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On September 24, 2014, the PCHHC Initiative launched a nationwide assessment to learn more about current efforts to promote preconception health, determine how professionals have utilized existing campaign materials, and gather input for strategic planning. The electronic survey was distributed through the PCHHC newsletter contact list and a wide variety of partner listservs and networks.  At the close of the assessment on October 24, 2014, there were 500 respondents. Thank you to everyone who took the time to participate!!

Respondent Characteristics

States with the greatest number of respondents included North Carolina, Florida, California, New York, and Rhode Island. While survey responses were received from every part of the country, overall, Region 4 had the highest proportion of respondents. A majority of these survey respondents (52%) self-identified as health or medical professionals (e.g. nurse, physician, clinician, health educator, social worker, nutritionist, etc.), while 36% of respondents identified as agency or organization managers/administrators. Few respondents identified as teachers or faculty (6%), statisticians or epidemiologists (4%), and students or fellows (2%). Additionally, most respondents reported working in a clinical setting (19%) or local or state health department (18%). Of those reporting their place of employment as "other," the most frequently stated organization types were federally qualified health centers, hospitals, residency programs, state Medicaid agency or department, and non-profit health services clinics. Many respondents also indicated being affiliated with a state or local infant mortality coalition and/or HRSA COIIN initiative. Other affiliations included local maternal, child, and adolescent health programs such as MIECHV, Title V-MCH block grant, and state level Healthy Start programs.

PCHHC Product Usage

Survey questions asked about respondents' usage of different preconception health materials. About 38% of survey respondents indicated that their state or agency had a preconception health website and educational materials. Some of these included  Every Woman California, Every Woman North Carolina, Every Woman Wisconsin, the Wisconsin Association for Perinatal Care, and Utah's Power Your Life. Many respondents also listed their state and local health department websites as preconception health sites and materials resources. About a third of the states reported that they had some kind of preconception health strategic plan. Approximately 29% of respondents indicated that they receive the bi-monthly PCHHC newsletter, whereas 19% indicated their receipt of the CDC's bi-weekly emails with preconception health news and research. Twenty-six percent of respondents reported use of CDC's PRAMS data to search for preconception health indicators; 16% indicated that their organization participated in the Show Your Love Campaign; and 13% participated in the Linked by Life webinar series or other preconception health-related webinars in the past year. 

Thirty-three percent of respondents indicated that they had visited the  Before and Beyond website; 28% indicated that they had viewed the toolkit. The most helpful resources on the website, according to survey respondents, were the toolkit, CME modules/presentations, and the news and articles - for the most part, though, many respondents stated that the entire website is very useful. After the close of the survey, web metrics indicated that there was an increase in the number of people accessing these resources.

Workgroup Kudos

Respondents were asked to give feedback in regards to what the workgroups were doing well - here are some quotes: "Show Your Love was a great example of what we can do -- we need to build on our success and take it to the next level," "Keeping the issue alive and supporting us in the field with new tools, materials, etc. is great," and "The energy, drive and commitment of the workgroups is commendable." When asked if they had an interest in being more involved with the initiative - the greatest areas of interest for respondents included public health practice, clinical care and practice, and integration into home visiting and child health services. Interested in getting involved? Email Sarah Verbiest at sarahv@med.unc.edu.

Activities in the Field

Partners are now working to reach their traditional MCH target groups, particularly adolescents and new mothers, with new messages such as reproductive life planning. Home visiting programs are expressing an interest in learning more about dyadic care - providing preventive services not only to the baby, but to the mother and the father as well. Some programs such as Peer to Peer Educators are beginning to reach beyond the traditional MCH target audience to serve young women and men who may very much want to stay far beyond our net of services for many years. There is also an increased emphasis on placing more responsibilities on providers and the larger system. There has been a gradual shift away from prenatal as a single focus.

Looking forward

Participants had many ideas for moving preconception health agenda forward. They suggested that health care providers and systems need to invest time in offering comprehensive screening and services to young women and men, with an eye toward supporting their reproductive intentions. They need to see this not only as a critical investment in preventive health services for two generations, but an intervention that offers a strong return on investment. Family planning services, including LARC, must be accessible.

There is a clear desire for significantly increased national visibility for preconception health via an expanded Show Your Love campaign and national website. Respondents thought this visibility would bolster their efforts to get the work out and to gain the attention of policy makers / budget makers. Respondents encouraged the PCHHC to continue to develop tools and resources to support work with adolescents, in communities, with men, and with special populations, as well as additional practice supports, including model policies, expanded consumer information, and clinic tools.

They also stressed that it is important for us to continue to focus on metrics, measures, return on investment calculations, and reimbursement as ways to move change through benchmarking, accreditation, and demonstrated revenue generation. Finally, but most importantly, we need to lead with health equity, using a new narrative to breathe fire into what we've always highlighted in that we need to address the conditions that either inhibit or support health and wellness.