Thursday, January 1, 2015
Public health programs are created on the foundation of evidence informed practice. The goal of the Reproductive Health Program Standard is “to enable individuals and families to achieve optimal preconception health, experience a healthy pregnancy, have the healthiest newborn(s) possible, and be prepared for parenthood” (Ontario Ministry of Health and Long-Term Care, 2010). In order to achieve this goal, the Reproductive Health Program team at Wellington-Dufferin-Guelph Public Health (WDGPH) conducted a literature review to understand how pregnant women access or receive information about pregnancy. One of the recommendations from this review was to conduct a survey with pregnant women in Wellington, Dufferin and Guelph (WDG) to better understand the pregnancy information needs and interests of the local population. Promising approaches and tools identified in the literature review guided the development of the local survey, focusing on: 1) information technology (i.e., text messaging, apps, email, and social media), 2) health care provider outreach, and 3) public awareness.
The objectives of the local survey for pregnant women were to:
1. Determine how pregnant women in WDG are accessing pregnancy related information
2. Learn which sources of information are most useful
3. Understand how pregnant women in WDG would like to receive pregnancy related information from WDGPH
4. Gain insight into the role of healthcare providers in relation to Internet-based resources; including the distribution of resources to pregnant clients and discussing Internet-based information accessed by them.
The community survey was developed by Public Health Nurses from the Reproductive Health Program, in consultation with the Program Manager, a Health Promotion Specialist, Data Analysts and an Epidemiologist. All survey materials were reviewed and approved by the WDGPH Ethics Review Board. The survey involved 37 brief questions; predominantly quantitative in nature.
The survey was uploaded to Fluid Surveys and was available online to participants. Participants had the option to complete hard copies of the survey at several healthcare provider offices, or to complete the survey on the phone by calling WDGPH. The survey was available to participants from November 21, 2013 to January 31, 2014. Promotional postcards and posters were designed and distributed through WDGPH programs and other community partners. Strategies were employed to optimize representation from a variety of demographics and all geographic areas within WDG.
A total of 237 pregnant women participated in the survey; 27 of these women lived outside the geographic areas served by WDGPH, or did not provide location of residence. As a result, responses from 210 participants were included in the analysis. Participants represented all geographic areas served by WDGPH, including both urban and rural, with the exception of the municipality of East Garafraxa. Participants are the total number of women who completed the survey, whereas respondents are the number of women who answered a particular question contributing to the results outlined below.
Sources of Pregnancy Information
- Of the 202 respondents, 48% (n=96) reported their healthcare provider as the most useful source of information.
- The top five sources of information identified by respondents (n=204), when asked to select all that apply, included:
• healthcare provider by 89% (n=182)
• websites by 84% (n=172)
• friends or family by 81% (n=166)
• books by 79% (n=162)
• pamphlets by 48% (n=98)
Public Health as an Information Source
- Of the 204 respondents, 84% (n=171) identified WDGPH as a trustworthy source, while 15% (n=30) were unsure.
Public Health Prenatal Classes
- Of the 204 respondents, 36% (n=73) had taken or planned to take prenatal classes with WDGPH. An additional 13% (n=27) were undecided.
- Just over half of the 204 respondents (51%, n=104) reported they would not be taking prenatal classes with WDGPH.
- Women who attended WDGPH prenatal classes were more likely to express interest in other WDGPH services.
Public Health Service Exploration
- Of the 197 respondents, 58% were interested in both online chat (n=115) and telephone (n=114) communication with WDGPH.
- Of the 200 respondents, 76% (n=152) were interested in communication from WDGPH via e-newsletter.
- Of the 197 respondents, 50% (n=99) were interested in Facebook communication with WDGPH.
Wellington-Dufferin-Guelph Public Health’s goal is to engage all women during the prenatal period. Based on the key findings from the community survey, supported by the literature review, it is recommended that WDGPH develop a multipronged communication and healthcare provider outreach strategy to most effectively reach women in the prenatal period. Further exploration and evaluation of the WDGPH Prenatal Program is also recommended to better understand the impact on pregnant women who participate, as well as the reasons why pregnant women choose not to participate. These recommendations are further described below.
Multipronged Communication Strategy
- Develop a marketing strategy to increase the number of calls to KIDS LINE during the prenatal period. KIDS LINE is an established telephone information line for parents and parents-to-be.
- Expand the current WDGPH parenting e-newsletter to include additional prenatal content. Wellington-Dufferin-Guelph Public Health has an existing e-newsletter subscription service, adapted from Grey Bruce Public Health’s Let’s Grow newsletter, which includes one e-newsletter during the prenatal period and 12 additional e-newsletters for parents who have children from birth to five years of age. Further expansion of the WDGPH e-newsletter prenatal content is recommended.
- Develop and implement a promotion plan targeting expectant parents with a goal of increasing the number of expectant families subscribing to the e-newsletter.
- Develop an evaluation plan targeting expectant parents who receive the e-newsletter.
- Build on the current Child Health Twitter account (@KIDSLINEonline), to develop a broad social media strategy using other platforms, such as Facebook, with a focus on the prenatal period.
Health Care Provider Outreach
- Increase the capacity of healthcare providers to direct their clients to reputable online prenatal sources.
- Explore existing best practices or promising approaches to support healthcare providers in the transfer of reputable online sources to their patients.
- Engage in a consultation process with key healthcare providers from a variety of disciplines and agencies with the following objectives in mind:
- Identify prenatal health champions
- Share findings from the literature review and community survey, emphasizing the importance of the interface between healthcare providers and online information
- Determine how WDGPH can best support healthcare providers in providing reputable online sources to patients
Public Health Prenatal Program Evaluation
- Address a gap in the community survey by developing and implementing a comprehensive prenatal program evaluation to answer the following questions:
- What other prenatal programs exist locally, provincially and/or nationally?
- Are WDGPH prenatal classes meeting the needs of those who attend?
- For those who do not attend WDGPH prenatal classes, what are the factors that influence that decision?
- How can WDGPH best support the needs of those who choose not to attend prenatal classes?
A literature review and community survey identified sources of information women are using, or are interested in using to obtain prenatal information. Healthcare providers were found to have a unique and valuable role in disseminating pregnancy related information, with the potential to guide women to reputable online sources. Pregnant women also indicated interest in multiple communication platforms with WDGPH, including Facebook, one-on-one telephone conversations, and email newsletters. Based on these findings, WDGPH will develop a multipronged communication strategy and health care provider outreach strategy to effectively reach as many women as possible during the prenatal period. To address gaps in the survey, WDGPH will also develop and implement a comprehensive prenatal education evaluation to identify outstanding needs and potential opportunities that exist in current prenatal programming.