials to educate health care professionals about

folic acid.

March of Dimes March of Dimes “Folic Acid and the “Folic Acid and the

Prevention of Neural Tube Prevention of Neural Tube Defects” Defects” CD-ROMCD-ROM

• Created by Jordan Perlow, MD, Folic Acid Education Campaign Chairman for the Arizona Chapter of the March of Dimes and Associate Director, Maternal-

Fetal Medicine for Phoenix Perinatal Associates

• To examine the effectiveness of incorporating CD-ROM

technology in the curriculum of future health care providers, a study was conducted

Importance of Patient Education &

Awareness About Folic Acid BEFORE

Pregnancy

It is estimated that throughout the world 500,000 infants are born every year with a neural

tube defect (NTD)3

Approximately 3,000 of these

births occur in the United States3

Differences in NTD Differences in NTD

rates based on rates based on Race/Ethnicity?? Race/Ethnicity??

Relative Risk for Spina Bifida

By Race/Ethnicity, U.S., 1983-1990

*Based on 16 state-based birth defects surveillance systemsSource: CDC, Teratology, July/August 1997

Prepared by March of Dimes Perinatal Data Center, 1999

RACE/ETHNICITY Adjusted Relative Risk (95% CI)

White 1.00

Black 0.80 (0.72-0.88)

Hispanic 1.41 (1.26-1.58)

Asian/ Pacific Islander

0.51 (0.38-0.70)

Native American 1.13 (0.74-1.74)

NTDs AmongNTDs Among Hispanic Infants Hispanic Infants

• Hispanic infants, particularly US-born Mexicans are at greatest risk

for NTDs• In an analysis of 6 selected states,

Hispanic infants had a significantly higher rate of NTDs than non-

Hispanic white infants• Not all birth defects surveillance programs collect data on

Hispanic ethnicity

Source: National Center for Health Statistics, period linked birth/infant death filePrepared by March of Dimes Perinatal Data Center, 2001

Rate per 100,000 live births

Infant Deaths due to NTDs by Race/Ethnicity, United States, 1995-1998

8.5

10.5

15.9

17.6

11

3.9

11.7

0

2

4

6

8

10

12

14

16

18

20

Black non-

Hispanic

White non-

Hispanic

Hispanic Mexican Puerto

Rican

Cuban Central/ Southern American

Rate per 100,000 live births

Participants in the study were local, full-time, first- year PA students enrolled in a Women’s Health course Total N= 73

The purpose of the course was to introduce PA students to gynecology and obstetrics with a primary care focus

Two of the course objectives were related to folic acid and birth defects: (1) assessment and management of perinatal women, and (2) identification of common fetal abnormalities

MethodologyMethodology

PROCEDUREPROCEDURE• Single-group, pretest/posttest survey design was

used to evaluate the effectiveness of using CD-ROM technology to increase knowledge of folic

acid

• Format of the Folic Acid CD-ROM: Voice-over narration of a 45-minute PowerPoint

presentation that includes graphs, photos, and text

• Content: Includes the etiology of NTDs, clinical research on folic acid, the need for preventive education, and current recommendations for

folic acid supplementation

Pre/Post Pre/Post Test InstrumentTest Instrument

18 multiple-choice questions, with each question listing 4 possible answers

Questions factually based and derived from a validated survey provided by the March of Dimes and additional information contained on the Folic Acid CD-ROM

Posttest consisted of the same 18 questions with the order changed to reduce recall from the pretest.

Posttest included 4 evaluation questions using

a 5-point Likert scale ranging from strongly agree to strongly disagree

Results

CONCLUSIONSCONCLUSIONS

Generally, the definitive improvement in posttest over pretest scores shows the effectiveness of the Folic Acid CD-ROM for increasing knowledge and awareness among students

In Addition…In Addition…Evaluation responses from these students

strongly suggested that the Folic Acid CD-ROM:

*provided information in a clear and effective manner

*adequately covered and delivered the

information

*encouraged students to commit to recommending folic

acid to their future patients

THE FUTURETHE FUTURE

• Educating women to supplement their food intake with synthetic folic acid will

reduce the likelihood of infants with NTDs 1,2,,4

• Given the student responses in this particular study, it is likely that this group of future PAs will promote folic acid supplementation with

their female patients, thereby potentially decreasing the number of

NTD-affected pregnancies

This represents a total 22% decrease in neural tube defects for Arizona over the course of the 7 year March of Dimes

Folic Acid Education Campaign.

REFERENCESREFERENCES1. U.S. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Morb Mortal Wkly Rep 1992;41(no. RR-14):1–7.

2. March of Dimes. Folic Acid and the Prevention of Birth Defects: A National Survey of Pre pregnancy Awareness and Behavior Among Women of Childbearing Age. 1995–2000. Conducted by the Gallup Organization. Publication no. 31-1404–00. White Plains, NY: March of Dimes, 2000.

3. U.S. Centers for Disease Control and Prevention. Knowledge about folic acid and use of multivitamins containing folic acid among reproductive aged women—Georgia 1995. MMWR Morb Mortal Wkly Rep 1996;45:793–795.

4. U.S. Centers for Disease Control and Prevention. Knowledge and use of folic acid by women

of childbearing age—United States, 1995 and 1998. MMWR Morb Mortal Wkly Rep 1999; 48: 325–327.