Participant Outreach for First Line Therapy at Rural Women's Clinic Caitlin Moore, RN, BSN, Annie Kate Smith, Lauren Palermo
The objective of this research is to determine the best way to support and educate pregnant or parenting young women, so that they and their children can be healthy. First, it is important to establish motivational methods. In this research, participants at Foothill Pregnancy Care Center (FPCC) were recruited to participate in the First Line Therapy Program (FLT), an evidenced based, professionally supervised, personalized lifestyle modification program. This program promotes healthy body composition and ultimately modifies risks and effects from chronic conditions.
Our sample consisted of women living throughout the upstate South Carolina area. The age ranged from 18 to 40. All participants either had young children or were expecting their first child. Participants were recruited by phone call by a person they had previously interacted with at the clinic. Twenty-one participants were called and two participants were present for the initial meeting.
Flyers were created to share with FPCC participants to encourage their attendance. The Bioelectrical Impedance Analysis machine and First Line Therapy guidebook were also used to guide the program. Guidebooks were given to each participant to work through over the course of the program. A healthy food demonstration based on the FLT diet plan was presented at the first meeting: including grapes, almonds, carrots, peppers and hummus. All the foods brought were included in the guidebook as foods that are approved throughout this program. Clients were also given a folder including a calendar describing the program as well as a consent form to create a medical record at the Sullivan Center.
Twenty-one FPCC clients were selected to be called. A FPCC staff member assisted to create a list of participants she thought would be good candidates for the FLT program. These criteria were based upon frequency of attendance to FPCC appointments, interest and involvement during FPCC appointments, and follow-up after each appointment. Three different lists were created throughout the process, with 5-10 names on each list. Each participant was called at least twice. If she did not answer, a voicemail that briefly explained the FLT program and appointment was left. If she did answer, a brief discussion regarding the FLT program, its benefits, and appointment time, as well as any questions were addressed. Texting was used to confirm participation in program, as well as additional outreach.
Phone calls were placed to participants of FPCC, and confirmed participants came to the initial meeting, where they had a Bioelectrical Impedance Analysis and were given a schedule of the program. The program was incentivized with healthy food demonstrations during the meetings as well as the incentive to improve one’s overall health.
There were 21 participants that were called. 12 participants did not answer. Seven participants were left two voicemails. Three participants either did not have their voicemail set up or it was full. One participant had a number that had been disconnected. One participant was not accepting calls. Nine participants answered. Three participants confirmed attendance for the FLT meeting, but were unable to attend. Two participants expressed interest, but did not confirm attendance after being texted. Two participants confirmed attendance and participated in the FLT meeting. Graph 1 demonstrates the amount of participants that were left two voicemails versus those who expressed interest and were present at the program. The graph shows how many participants were not responsive to outreach.
Barriers to a Healthy Lifestyle
- Financial deficit
- Lack of access to transportation
- Chronic Illness
- No health insurance
- Lack of education
- Perception of inability to afford or be educated
Facilitators within research
- Texting participants to reach out and receive feedback
- Program flexibility
- Incentives: free bioelectrical impedance analysis, free guidebook, free snacks
Barriers Within Research
- Out of state phone number used for outreach
- Lack of added incentives such as diapers, baby food or formula
- Frequent meetings for participants
- Inability to gauge participant's attitude towards program
- Time constraints between participants, staff, and facility space
Our goal for this research is to determine how best we can get this population involved in their health and improve their health literacy, thus improving the overall health of their family. For future research we would like to:
- improve compliance using multiple forms of communication, including phone call and text, from a familiar or local phone number
- utilize incentives that participants believe to be "needs" such as diapers, wipes, baby clothing
- make use of the Sullivan Center's mobile unit to meet the needs for facility space, accessibility, and flexibility
- create and implement a survey to measure participant's opinions and attitudes towards the program
Brewin, D. & Nannini, A. (2014). Using a life course model to examine racial disparities in low birth weight during adolescence and young adulthood. Journal of Midwifery & Women’s Health, 59(4), 417-427. doi: 10.1111/jmwh.12110
Danhausen, K., Joshi, D., Quirk, S., Miller, R., Fowler, M., & Schorn, M. (2015). Facilitating access to prenatal care through an interprofessional student-run free clinic. Journal of Midwifery & Women’s Health, 60(3), 267-273. doi: 10.1111/jmwh.12304
Feldman, J. (2011). Best practice for adolescent prenatal care: Application of an attachment theory perspective to enhance prenatal care and diminish birth risks. Child & Adolescent Social Work Journal, 29(2), 151-166. doi: 10.1007/s10560-011-0250-0
Hackley, B., Kennedy, H., Berry, D. & Melkus, G. (2014). A mixed-methods study on factors influencing prenatal weight gain in ethnic-minority women. Journal of Midwifery & Women’s Health, 59(4), 388-398. doi: 10.1111/jmwh.12170
Renault, K., Norgaard, K., Nilas, L., Carlsen, E., Cortes, D., Pryds, O. & Secher, N. (2014). The treatment of obese pregnant women study: A randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. American Journal of Obstetrics and Gynecology, 210 (2), 134.e1-134e9. doi: 10.1016/j.ajog.2013.09.029
Saunders, L., Guldner, L., Costet, N., Kadhel, P., Rouget, F., Monfort, C,.… Cordier, S. (2014). Effect of a Mediterranean diet during pregnancy on fetal growth and preterm delivery: Results from a French Caribbean Mother-Child Cohort Study (TIMOUN). Paediatric & Perinatal Epidemiology, 28(3), 235-244. doi: 10.1111/ppe.12113
Schoenaker, D., Soedamah-Muthu, S., Callaway, L. & Mishra, G. (2015). Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: Results from the Australian longitudinal study on women’s health. The American Journal of Clinical Nutrition, 102 (1), 94-101. doi: 10.3945/ajcn.114.102475
Wise, N. (2015). Pregnant adolescents, beliefs about healthy eating, factors that influence food choices, and nutrition education preferences. Journal of Midwifery & Women's Health, 60(4), 410-418. doi: 10.1111/jmwh.12275