Bundling Preconception Health Messages: Results From Focus Groups with Non-Pregnant Women In North Carolina

Theoretical Background and research questions/hypothesis: Preconception health emphasizes certain factors that must be acted on before conception to have the greatest impact. Public health materials traditionally address one or two key preconception behaviors, but the effectiveness of bundling several messages together in one printed piece remains relatively unexplored. The research questions were: 1. Which preconception health messages appeal to non-pregnant, non-parenting women ages 18-34; 2. How do women want to receive these preconception health messages?

Methods: A literature review and key informant interviews were conducted to determine potential messages appropriate for bundling. Based on this information, focus group guides were developed and groups were recruited throughout North Carolina. To be eligible, women had to be between the ages of 18-34, not pregnant, not planning a pregnancy and not currently a parent. In all, five focus groups (n=53) were conducted in early 2012. In the preliminary groups, women were given three brochure concepts and asked to rank them and provide feedback. Three additional groups were then held to test the resulting tri-fold brochure’s design, colors, content, vocabulary, photos, and preconception health messages.

Results: 52% of participants were black, 30% were white, and 18% percent identified as other. 60% of participants were ages 18-24 and 40% were 25-35. The median age was 22. Participants reacted positively to the bundling of preconception health messages and believed all seven messages should be included in the brochure. The health behaviors that women felt were most important to include were: getting to or maintaining a healthy weight, doing something active every day, and eating healthy foods. Two health behaviors were identified as least important: making a plan for when to have children and taking a multivitamin with folic acid every day. In fact, most women did not know about the importance of folic acid and its role in preventing neural tube birth defects, nor did they conceptually understand the association between their health and having a reproductive life plan. In spite of general consensus around the messages themselves, there was little consensus about how this content should be presented in a brochure. Participants had strong, yet often opposing, ideas of how the messages should be worded, ordered, and the level of detail required. Women with higher income and/or higher education were more likely to have heard of the preconception messages and some thought the brochure didn’t apply to them. Race/ethnicity also played a role; black and Hispanic women generally felt like the messages were relevant. Photo and title preference also differed by race/ethnicity.

Conclusions: Non-pregnant women of childbearing age are receptive to preconception health messages bundled together. However, the intended target audience for this project may have been too broad to create a preconception health brochure that appeals to all segments of the audience.

Implications for research and/or practice: Bundling of preconception health messages is appropriate for non-pregnant women, but future preconception health brochures should have several versions that take into consideration the specific preferences of smaller segments of the target population.