Brandi Cooke Student Intern 3 rd National Summit on Preconception Health and Health Care June 12-14, 2011 Factors Affecting the Willingness of Counselors to Integrate Preconception Care into Sexually Transmitted Disease Clinics National Center on Birth Defects and Developmental Disabilities Place Descriptor Here

Preconception Care  Best time to identify and address risk factor for reproductive health is before not after conception  Not universally available  Advancing as standard of care “Recommendations to Improve Preconception Health Care -- United States” (Johnson et al., 2006) “Policy and Financing Issues for Preconception and Interconception Health “ (Markus, 2008) “Preconception Health and Health Care: The Clinical Content of Preconception Care” (Jack & Atrash, 2008)

Preconception Care Challenges  Major Challenges  Insufficient reimbursement for risk assessment and health promotion activities  Lack of clinical training programs emphasizing PCC risk assessment  Lack of data on effectiveness  Ongoing Challenge  Rate of unintended pregnancies “Despite these national recommendations and the plethora of newly published content there are many challenges to ensuring that all women of childbearing age in the United States receive preconception care services that will enable them to enter pregnancy in optimal health “

Preconception Care Solutions  Integrating PCC into other public health programs accessed by women at risk for unintended pregnancy  STD clinics in unique position to offer PCC information Women at high risk for contracting STD also at high risk for unintended pregnancy More likely to have modifiable medical and behavioral risks STD clinics have skilled counselors Service admirable to expansion of preconception counseling o Similar content- risk assessment, education, client-centered intervention

Previous Studies vs Present Study  Previous Studies-  Ignore counselors focus on doctors and nurses  Present Study-  Assess counselor perception of PCC importance  Identify factors that affect willingness of counselors to integrate PCC into STD clinics

Initial Questionnaire Development  Initial Draft- self-administered, structured, closed- end questionnaire utilizing questions modified from: March of Dimes, Folic Acid and the Prevention of Birth defects, and ACOG surveys  Pretested by 10 former STD counselors currently working as project managers at CDC  6 questions assessed: Completion time Level of complexity Readability Interest

Final Questionnaire  Final Draft solely professional attributes no demographics  Questionnaire ed to current and former STD counselors in urban,suburban, and rural areas of US Counselors found through CDC listing All counselors had at least 2 years experience providing HIV pretest/posttest counseling and syphilis interviewing  201 counselors ed, 140 (71.4%) counselors participated and signed IRB consent form

Counselor Classifications  Level of responsibility  Lower level- counselors and first line supervisors  Higher level- managers and administration  Level of Syphilis Morbidity  High morbidity- primary and secondary case rate >2.0/100,000 population  Moderate morbidity- primary and secondary case rate /100,000 population  Low morbidity- primary and secondary case rate <1.0/100,000 population

Counselor Classifications  Knowledge of PCC counseling  Years of experience providing STD counseling  Are patients asked about PCC issues? (i.e., obesity, drug use, smoking, diabetes, physical activity, asthma, cardiovascular disease)  Does clinic provide referrals for high risk issues?  How prepared are you to provide PCC counseling?

Major Characteristics of Study Participants and Clinics

Univariate Results: Most likely to report PCC as important and believe in PCC and ICC delivery  High level of responsibility  Good or excellent knowledge of PCC  >5 years of experience  Moderate or high level of syphilis morbidity

PCC Findings  Findings Reveal  Mostly all STD counselors report PCC was important but counselors vary on whether PCC should be delivered  Cannot make conclusion about some factors  Reason for varied findings  Counselors recognize interrelationship between PCC and STD  Counselors predisposed to HIV and hepatitis B integration attempts  Counselors already asking patients about high-risk behaviors

PCC Study Limitations  Focus on integration of PCC into STD clinics  No account for variability among clinics and counselors  Difficult to evaluate effect of counseling session  Findings not generalizable to other professionals ( i.e., nurses and social workers)  Self reported error assessing level of knowledge and attributes

What’s Next?  STD clinics may be plausible alternative for targeting females who might not otherwise receive PCC benefits  CDC guidelines for STD clinic sessions tailored to provide PCC counseling  Additional PCC training for STD counselors

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Failure to provide adequate medical consultation and care before conception for both planned and unplanned pregnancies will continually result in long term consequences for parents and children National Center on Birth Defects and Developmental Disabilities Place Descriptor Here