Background:
Numerous studies have shown that periconceptional use of folic acid is effective for reducing the risk of neural tube defects (NTDs). Although NTD rates have declined since fortification of the U.S. food supply began, most women do not reach the daily recommended level. Latinas, in particular, remain the ethnic group with the highest rates of NTDs. Therefore, increasing the use of vitamins containing folic acid remains an important component of NTD prevention for all women.

Objectives:
Formative research with the target audience is essential to understanding the complexity of vitamin use among women of childbearing age and identifying differences among women of varying demographic groups in order to guide the development of communication and educational interventions.

Methods:
To this end, formative research was conducted in two different studies with English- and Spanish-speaking women of childbearing age. Women participated in focus groups and interviews throughout the United States. These studies were designed to explore issues related to women's perceptions of health, the perceived relationship between diet and the need for multivitamins, women's knowledge about folic acid, and women's perceptions about taking a multivitamin daily.

Results:
Research indicated that English-speaking women were less receptive to messages about pregnancy and birth defects prevention specifically, but were open to information about protecting their reproductive health for the future. Spanish-speaking women were much more open to messages about having a baby. Both English and Spanish speaking women had preconceived ideas about multivitamins (e.g., barriers to taking multivitamins, outcomes that might motivate them to take multivitamins) and very few women had any previous knowledge about folic acid.

Conclusion and implications for practice:
The implications of these results will be discussed in terms of their contribution to the development of a creative, new approach to increase multivitamin consumption among English-speaking women of childbearing age, while also informing the development of culturally relevant materials and messages to increase folic acid awareness, knowledge, and consumption among Spanish-speaking women.