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Increasing Folic Acid Awareness and Knowledge of Future Health Care Providers to Reduce the Incidence of Neural Tube Birth Defects. Diane Zipley, State Director of Program Services, March of Dimes Arizona Chapter August 26, 2007. Folic Acid Awareness.

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Increasing Folic Acid Awareness and Knowledge of Future Health Care Providers to Reduce the Incidence of Neural Tube Birth Defects

Diane Zipley, State Director of Program Services,

March of Dimes Arizona Chapter

August 26, 2007

folic acid awareness
Folic Acid Awareness
  • 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
slide3
To address this knowledge gap, the March of Dimes has developed various materials to educate health care professionals about

folic acid.

march of dimes folic acid and the prevention of neural tube defects cd rom
March of Dimes “Folic Acid and the Prevention of Neural Tube Defects” CD-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

slide7
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

relative risk for spina bifida by race ethnicity u s 1983 1990
Relative Risk for Spina BifidaBy Race/Ethnicity, U.S., 1983-1990

*Based on 16 state-based birth defects surveillance systems

Source: CDC, Teratology, July/August 1997

Prepared by March of Dimes Perinatal Data Center, 1999

ntds among hispanic infants
NTDs Among 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
slide11

Rate per 100,000 live births

Black

non-Hispanic

White non-Hispanic

Central/ Southern American

Hispanic

Mexican

Puerto Rican

Cuban

Rate per 100,000 live births

Source: National Center for Health Statistics, period linked birth/infant death file

Prepared by March of Dimes Perinatal Data Center, 2001

methodology
Methodology
  • 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

procedure
PROCEDURE
  • 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 test instrument
Pre/Post Test 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
conclusions
CONCLUSIONS

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 future
THE FUTURE
  • Educating women to supplement their food intake with synthetic folic acid will reduce the likelihood of infants with NTDs1,2,,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
slide19

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.

references
REFERENCES

1. 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.

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