RTI International

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Formative Research with Consumers about Preconception Health and Care

Linda Squiers, PhD,1 Elizabeth W.  Mitchell, PhD2 Denise M. Levis, PhD,2 Molly Lynch, MPH,1 Karen Isenberg, MPH1

Megan A. Lewis, PhD,1 Marjorie Margolis, BS,1 Julia Kish-Doto, PhD1

Monica Scales, PhD,1 Patricia Green, PhD2

1 RTI International2 CDC Division of Birth Defects and Developmental Disabilities

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RESEARCH TO INFORM SOCIAL MARKETING STRATEGY

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2Market

Research

Social Marketing Phases

Goal: To develop an actionable multi-organizational social marketing plan

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What are the challenges in marketing preconception health and health care?

The target population is large 50% of women 18-44 years old have not heard of

preconception health (Mitchell et al., 2009) PCH terminology is not lay-friendly Having a healthy baby is a great motivator, however 65%

of pregnancies are unplanned (Chandra et al. 2005) Messages that focus on having a baby may not work for

women who are not planning to become pregnant

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Study Aims

Conduct formative research with consumers to learn more about their knowledge, attitudes, and beliefs about preconception health behaviors and health care services

Use findings to inform the development of a social marketing plan: a brand advertising concepts messages

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Methods

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Theoretical Framework: Social Marketing

Product

Price

PlacePromotion

Partnership

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Research Questions

Product

How do consumers refer to/think about the terms preconception health and preconception care? What other terms could be used to describe PCH or PCC?

Should this be referred to as a set of behaviors, a set of services, or both? Are there terms or words that make more sense to them, or that they use to describe this type of care or set of behaviors?

Do consumers understand the behaviors that fall under the PCC/PCH umbrella?

 

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Research QuestionsPrice

What motivates consumers to engage in PCH behaviors?

What are the barriers/challenges to engaging in these behaviors?

Promotion What types of messages would be most effective (e.g.,

reduced rates of birth defects vs. healthy bodies vs. healthy babies)?

Place What are consumers’ preferred channels for receiving

information about PCC? What venues would be most effective to promote these

messages?

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Segmenting the Target Audience

Target audience for PCH is women 18-44 years of age Need to identify smaller segments to effectively

target messages Literature review suggested that these factors would

affect receptivity to the message: future pregnancy plans whether woman already has a child

Used 2007 HealthStyles (n=639) data to examine demographic questions and attitudes to determine if segmentation approach was viable

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Audience Segmentation Analysis ResultsDo Not Have Children Have Children

Plan to Become a Parent

N=78; 12% of sample32% aged 18-24 years51% aged 25-34 years

47% married76% employed

53% own residence58% drink alcohol

Do Not Plan to Have Any Children

N=78; 12% of sample67% aged 35-34 years

41% married83% employed

67% own residence65% drink alcohol

Plan to Have More Children

N=95; 15% of sample59% aged 25-34 years

74% married55% employed

63% own residence47% drink alcohol

Do Not Plan to Have More Children

N=388; 61% of sample69% aged 35-44 years

81% married68% employed

78% own residence47% drink alcoholDo

Not

Pla

n to

Ha

vePl

an to

Hav

e

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Age Distribution across Audience Segments

10

32

17

2

23

51

59

29

67

17

24

69

0

10

20

30

40

50

60

70

80

90

100

Do Not Plan to HaveAny Children

Plan to Become aParent

Plan to Have MoreChildren

Do Not Plan to HaveAny More Children

% o

f Seg

men

t

18-2425-3435-44

p < .001

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Descriptive Statistics for Active Pregnancy Planning Scale

Scale/Item N (%)/Mean (SD)

Item-Total Correlation

CronbachAlpha

Active pregnancy planning (1-5) 0.83My partner and I had/have a plan for having a child 3.1 (1.8) 0.72

My partner and I talked about when we wanted/want to have a child 3.4 (1.6) 0.74

My partner and I have talked about how many children we wanted/want to have 3.8 (1.5) 0.56

My partner and I have talked with a health care provider about having a child 2.5 (1.7) 0.59

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Mean Active Pregnancy Planning Scale Scores by Audience Segments

2.1

3.4

3.8

3.2

1

2

3

4

5

Do Not Plan to HaveAny Children

Plan to Become aParent

Plan to Have MoreChildren

Do Not Plan to HaveAny More Children

Mea

n A

ctiv

e P

regn

ancy

Pla

nnin

g S

core

p < .001

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Segmentation Strategy: Consumers

Planning Status Audience Segment Lower SES

Middle SES

Planners Women who have not had a child and want to be pregnant

1 1

Planners Women who have had children (a year ago or more) and want to have more children

1 1

Non-planners Women who do not want to have children

1 1

Non-planners Women who have had children (a year ago or more) and are not planning to have more

1 1

Interconception Women who have had a baby in the last year (irrespective of their future pregnancy plans)

1 1

TOTAL 5 5

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Methods

Held 10 Focus Groups with consumers in Atlanta Professional recruitment firm used screener to

recruit group members 90 minute discussion groups Exit survey on demographics Provided $75 incentive

Analyzed data using QSR NVivo 8.0

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Participant Eligibility Criteria

Woman between the ages 18-44 years Not currently pregnant Do not have condition that would make them

unable to get pregnant Total annual household income no more than

$75,000

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Participant Characteristics

N=65 participants 21% had given birth in the last 12 months Age:

20% aged 18-24 35% aged 25-34 45% aged 35-44

Race/ethnicity: 51% White, 42% Black, 1% Latino, 1% American

Indian

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Participant Characteristics

Insurance status 78% had private or employer-based 10% had Medicaid or Tricare 12% were uninsured

76% of those who had children had not seen a provider before becoming pregnant.

63% of those who plan to become pregnant plan to see a provider before becoming pregnant.

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Findings

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Product – Consumer Understanding

Participants had a general understanding of PCH behaviors and their importance Limiting alcohol, quitting smoking, and taking

prenatal vitamins were most salient, especially for planners

Non-planners questioned the need to do these behaviors when not preparing for a pregnancy

Recommendation for vaccinations (Rubella and Influenza) were confusing to some

Overall, PCH perceived as a lifestyle (i.e. being healthy) rather than a set of services

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Product –Terminology

Preconception

Reproductive Life Planning

Preconception Health

Promotion

Preconception Health Behavior

Pre-pregnancy /

Pre-baby

Steps to Pregnancy

Positive Planning

Women’s Health

Women’s Health

Management

Healthy Lifestyle

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Product – What is Preconception Health?

“People might be like, ‘Oh, that’s not me’. Because really I’ll probably read it and be like, ‘I don’t fall in that group. I’m not looking to get conceived, or pregnant.’”

“I’m just looking at it going, if I was to say that to one of my

friends, they would just look at me and go ‘Huh?” Because, I

mean, it, it’s just not something that I would use in my everyday

vocabulary.”

“Preparing your body for a pregnancy.”

“Making sure you’re healthy enough and you have all the, I guess, essential vitamins and make sure your blood pressure and everything, that you’re healthy enough to carry a child.”

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Price - Motivators Age and maturity Social support: partner, family, friends Access to a doctor: ability to discuss with a doctor

Health insurance Planning: the desire to be pregnant was the strongest motivator across

groups Motivators for Planners:

Health of the baby and mother Contribution to fertility Being in the pregnancy mindset

Motivators for Non-planners: Not much motivation overall besides living a generally health

lifestyle

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Motivators - Examples of what Participants Said

“But even if you are planning on trying to get pregnant and you’re young, I don’t think you think about this stuff because you’re not mature…and you’re just like ‘My baby’s going to be fine, I don’t need to do nothing…’ You’re older, then you’re going to think more about the stuff and go through the steps to do it…”

“If they’re planning then they’re like 100% [motivated].”

“My boyfriend…was all like, ‘Did you take your, your vitamins?’ I’m like, “Yeah.” He was like on me.”

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Price - Barriers

Addiction (e.g., cigarettes, alcohol, drugs) Lack of social support: unsupportive partner or family

“My family wasn’t really a great support system…so you, you have to get your information from somewhere else.”

Perceived lack of control over outcomes: Cause of premature births or birth defects not always

clear Healthy women have premature babies, smokers and

drug addicts can have a healthy babies Finances: living a healthy lifestyle is expensive

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Price – Barriers by Planning Status

PLANNERS Low income (being healthy is expensive) Lower education level (not having awareness/knowledge) Lack of support systems Lack of access to healthcare

NON-PLANNERS Lack of trigger event such as pregnancy or planning for pregnancy Even if practicing healthy behaviors, not likely to do pregnancy-

specific behaviors (e.g., folic acid, Rubella vaccine) Enjoyment of non-pregnancy behaviors, e.g., smoking, street drugs,

and drinking too much alcohol

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Promotion – Types of Messages

Messages for planners PCH contributes to a healthy baby Negative behaviors can lead to serious consequences

Baby with birth defects (fear appeals) PCH contributes to a healthy mother

Different messages needed for non-planners Overall health, healthy lifestyle OOPS! campaign: “Oops. Did you know that 50% of

women get pregnant later in life when they say that they’re done having children?”

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Promotion – Types of Messages

Emphasis on consequences of negative behaviors “…hit on where it hurts almost to stop them in their

tracks” “…enough to shock you, but not enough to traumatize

you” “…people are so much more motivated by the

consequences of their actions”

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Place – Channels and Venues

Discussion with provider (e.g., routine check-ups) Sexual education curriculum Points of temptation

At lunch hour when choosing between a salad and a hamburger: “And you’re bombarded with bad stuff everywhere so you should be bombarded with this stuff everywhere.”

Product placement for non-planners Pharmacy – birth control pills Tampax boxes Yogurt tabs Backs of beer bottles, fliers at bars, Women’s apparel stores (e.g. Victoria’s Secret)

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Results – Potential Partners

Women’s healthcare providers/resource centers Women’s health clinics Planned Parenthood Childbirth classes WIC

Women’s consumer brands Tampax, Playtex, Yoplait

Web-based Partners WebMD Facebook

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Next Steps

Use findings to inform: 1. A Social Marketing Plan for a Preconception Health

Campaign2. The development of a brand and ads for PCH

Plan is being developed with the Preconception Health & Health Care Consumer Workgroup CDC staff from the National Center for Birth Defects

and Developmental Disabilities

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Partners

March of Dimes State and local health departments National Healthy Mothers Healthy Babies Coalition Office of Minority Health Resource Center National Healthy Start Association CityMatCH Every Woman Southeast UNC Center for Maternal and Infant Health

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Questions?

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Contact

Linda Squiers, Ph.D.Senior Research Scientist

RTI International919-597-5128

lsquiers@rti.org

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References

Mitchell, E. W., Lewis, M. A., Bann, C., Squiers, L. B., McKnight, M., Isenberg, K. L., Levis, D., Mersereau, P., & Taylor, M. (2009, August). Formative research on preconception health for consumers. Poster presented at annual meeting of the National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, GA.

Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 23(25). 2005.