Folic acid knowledge and practices among health care providers, 2002-2003

Jennifer Williams, MSN, MPH¹, Steve Abelman, MBA CHE², Elizabeth Fassett, MS CHES¹, Joann Petrini, PhD, MPH³, Karla Damus, RN, PhD³, Cheryl E. Stone, MPH⁴, and Joe Mulinare, MD MSPH¹. (1) National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Rd, MS E-86, Altanta, GA 30333, 404 498 3838, znv8@cdc.gov, (2) National Education Initiatives, March of Dimes, 1275 Mamaroneck Ave, White Plains, NY 10605, (3) Perinatal Data Center, March of Dimes Birth Defects Foundation, 1275 Mamaroneck Ave, White Plains, NY 10605, (4) Rynne Marketing Group, 1603 Orrington, Suite 1100, Evanston, IL 60201

Background/Methods: In 1992 the USPHS recommended all reproductive age women consume 400 mcg of folic acid (FA) daily for neural tube defect (NTD) prevention. In 1998, the U.S. fortified grain products with FA, but at amounts insufficient to avert all FA preventable NTDs. Healthcare providers (HCPs) are instrumental in educating women about supplemental FA. We conducted telephone surveys among 608 obstetricians/gynecologists (OB/GYNs) and family physicians (FPs), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (RNs). We examined HCP FA knowledge and practice patterns. We used univariate and multivariate logistic regression modeling. Results: Universally, providers knew FA prevents birth defects. Over 80% knew FA beyond what is available in diets is necessary. Less than 50% of providers knew that 50% of pregnancies in the U.S. are unplanned. FPs were least knowledgeable (42%) and CNMs most knowledgeable (73%) about FA’s correct dosage (400mcg daily). Providers personally taking multivitamins were over two times as likely to recommend multivitamins to their patients (OR 2.27 95% CI 1.75-2.94). Providers with lower income clients (OR 1.49 CI 1.22-1.81), and providers with practices having >10% minorities (OR 1.46 CI 1.11-1.92) were more likely to recommend supplements. Conclusions: Knowledge about birth defects and the necessity of additional FA for NTD prevention is high, however increasing HCP knowledge about unintended pregnancy rates and correct amounts of FA is needed. HCPs recommending multivitamins are targeting vulnerable populations. The strongest predictor for recommending the use of FA supplements was whether the provider personally took a multivitamin.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to

1.Identify predictors of provider behavior learned from a national survey of health care providers about folic acid knowledge, awareness, and behavior.
2.Identify which provider types would benefit most from folic acid education.
3.Identify communication channels most widely utilized by physicians and non-physician providers.

Keywords: Birth Defects, Health Care Workers

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation

Determinants of Maternal and Infant Health: Interventions to Improve Outcomes

The 132nd Annual Meeting (November 6-10, 2004) of APHA