1
|
Hall J, Chawla M, Watson D, Jacob CM, Schoenaker D, Connolly A, Barrett G, Stephenson J. Addressing reproductive health needs across the life course: an integrated, community-based model combining contraception and preconception care. Lancet Public Health 2023; 8:e76-e84. [PMID: 36603914 DOI: 10.1016/s2468-2667(22)00254-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
Prevention of pregnancy (contraception) and preparation for pregnancy (preconception care) are services that most people need during their reproductive life course. Despite increased attention, and growing recognition that health before pregnancy is crucial to addressing disparities in maternity outcomes, service provision is far from routine. We bring together evidence from the literature, new quantitative and qualitative data on women's preferences, and case studies of existing practice, to develop an integrated, community-based model that synthesises reproductive life planning, contraception, and preconception care. Our model provides a holistic, life course approach, encompassing school-based education, social media, and national campaigns, and highlights the need for training and system-level support for the range of health-care professionals who can deliver it. This high-level model can be adapted across settings, leading to a step change in the provision of preconception care in the community with consequent improvements in health and wellbeing, and reductions in inequalities at population level.
Collapse
Affiliation(s)
- Jennifer Hall
- Sexual and Reproductive Health Research Team, UCL EGA Institute for Women's Health, London, UK.
| | - Mehar Chawla
- Sexual and Reproductive Health Research Team, UCL EGA Institute for Women's Health, London, UK; Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Daniella Watson
- Global Health Research Institute, Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Geraldine Barrett
- Sexual and Reproductive Health Research Team, UCL EGA Institute for Women's Health, London, UK
| | - Judith Stephenson
- Sexual and Reproductive Health Research Team, UCL EGA Institute for Women's Health, London, UK
| |
Collapse
|
2
|
Eastwood KA, Allen-Walker VA, Maxwell M, McKinley MC. Raising awareness of pre-conception care in community pharmacies: a feasibility study. Pilot Feasibility Stud 2022; 8:44. [PMID: 35219338 PMCID: PMC8881876 DOI: 10.1186/s40814-022-01001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is growing evidence to support the introduction of pre-conception interventions to optimise the health of mothers and their future children. At present, there is poor awareness regarding the importance of pre-conception care (PCC) amongst healthcare professionals and couples planning a pregnancy. Community pharmacies are ideally placed to reach a range of prospective couples planning a pregnancy and could effectively provide information about PCC. Methods This study assessed feasibility of an intervention to raise awareness of PCC in community pharmacies in Northern Ireland over 3 months. Inclusion criteria: women of childbearing age (16–45 years) engaging with services at participating pharmacies. Study resources: campaign posters, information cards, crib sheets for pharmacy staff. A mixed methods approach was employed, including, brief information provision for women, record of staff interactions with customers, customer feedback cards and qualitative interviews with pharmacy staff. Descriptive statistics assessed distribution of study resources and staff interviews were analysed using a thematic analysis framework. Results There were eight participating pharmacies, three of which consented to post-study interviews. Three pharmacies chose not to deliver the planned intervention. Distribution of campaign cards (n = 456) varied (0–86%). Analysis of customer feedback cards (n = 9) demonstrated that the majority of respondents were happy to receive information on pre-conception health. Of the women who responded to this question (n = 8), all were ‘extremely likely’ or ‘likely’ to act on the information provided. Four main themes emerged from analysis of staff interviews: (1) training and experience in providing health advice, (2) intervention resources, (3) understanding the aims of the intervention, (4) perceived value of the intervention. Barriers to intervention delivery included non-engagement from pharmacies and need for additional training of staff. Conclusions An intervention to raise awareness of PCC within a community pharmacy setting was feasible and acceptable to both women and staff in participating pharmacies. This study indicates that a number of factors must be considered to enhance implementation and effectiveness of PCC interventions in this setting. In particular, better understanding of non-engagement, provision of adequate training and support for staff, and exploring incentives for pharmacies to prioritise PCC.
Collapse
Affiliation(s)
- K A Eastwood
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK. .,Royal Jubilee Maternity Hospital, Department of Obstetrics and Gynaecology, 274 Grosvenor Road, Belfast, BT12 6BA, UK.
| | - V A Allen-Walker
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - M Maxwell
- Hearty Lives, Carrickfergus, Carrickfergus Borough Council, Museum and Civic Centre, Street, Carrickfergus, Antrim, BT38 7DG, UK
| | - M C McKinley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.,Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5BN, UK
| |
Collapse
|
3
|
Scott PA, Quotah OF, Dalrymple KV, White SL, Poston L, Farebrother J, Lakhani S, Alter M, Blair M, Weinman J, Flynn AC. Community Pharmacist-Led Interventions to Improve Preconception and Pregnancy Health: A Systematic Review. PHARMACY 2021; 9:pharmacy9040171. [PMID: 34698302 PMCID: PMC8544701 DOI: 10.3390/pharmacy9040171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Community pharmacist-led interventions are effective in improving health outcomes; however, their impact in improving preconception and pregnancy health is not clear. This study evaluated the effectiveness of community pharmacist-led interventions which aimed to improve health outcomes of preconception and pregnant women. Methods: A systematic review of the literature, consistent with PRISMA guidelines, was performed. Five electronic databases were searched up to February 2021. Results: Four studies, three in pregnant women and one in preconception women, were identified. The studies focused on improving micronutrient status and smoking cessation. The studies increased knowledge about, and use of, iron supplements, and improved iron status and smoking cessation rates in pregnant women, while improving knowledge regarding, and increasing the use of, preconception folic acid. The studies were ranked as weak to moderate quality. Conclusion: This review provides preliminary evidence for the potential benefit of community pharmacist-led interventions to improve the health of women before and during pregnancy.
Collapse
Affiliation(s)
- Polly A. Scott
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (P.A.S.); (O.F.Q.); (K.V.D.); (S.L.W.); (L.P.)
| | - Ola F. Quotah
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (P.A.S.); (O.F.Q.); (K.V.D.); (S.L.W.); (L.P.)
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (P.A.S.); (O.F.Q.); (K.V.D.); (S.L.W.); (L.P.)
| | - Sara L. White
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (P.A.S.); (O.F.Q.); (K.V.D.); (S.L.W.); (L.P.)
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (P.A.S.); (O.F.Q.); (K.V.D.); (S.L.W.); (L.P.)
| | - Jessica Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland;
| | - Shivali Lakhani
- The Middlesex Pharmaceutical Group of LPCs, 1278 High Road, Whetstone, London N20 9HH, UK; (S.L.); (M.A.)
| | - Marsha Alter
- The Middlesex Pharmaceutical Group of LPCs, 1278 High Road, Whetstone, London N20 9HH, UK; (S.L.); (M.A.)
| | - Mitch Blair
- Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK;
| | - John Weinman
- Institute of Pharmaceutical Sciences, King’s College London, London SE1 9NH, UK;
| | - Angela C. Flynn
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London SE1 9NH, UK
- Correspondence:
| |
Collapse
|
4
|
Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
Collapse
Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | | |
Collapse
|
5
|
Abramsky L, Busby A, Dolk H. Promotion of periconceptional folic acid has had limited success. ACTA ACUST UNITED AC 2016; 125:206-9. [PMID: 16220729 DOI: 10.1177/146642400512500507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial. Public Health Nutr 2014; 18:1119-26. [DOI: 10.1017/s1368980014000986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo test the hypothesis that a concise intervention to promote the preconception use of folic acid (FA) supplements among mothers who visit a well-baby clinic (WBC) for the 6-month check-up of their youngest child is effective. Effectiveness was measured as intention to use or actual use of FA supplements before a next pregnancy among women who expected to be pregnant within 0–12 months.DesignControlled intervention study with independent samples of intervention and control mothers. The intervention took place at the 6-month visit. A post-intervention measurement was done in the intervention group and a comparable measurement in the control group at the 11-month check-up visit.SettingThe intervention, verbal and in writing, was implemented in four Dutch WBC and given by the WBC physician to the mothers who visited the WBC.SubjectsAll mothers visiting the WBC were eligible for inclusion, unless they were unable to complete a questionnaire. The intervention group consisted of 198 (68 %) mothers recruited from 291 6-month intervention visits and the control group of 215 (84 %) mothers recruited from 255 11-month normal visits.ResultsIn mothers who expected to be pregnant within 0–12 months, the proportion using or intending to use FA was 65 % in the intervention group (n 49) v. 42 % in the control group (n 43; difference 23 %, 95 % CI 4, 43 %, P<0·05).ConclusionsHealth education intervention at the 6-month WBC visit is an effective means to promote the use of FA supplements or the intention to do so.
Collapse
|
7
|
Brown D, Portlock J, Rutter P. Review of services provided by pharmacies that promote healthy living. Int J Clin Pharm 2012; 34:399-409. [PMID: 22527479 DOI: 10.1007/s11096-012-9634-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recognition that community pharmacies have the potential to make a greater contribution to promoting public health has led to a new concept, called the Healthy Living Pharmacy (HLP). These are designed to meet public health needs through a tiered commissioning framework delivering health and well being services through community pharmacy, tailored to local requirements for tackling health inequalities. AIM To search the literature for quality evidence to support the inclusion of services in the HLP portfolio and suggest areas where more evidence is required. METHOD A systematic review of the research literature covering the period January 1990-August 2011 inclusive, using MEDLINE, EMBASE, Pharmline, NHS Evidence and the Cochrane databases. On-line searching of the grey literature (e.g. conference proceedings) was also carried out. Standard methods of assessing quality were employed. RESULTS A total of 377 papers were included. Over time, there was a marked increase in frequency of publications reflecting a growing pharmacy interest in the public healthcare agenda; over a third (35 %) of papers appeared in the last three-year study period. The body of research had a wide geographical basis; contributions were as follows: UK (51.5 %), US (20.4 %), Australia/New Zealand (9.8 %), Europe (7.7 %) and Canada (7.2 %). The topics of contraception, cardiovascular disease prevention, diabetes and smoking cessation accounted for 40 % of included papers. The literature supports the introduction of specific community pharmacy services, targeted at customer groups, both with and without pre-existing diseases. Good evidence exists for smoking cessation, cardiovascular disease prevention, hypertension and diabetes. Some good evidence exists for interventions on asthma and heart failure. The evidence supporting weight management, sexual health, osteoporosis detection, substance abuse and chronic obstructive pulmonary disease is weak and needs development. CONCLUSION There is strong evidence for the role of community pharmacy in a range of services, not only aimed at improving general health, but also maintaining the health of those with existing disease. In other areas, the evidence is less strong and further research is required to justify their inclusion in a HLP portfolio.
Collapse
Affiliation(s)
- David Brown
- University of Portsmouth, Portsmouth, Hampshire, UK.
| | | | | |
Collapse
|
8
|
Holzgreve W, Pietrzik K, Koletzko B, Eckmann-Scholz C. Adding folate to the contraceptive pill: a new concept for the prevention of neural tube defects. J Matern Fetal Neonatal Med 2012; 25:1529-36. [PMID: 22272814 DOI: 10.3109/14767058.2011.648672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although it is proven for a long time that folic acid supplementation in the periconceptional period can prevent neural tube defects (NTDs) effectively, all measures taken so far including food fortification and awareness campaigns so far had only limited success. Since more than 50% of the pregnant women in Europe get pregnant after they have used oral contraceptives (OCs) before, OCs are an ideal vehicle to increase not only the awareness for periconceptional folate application, but they can also help to bridge the gap between the recognition of a pregnancy and closure of the neural tube which is before day 26. In order to reach a truly protective folate level at the critical time period during pregnancy, now OCs are available which contain metafolin. The availability of this innovative type of OC will significantly reduce the number of NTDs.
Collapse
|
9
|
Hammiche F, Laven JSE, van Mil N, de Cock M, de Vries JH, Lindemans J, Steegers EAP, Steegers-Theunissen RPM. Tailored preconceptional dietary and lifestyle counselling in a tertiary outpatient clinic in the Netherlands. Hum Reprod 2011; 26:2432-41. [DOI: 10.1093/humrep/der225] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Periconceptional Folic Acid Supplementation: A New Indication for Therapeutic Drug Monitoring. Ther Drug Monit 2009; 31:319-26. [DOI: 10.1097/ftd.0b013e31819f3340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
de Jong-van den Berg LTW. Monitoring of the folic acid supplementation program in the Netherlands. Food Nutr Bull 2008; 29:S210-3. [PMID: 18709895 DOI: 10.1177/15648265080292s125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In November of 1993, the Dutch government recommended daily folic acid supplementation of 0.4 or 0.5 mg for all women planning pregnancy, starting 4 weeks before conception until 8 weeks after. In 1995, a one-time mass media campaign was conducted, and due to this campaign, the use of folic acid in this recommended period increased from 4.8% in 1995 to 21% in 1996. Subsequently, no structural strategies were undertaken until 2003, and at that time, 22% of lower-educated women used folic acid in the recommended period. The prevalence of neural tube defects (NTD) decreased from 11.44/10,000 before the official recommendations to 6.52/10,000 thereafter. Currently, community pharmacies proactively approach women before their first pregnancy on the subject of folic acid supplementation. This is done by means of a sticker placed on packages of oral contraceptives with the text "Child wish?*". "Ask for information about folic acid in your pharmacy," and a brochure (leaflet) containing detailed information about folic acid. (*"Child wish" refers to women who plan to become pregnant.) Data from an explorative, comparative study strongly suggest that this intervention is effective. Sustainable education programs through which women are informed repeatedly to take folic acid supplements during the periconceptional period are urgently needed.
Collapse
Affiliation(s)
- Lolkje T W de Jong-van den Berg
- Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groninger University Institute of Drug Exploration, Groningen, the Netherlands.
| |
Collapse
|
12
|
Ten years after the Dutch public health campaign on folic acid: the continuing challenge. Eur J Clin Pharmacol 2008; 64:539-43. [PMID: 18213474 PMCID: PMC2668616 DOI: 10.1007/s00228-007-0446-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 12/10/2007] [Indexed: 11/30/2022]
Abstract
Background Folic acid use in the periconceptional period reduces the risk of neural tube defects (NTDs). However, applying this knowledge in daily practice is not an easy task. We report here the current level of folic acid use in the Netherlands and discuss the figures within the framework of a national governmental campaign held in 1995 promoting the use of folic acid and the professional interventions undertaken since then. Methods We carried out six studies in the northern Netherlands during 1995, 1996, 1998, 2000, 2003 and 2005, respectively. The same methodology in the same health professionals’ practices was followed in all studies. Pregnant women attending their first or second antenatal visit were asked to fill in a questionnaire aimed at assessing their awareness and use of folic acid. Results In 2005, most of the pregnant women used folic acid “at some time in their pregnancy”, and 51% used it for the entire advised period. Prior knowledge on the protective affect of folic acid and on the period of use was strongly related to the level of education. The use of folic acid in a previous pregnancy [odds ratio (OR) 3.9, 95% confidence interval (95% CI) 1.6–9.9], the use of an oral contraceptive (OR 2.1, 95% CI 1.1–4.1) and parity (OR 0.08, 95% CI 0.01–0.5) significantly predicted the current correct use. The most recent figures revealed that there is still a large gap between more highly and less educated women in terms of taking folic acid in the advised period: 63 versus 31%, respectively. Discussion The aim of the Dutch Ministry of Health is to have 70% of Dutch women wanting to become pregnant use folic acid supplements in the advised period by 2010. While this level has almost been reached among more highly educated women (63%), it will take a great deal more effort, money and creativity to achieve the necessary increase from the current level of 31% among women with a lower educational background.
Collapse
|
13
|
Achterbergh R, Lakeman P, Stemerding D, Moors EHM, Cornel MC. Implementation of preconceptional carrier screening for cystic fibrosis and haemoglobinopathies: a sociotechnical analysis. Health Policy 2007; 83:277-86. [PMID: 17368860 DOI: 10.1016/j.healthpol.2007.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Revised: 02/04/2007] [Accepted: 02/10/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To obtain more insight into the process of potential implementation of a screening program, which aims to identify carriers of cystic fibrosis and haemoglobinopathies before pregnancy, in order to enable couples at high risk of having a child with these disorders, to make informed reproductive decisions. METHODS Use of sociotechnical analysis, based on a model of co-evolution between technology and society, and, for comparison, the study of the implementation processes of two already existing health care programs with similar aspects to the screening program at issue. RESULTS Factors important for success appeared to be the existence of sociotechnical niches, in which technological options can be developed and studied in an experimental setting; a structural approach of providing information to future parents; a party that can articulate demand; governmental involvement in the attunement between various stakeholders; and a screening infrastructure in which large-scale DNA diagnostic services are available. CONCLUSIONS Successful implementation of preconceptional carrier screening for cystic fibrosis and haemoglobinopathies will depend on changes at both regime and landscape level, including the establishment of a new preconceptional health care setting and a clearly visible public health authority which can coordinate, monitor and evaluate such an initiative in public health care.
Collapse
Affiliation(s)
- Roos Achterbergh
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|