College women's awareness and consumption of folic acid for the prevention of neural tube defects

A comprehensive assessment of preconception health needs and interventions regarding women of childbearing age: a systematic review

Background

This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy.

Methods

Web of Science, PubMed and Scopus were searched. We excluded studies involving women with reproductive system pathologies and referring to interconceptive or pregnancy period and non-empirical or only abstract studies. Two researchers independently performed the blind screening based on titles/abstracts and full-text and the quality assessment.

Results

Four major domains resulted from the thematic analysis: knowledge, behaviors and attitudes, health status and access to healthcare services. The most examined topics were knowledge and awareness on preconception health, folic acid assumption, tobacco and alcohol consumption, physical activity and healthy diet.

Conclusions

This review could assist healthcare professionals (physicians, nurses, midwives) in guiding tailored counselling to women to provide the adequate level of preconception care and act as a reference to policymakers.

Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon

BACKGROUND

Maternal behavior before and after conception affects maternal and child health. Limited awareness of adolescents in preconception health may be addressed through school education. The aim of this intervention is to assess preconception health awareness among adolescents in Lebanese high schools and to test the effectiveness of a one-time educational session in improving preconception knowledge.

METHODS

The intervention consisted of a 30-minute educational session about good practices in preconception health, developed by the National Collaborative Perinatal Neonatal Network's (NCPNN) research team. A convenience sample of high school Lebanese students in grades 10 to 12, aged 14 to 26 years old, from 70 private and public schools in all six Lebanese provinces, participated in the intervention in 2011 and 2012. A multiple-choice questionnaire administered prior to and 2 months after the session was used to assess knowledge improvement among the students.

RESULTS

A total of 7,290 students were enrolled. After the session, mean scores of correct answers increased from 4.36 to 6.42 out of 10, representing a 47.2% improvement (p < 0.001). The percent of correct answers increased for all the questions regarding health practices (p < 0.001). The greatest improvement was observed for questions about Trisomy 21, folic acid intake and toxoplasmosis with percentages improvement of 96%, 172% and 83% respectively. Being female or in private school was a significant predictor of higher scores in both pre-test and post-test (p < 0.001).

CONCLUSIONS

Awareness campaigns in schools increased the preconception health knowledge among high school students. We recommend expanding the scope of this intervention into universities in Lebanon.

Impact of a pharmacist-directed educational program on the long-term knowledge and use of folic acid among college women: a 12-month follow-up study

Few studies have examined the impact of educational interventions on participants’ long-term knowledge and use of folic acid for prevention of neural tube defects (NTD).

Objective

The objective of this pilot study was to evaluate changes in knowledge and behaviors in a sample of college women one year after such a program.

Methods

Female students of a residential college campus voluntarily attended the event, which was advertised to the campus community as a women’s health seminar. Participants completed a multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use before and immediately after a 30-minute oral presentation. Following 3 reminder messages sent via email or mail, knowledge and multivitamin use were re-assessed 1-month and 12-months post-intervention.

Results

Thirty-two college women participated in the educational intervention; 27 (84%) completed the 12-month post-test. At 12 months, statistically significant increases in knowledge from baseline remained for questions pertaining to food high in folic acid (p=0.023); completion of spinal column (p=0.011); and 2 questions on NTD prevention (p=0.044). Increases in knowledge regarding recommended daily allowance of folic acid (p=0.817) and difficulty in receiving adequate folic acid from diet alone (p=0.617) were not statistically significant from baseline. Regular multivitamin use (≥4 times per week) was not statistically significantly increased from baseline (p=0.592).

Conclusions

Although it was encouraging that the women retained much of the information learned during the program, it appears that the changes in multivitamin use seen at 1-month were not sustained at 12-months. Further study with larger groups of college women is recommended.

Factors contributing to the success of folic acid public health campaigns

BACKGROUND

Studies in the 1990s have found that periconceptional dietary folate, supplementation of folic acid or supplemental multivitamins containing folic acid, help prevent neural tube defect (NTDs) if taken at the right time. This literature review assesses the extant folic acid public health campaigns literature and identifies some common variables used in folic acid consumption campaign evaluations.

METHODS

This review was part of a larger study that searched PUBMED, PsycINFO and Embase from 1976 to 2010 to identify articles related to the psychosocial and economic impact of NTDs (especially spina bifida) on patients and caregivers.

RESULTS

Awareness of folic acid levels prior to conception improved post-campaign from 6 to 41%. Knowledge about consumption and correct periconceptional use of folic acid also improved. However, in most studies more than 50% of women did not take folic acid as prescribed. Many factors were associated with or without taking folic acid post-campaign, including incomplete outreach, prior awareness and knowledge, closeness to pregnancy, demographics and other personal characteristics.

CONCLUSIONS

Sustained campaigning to maintain awareness about and promote periconceptional consumption of folic acid in order to reduce the incidence of NTDs is clearly needed. Additional initiatives could complement existing public health strategies.

Impact of a stage-tailored, web-based intervention on folic acid-containing multivitamin use by college women

PURPOSE

To examine effectiveness of a Web-based, stage-tailored folic acid intervention compared to non-stage-tailored education to promote folic acid-containing multivitamin use among college women.

DESIGN

Pretest/posttest with random assignment to groups.

SETTING

Internet-based on college campus.

PARTICIPANTS

Female college students (n = 408; mean age +/- SD = 20.8 +/- 2.6; range 18-29 years).

INTERVENTION

Transtheoretical Model-based folic acid modules delivered over 4 weeks. Traditional brochure formatted online for nontailored group.

MEASURES

Questionnaire assessing stage of change, self-efficacy, and decisional balance.

ANALYSIS

Chi-square test and logistic regression. Results Of the participants who reported not taking a multivitamin at pretest, a greater proportion of participants in the tailored group (32.6%; n = 47) reported taking a multivitamin at posttest than in the nontailored group (19.9%; n = 27), chi(2)(1, n = 280) = 5.9, p = .015. At posttest tailored intervention participants were 2.5 times more likely to be in a later stage of change (odds ratio [OR] = 2.45; 95% confidence interval [CI] = 1.52, 3.99; p = .0003) and 2.3 times more likely to be in action (OR = 2.27; 95% CI = 1.28, 4.01; p = .005) than nontailored participants. They also had greater increases in self-efficacy and pros. Movement from precontemplation to a later stage occurred significantly more often in the tailored than in the nontailored group. Conclusion Stage-tailored vs. traditional folic acid education was more effective in improving stage of readiness to consume a folic acid-containing multivitamin. The Internet was a successful medium for targeting college females for preconception health care education.

Knowledge and use of folic acid among college women: a pilot health promotion program led by pharmacy students and faculty

As pharmacists and pharmacy students are increasingly called upon to assume roles in public health activities, it is important to recognize unique opportunities to educate community members on health, wellness, and disease prevention.

OBJECTIVE

To evaluate the impact of a pilot health promotion program on college women's knowledge regarding folic acid and prevention of neural tube defects (NTD) and frequency of multivitamin use.

METHODS

A health promotion program was developed by a pharmacy student and two pharmacy faculty members that included an oral presentation and reminder messages. A multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use was given to participants before and immediately after the presentation. Participants then received a reminder message regarding folic acid once a week for three weeks. Knowledge and multivitamin use were reassessed four weeks post-intervention.

RESULTS

Thirty-two college women voluntarily attended the oral presentation. Twenty-five women (78.2%) completed the four-week post-test. Compared to the pre-test, there were statistically significant increases in average test score (p<0.0001) and correct responses to questions regarding folic acid and NTD (p<0.05 for each question). Participants reported a statistically significant increase in regular (≥4 times/week) multivitamin use (p=0.023).

CONCLUSION

Participants in the pilot health promotion program demonstrated a statistically significant increase in knowledge about folic acid and frequency of multivitamin use. A similarly-modeled health promotion program may be an effective way of increasing folic acid and NTD knowledge and changing behaviors of multivitamin use in college women.

A systematic review of interventions to increase awareness, knowledge, and folic acid consumption before and during pregnancy

OBJECTIVE

We conducted a systematic review of studies designed to increase awareness of knowledge about, and consumption of folic acid before and during pregnancy.

DATA SOURCES

Studies were identified from Cochrane Library, Medline, and the references of primary studies and reviews.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies included randomized controlled trials, quasi-experimental interrupted time series studies, follow-up studies, case-control studies, and before-and-after studies, all of which were conducted between 1992 and 2005 on women ages 15 to 49 years and/or health professionals, evaluating awareness and/or knowledge and/or consumption of folic acid both before and after intervention. Studies were excluded if data were not presented both before and after intervention or were other outcomes than those mentioned here.

DATA EXTRACTION

Data were extracted in relation to characteristics of studies, participants, interventions, and outcomes.

DATA SYNTHESIS

Because of heterogeneity, we performed a narrative synthesis describing the direction and the size of effects.

RESULTS

On average, women's awareness increased from 60% to 72%, knowledge from 21% to 45%, and consumption from 14% to 23%.

CONCLUSIONS

Interventions had a positive effect on folic acid intakes before and during pregnancy, although the average usage reached less than 25%.

Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK

OBJECTIVE

To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women.

DESIGN

Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand.

RESULTS

Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available.

CONCLUSIONS

Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.

College Women's Reported Behaviors and Beliefs Regarding Fish and Folic Acid and Their Roles in Birth Defects

The purpose of the current study was to examine college women's beliefs and behaviors regarding birth defect prevention via folic acid intake and avoidance of fish with high mercury levels. We surveyed 313 college women and found that the majority of them reported eating fish despite their awareness that certain types of fish contained levels of mercury that are dangerous for women of childbearing age. We also found that the majority of the women did not comply with dietary guidelines for vegetable and legume consumption, and more than half of them did not take vitamin supplements that provide folic acid.

Prevention of birth defects: folic acid

Neural tube defects (NTDs) comprise an important category contributing to infant mortality. While some NTDs may be due to identifiable inherited or specific environmental factors, most are multifactorial, with genetic and environmental factors contributing to their occurrence. Folic acid has been found to have a protective effect against the recurrence and occurrence of NTDs. In addition to natural dietary sources, in the United States, all enriched grain products now are fortified with folic acid. In addition, all women who could become pregnant are recommended to consume 0.4 mg of folic acid daily. Despite these measures, not all women of childbearing age have added sufficient folic acid to their diets or take a vitamin supplement. Challenges remain regarding educating women of childbearing age about the potential health benefits of adequate folic acid consumption.