PRECONCEPTION
W.H.E.E.L.S
Working to Help Educate and Empower
healthy Life Styles
Rhonda Freeman, MPH
Maternal, Child, and Adolescent Health Coordinator
County of San Diego, Health and Human Services Agency
Maternal, Child and Family Health Services
3rd National Summit on
Preconception Health
Tampa, FL
June 12-14, 2011
TIMING IS EVERYTHING!
SAN DIEGO, CALIFORNIA
Geography
Population
Black
6%
Other
2%
Asian
11%
Hispanic
31%
White
50%
Source: United States Census Bureau, American Community Survey 2009
INFANT MORTALITY RATE, 2005-2008
SAN DIEGO COUNTY RESIDENTS
All
African-American
Asian
Hispanic
White
16.0
14.1
Deaths per 1,000 births
14.0
12.0
10.0
8.0
7.0
6.5
5.9
6.0
4.3
4.0
2.0
0.0
Race/Ethnicity
Race/ethnic groups not shown: Native American, Pacific-Islander, Other (due to small numbers) and Two or More Races and Unknown.
PERCENT OF LOW BIRTH WEIGHT BIRTHS, 2006-2009
SAN DIEGO COUNTY RESIDENTS
All
African-American
Asian
Hispanic
Native Amer./Alaskan
Pacific-Islander
18.0
16.0
15.1
14.0
12.0
Percent
10.0
8.0
10.7
9.3
8.8
9.3
7.7
6.0
4.0
2.0
0.0
Race/Ethnicity
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
8.0
White
PECENT OF PRETERM BIRTHS, 2006-2009
SAN DIEGO COUNTY RESIDENTS
All
African-American
Asian
Hispanic
Native Amer./Alaskan
Pacific-Islander
25.0
19.2
20.0
Percent
16.9
15.0
17.9
15.0
13.7
12.7
10.0
5.0
0.0
Race/Ethnicity
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
12.7
White
PERCENT OF BIRTHS WITH LATE OR NO PRENATAL
CARE, 2007-2009, SAN DIEGO COUNTY RESIDENTS
All
African-American
Asian
Hispanic
Native Amer./Alaskan
12.0
10.9
10.0
8.9
7.7
Percent
8.0
6.0
4.0
Pacific-Islander
7.1
5.5
3.2
2.9
2.0
0.0
Race/Ethnicity
Race/ethnic groups not shown: Other (due to small numbers), Two or More Races and Unknown.
White
HISTORY
County's Fetal Infant Mortality Review (FIMR) Program

Conducted Case Reviews

Convened Community Action Teams

Utilized Perinatal Periods of Risk (PPOR) Analysis

Focus on African American women
FIMR FINDINGS
Fetal
Deaths - 31
• 77% of deaths caused by pregnancy or delivery
complications
• 55% were very low birth weight (under 1500g)
• 77% preterm
Infant
Deaths - 61
• 36% of deaths caused by pregnancy or delivery
complications
• 43% caused by prematurity or its complications
• 66% born preterm
FIMR FINDINGS
Contributing Factors
•
•
•
•
Negative life course experiences
Serious stressors during pregnancy
Moms with significant pre-existing medical conditions before pregnancy
Moms with prior pregnancies
• Infant or fetal loss
• Pregnancy or delivery complications
Recommendations
• Provider opportunities
• Family planning counseling
• Referrals to genetic counseling, support programs, etc.
• Follow-up after birth and infant death
• Education to women, parents, and community
• Policy
A LIFE COURSE PERSPECTIVE: RACIAL AND
ETHNIC DISPARITIES IN BIRTH OUTCOMES
Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30.
THE FACTors OF LIFE
Organizations
Interpersonal
Individual
Community
Environment
Society/Public
Policy
A CALL TO ACTION

Create an interactive user-friendly tool to increase knowledge
and change behavior among women to take action to improve
health and lifestyle choices

Build partnerships with organizations and providers in moving
the concept of "waiting until pregnancy to think about being
healthy is too late" to the forefront

Ensure resources are available for women to access and utilize

Improve maternal health and birth outcomes
EXPANSION
March of Dimes

Received Community Services Grant for Preconception
Health Awareness Project

Expansion of wheels to other ethnic groups for women of
childbearing age

Partner with non-clinical organizations
METHODOLOGY

Data analysis and recommendations of local FIMR
case review findings

Identification of clinics and organizations in high risk
geographic areas

Solicit input from key community stakeholders
KEY STRATEGIES

Strategy #1: Develop culturally and linguistically
appropriate educational tools

Designed an eye-catching and interactive tool

African American, Spanish, and Multi-Cultural

Developed specialized messages

Translated into Spanish

Selected culturally appropriate images

Conducted focus groups

Created preconception toolkit
PRECONCEPTION WHEEL
Healthy Women Have Healthy Babies

Nutrition

Weight and Exercise

Stress Management

Family Planning

Medical and Dental Check-ups

Communicating with Your Healthcare Provider

Smoking, Alcohol, Drug Use and Environmental Exposure

Resources
KEY STRATEGIES

Strategy #2: Identify and engage community
participation

Utilize existing task force partners in promoting project

Establish relationships with community clinics and
organizations

Outreach and recruit to non-traditional agencies

Develop distribution plan

Conduct educational trainings

Provide follow-up and technical assistance
KEY STRATEGIES

Strategy #3: Develop evaluation process and tools

Create database for tracking project activities

Contact information

Organization profile

Material distribution

Administer surveys

Client

Staff

Conduct focus groups
RESULTS

Project Period: March 2008 – November 2009

Partners
 Clinics – 18
 Organizations – 26

Total surveys – 321 surveys completed

Focus groups - 8 conducted

Wheels – 8,000 distributed
RESULTS
Focus Groups

59% reported using tips from the wheel

77% learned something new
Staff Survey

91% stated it was easy to incorporate into their routine and facilitated
healthy behavior discussions with clients
Client Survey

88% learned new information and wheel was easy-to-use

83% would use the wheel more than once

Most helpful sections:
 Eat right (63%)
 Manage stress (52%)


Take care (52%)
Get moving (47%)
CONCLUSIONS

Realistic time frames need to be set when developing new
materials

Creating a tool with target population input is critical for
acceptance

Routine follow-up is key in keeping partners motivated in
delivering preconception messages

Partner buy-in is instrumental for sustainability of project

Tailor intervention to organization’s infrastructure
FUTURE DIRECTION
A Look Ahead…

Adapt wheel for other target populations

Incorporate preconception wheels into other settings

Institutionalize preconception education with existing
partners

Serve as an example for other counties to replicate

Connect and integrate with other initiatives

A LIFETIME OF GOOD HEALTH
THANK YOU



Community clinics and organizations
FIMR task force
County staff:
 Sutida Jariangprasert, MPH
 Shukri Adam, PHN
 Cindy Tso, MPH
 Amethyst Cureg, MD, MPH, FAAP
Preconception Health Awareness Project funded by
March of Dimes California Chapter
CONTACT INFORMATION
Rhonda Freeman, MPH
Maternal, Child, and Adolescent Health Coordinator
County of San Diego, Health and Human Services Agency
Maternal, Child, and Family Health Services
Phone: 619.542.4039
Email: Rhonda.freeman@sdcounty.ca.gov
Website: www.sdmcfhs.org