Using the March of Dimes "Becoming a Mom" Prenatal Program to Improve Maternal Attitudes and Knowledge

BACKGROUND: Premature birth, low birth weight, birth defects, and Sudden Infant Death Syndrome were identified as issues contributing to infant mortality in Kansas by the state’s Blue Ribbon Panel. The March of Dimes Becoming a Mom (BAM) prenatal program was implemented in four counties identified with high infant mortality rates and significant birth numbers (Geary, Saline, Sedgwick, and Shawnee) by the Kansas Blue Ribbon Panel. The purpose of this study was to identify the changes in prenatal attitudes, knowledge, and health outcomes among BAM program participants. METHODS: A collaborative community-based model incorporating multidisciplinary teams was created to address the health disparity gap in birth outcomes. Patients participated in multiple prenatal education sessions using a curriculum developed by the March of Dimes. A pre-/post-test design was implemented for the prenatal sessions. Changes in attitudes were assessed using descriptive statistics. Paired t-tests were used to assess the difference in knowledge questions from pre- and post-tests. Health outcomes were analyzed using descriptive statistics. RESULTS: Participants were 69% White, 87% spoke English, 64% were under age 26, 41% were employed full time, 45% had some high school or had a diploma, 39% had Medicaid, and 49% were enrolled in WIC (N=114). Participants demonstrated a statistically significant increase in knowledge among 14 out of 32 questions including: identifying signs of preterm labor, what to do during preterm labor, postpartum symptoms, and baby sleep position. There were also changes in prenatal attitudes including: need for prenatal care as soon as possible, continuing prenatal care when feeling healthy and not smoking during pregnancy. Relative frequencies were tabulated for week of delivery, infant birth weight, type of delivery, and presence of maternal and infant medical conditions. CONCLUSION: The March of Dimes BAM program participants reported improvements in prenatal knowledge. The BAM program can improve maternal knowledge through a community-based collaborative model of care. The combined prenatal education program with quality prenatal care can result in better maternal and child health outcomes

Integrating Health Literacy Questions into a Statewide Behavioral Risk Factor Surveillance System (BRFSS) Questionnaire

Objectives. The purpose of this pilot study was to evaluate the feasibility of adding health literacy questions to a state health assessment questionnaire. Methods. Researchers conducted a series of telephone interviews (N = 20) to test the telephone administration of three health literacy screening questions with a convenience sample. Feedback obtained during the telephone interviews was used to revise the questions for clarity. The revised questions were proposed as an addition to the Kansas Behavioral Risk Factor Surveillance System (BRFSS). Results. Pilot data included minor modifications to the language of the questions to broaden their interpretation outside of a hospital setting. Most participants (90%, n = 18) had adequate health literacy. The proposed questions were approved for addition to the BRFSS questionnaire. Prompts were added to a telephone script to aid BRFSS survey administrators. Conclusion. As one of the first statewide health literacy assessments, this study has demonstrated one method for collecting baseline data. This new methodology has the potential to impact both patient care and broad public health efforts

Visual Recognition of Child Body Mass Index by Medical Students, Resident Physicians, and Community Physicians

Background: Many studies have assessed the ability of mothers to identify their child’s Body Mass Index (BMI) category and the vast majority of mothers are unable to do so accurately. This suggested a need for physicians to inform parents about their child’s weight status. However, many physicians do not chart BMI-for-age, even though it is recommended. Instead they rely on their visual perception of the patient’s weight status. This study determined the number of medical students, resident physicians, and community physicians who correctly categorize preschool children into their appropriate weight class by visual cues alone. Methods: Fourth-year medical students, family medicine and pediatric resident physicians, and family medicine and pediatric community physicians completed a brief on-line survey. Pictures of three preschool children were shown and respondents described each child’s BMI-for-age category. Results: A 43% (134/312) response rate was achieved. Only 15% of respondents correctly identified a 3-year-old boy, whose BMI was >95th percentile for his age, as obese. Nearly 86% correctly identified a 4-year-old girl with normal BMI-for-age, but only 21% correctly identified another girl who was overweight at the 90-95th percentile BMI-for-age. No significant difference was found in total accuracy between medical students, resident physicians, or community physicians (F(2,123)=0.743, p=0.478) or between family medicine physicians and pediatricians (F(1,107)=2.269, p=0.135) when predicting the BMI-for-age categories. Conclusions: Medical professionals and trainees have difficulty visually assessing a child’s BMI-for-age weight status. This underscores the importance of calculating and plotting BMI at healthy check-ups

A Qualitative Assessment of Kansas Tracking and Reporting of Controlled Substances (K-TRACS)

Introduction. This study assessed the Kansas Tracking and Reporting of Controlled Substances system (K-TRACS), the online controlled prescription medication monitoring website in Kansas. The specific aims were to determine if and when pharmacists and physicians in Kansas were using K-TRACS and to identify any perceived benefits or barriers to using K-TRACS. Methods. A non-randomized, convenience sample of Kansas pharmacists and family physicians were interviewed face to face using a guided semi-structured questionnaire. NVivo 10 (QSR International Pty Ltd.) was used to analyze data. Results. Ten physicians and sixteen pharmacists were interviewed. All pharmacists and 70% of physicians were using K-TRACS. Usage was prompted by encounters with new patients or unease with the patient interaction. The perceived benefits included increased communication with the patient and all providers, increased provider comfort with treating chronic pain, and altered prescriber habits. Barriers to the use of K-TRACS were identified as login, password, and operating system problems. Conclusions. Among study participants, K-TRACS is used regularly, is perceived to be a benefit to providers, patients and communities, and has become a useful new tool in the treatment of chronic pain. K-TRACS is perceived to facilitate increased communication between providers and with patients

Examining Communication and Patient Recall in a Family Medicine Residency

Background. Understanding key aspects of effective physician-patient communication could benefit residency education and improve patient comprehension of health information. Discrepancies between what physicians say and what patients understand can reduce quality of care (e.g., patient adherence and satisfaction), making it imperative to know when gaps in patient understanding exist. The objective of this study was to identify residents’ efforts to assess patient understanding and the degree to which patients recalled information and instructions provided in the medical encounter. Methods. Residents and patients were observed in routine medical encounters in a Midwestern family medicine residency center. Patients were surveyed immediately following the encounter for recall of information and recommendations from the encounter, satisfaction with physician communication, and health literacy. Results. A total of 21 physician-patient encounters were observed. An inverse relationship was noted (Spearman’s rho = -0.43, N = 21, p = 0.05) between number of topics discussed during the encounter and the percentage of information recalled. Conclusions. Patient recall was related inversely to the number of topics covered by resident physicians. These results challenge physicians and medical educators to study and employ further those elements of physician-patient communication that enhance patient recall and understanding

Assessing Physician Response Rate Using a Mixed-Mode Survey

Background. It is important to minimize time and cost of physician surveys while still achieving a reasonable response rate. Mixed-mode survey administration appears to improve response rates and decrease bias. A literature review revealed physician response rates to mixed-mode surveys averaged about 68%. However, no identified studies used the combination of e-mail, fax, and telephone. The purpose of this study was to evaluate physician response rates based on surveys first administered by e-mail, then fax, then telephone. Methods. Surveys initially were administered by e-mail to 149 physicians utilizing SurveyMonkey©. Two follow-up reminder e-mails were sent to non-respondents at two-week intervals. Surveys then were faxed to physicians who had not responded. A follow-up fax was sent to non-respondents one week later. Finally, phone interviews were attempted with physicians who had not responded by e-mail or fax; each physician was called at least twice. Results. Of the 149 eligible physicians, 102 completed the survey for a response rate of 68.5%. Of those who responded, 49 (48%) responded by e-mail, 25 (24.5%) by fax, and 28 (27.5%) by phone. Mode of response did not differ by gender, specialization, or years in practice. In addition, mode of response was not related to the primary study question, physician willingness to use text messaging for immunization reminders. Conclusions. This mix of survey methodologies appeared to be a feasible combination for achieving physician responses and may be more cost effective than other mixed methods