Project Title

Transforming prenatal education to reduce health disparities

Objective

Deliver a quality prenatal education curriculum that is relevant, evidence-based, and easy to reference for all patient groups in order to reduce maternal morbidity and mortality. 

What We Will Do

The State of North Carolina’s Public Health Department under The Maternal Health Program (administered within the Women’s Health Branch (WHB), Perinatal Health Unit) has “the primary mission to ensure that all low-income pregnant women have access to early and continuous prenatal and postpartum care.” In addition, [the FCHD] will work to enhance public education and community awareness regarding risk prevention and reduction strategies.” The March of Dimes 2021 Report Card gave North Carolina a grade of “D” for maternal care. Poor education contributes to these failing efforts of North Carolina’s annual statistics regarding maternal morbidity and mortality. The annual report revealed stark disparities across race and ethnicity in prenatal outcomes. The following statistics show a desperate need for change:

• NC preterm birth rate= 10.8%
• NC preterm birth rate among Black women= 48% higher than all other women
• NC infant mortality rate= 6.8% compared to a national rate of 5.6%
• NC Inadequate prenatal care= 17.1% compared to a national average of 14.9%

In obstetrics and gynecology, basic prenatal counseling is the answer to healthy pregnancies and families. Patients need to understand their care, screenings, labs, and signs and symptoms of a normal and abnormal pregnancy in a way that is up-to-date, accessible, and easy to comprehend. The purpose of this project is to improve prenatal care and decrease disparities at the rural health department located in Franklin County, as a means of addressing the needs of the increasing population.

Who Is Involved

Lana Cooper, PA-C - FCHD Maternal Health Provider 

Franklin County Health Department Clinic Staff 

Campbell University 

Program Design

Primary stakeholders, specifically the nurses, providers, health director, director of nursing, and nurse supervisor were interviewed to better understand their current knowledge base regarding prenatal counseling and the method of patient education being delivered. Obstetric patients were asked about their satisfaction with the current process of patient education during clinic visits and what might work better for them. The data gathered was used to develop a new maternal health curriculum that utilizes electronic resources, as well as traditional handouts and oral communication for consistent delivery. The different types of resources for patient education were: 

• Mobile phone apps
• Clinic videos shown on tablets 
• Paper handouts 
• Nurse counseling 
• Provider counseling 
• Posters on the walls

All educational materials was analyzed to ensure they were evidence-based, presented at an appropriate health literacy level, and available in English and Spanish. Staff were trained on the new program and implementation of the new curriculum started on June 13th, 2022 for all patients seeking prenatal.

When this Takes Place

This was a pilot program to determine the effectiveness of using the new prenatal patient education in our maternal health clinic. The pilot program ran from June to October 2022. However, even though the pilot program has ended, the prenatal curriculum is still provided to all of the FCHD's maternal health patients on an ongoing basis. 

Results/Outcomes

Patient surveys were given at the end of the second and third trimester and were available in English and Spanish. Surveys utilized a likert-scale model and the inquiries focused on how patients felt the staff did in delivering the material. In this curriculum, the “staff” consisted of the nurses, educators on the digital videos, and the provider in the clinic. The care evaluation also attempted to understand how patients preferred to be educated during their pregnancy and what resources they found most useful. Finally, the evaluation ended with a free text box for patients to provide any positive or negative feedback.

Discussion/Next Steps

The curriculum is a living document and will continue to be studied, evaluated, and updated as needed. With time, more languages will be incorporated, and supplementary resources will be included as they are discovered. The maternal health curriculum being implemented into the prenatal clinic has high hopes of decreasing the social vulnerability index, reducing health disparities among women of color and low socioeconomic status, and improving maternal and infant outcomes.

References

1. Division of public health agreement addendum FY 21-22. https://whb.ncpublichealth.com/provpart/docs/101-MH-GenericAA-FY-2022.pdf. Accessed January 16, 2022.

2. Premature birth report card. https://www.marchofdimes.org/peristats/tools/reportcard.aspx?frmodrc=1®=37. Accessed January 18, 2022.

3. Bryson B. The body: A guide for occupants. Transworld Digital; 2019.

4. Murdock N, Batch S, Salvador D. North Carolina Momnibus Act. 2021;1.1(SESSION 2021).

5. de Leeuw RA, van der Horst, Sabine, Fiona Bianca, de Soet AM, et al. Digital vs face-to-face information provision in patient counselling for prenatal screening: A noninferiority randomized controlled trial. Prenat Diagn. 2019;39(6):456-463.

6. Car J, Carlstedt-Duke J, Car LT, et al. Digital education in health professions: The need for overarching evidence synthesis. Journal of Medical Internet Research. 2019;21(2):e12913. https://www.jmir.org/2019/2/e12913. Accessed Mar 4, 2022. doi: 10.2196/12913.