Public health as a catalyst for interprofessional education on a health sciences campus.

Although interprofessional education (IPE) has existed in various formats for several decades, the need for IPE recently has taken on renewed interest and momentum. Public health has a critical role to play in furthering IPE, yet schools of public health are often underrepresented in IPE initiatives. The University of Iowa College of Public Health is serving as a catalyst for IPE activities on our health sciences campus, which includes colleges of dentistry, medicine, nursing, pharmacy, and public health. IPE-related activities have included campus visit by IPE leaders, administration of the Survey of Critical Elements for Implementing IPE, administration of the Interprofessional Learning Opportunities Inventory survey, the development of a comprehensive strategic plan, and the pilot of an IPE course for all first-year prelicensure students and Master of Health Administration students. Although more work is needed to more fully integrate IPE into the curriculum, success to date of the University of Iowa IPE initiative demonstrates that public health can play a critical role as a convener and catalyst for IPE curricular innovations on a health sciences campus.

Across the fertility lifespan: desire for pregnancy at conception.

PURPOSE: To illustrate trends in unintended pregnancy over a 5-year period and to describe variations in desire for pregnancy at conception in relation to maternal age, race/ethnicity, income, and education. STUDY DESIGN AND METHODS: Data were collected as part of the Iowa Barriers to Prenatal Care Project, a large, multiyear study of new mothers. A brief questionnaire eliciting maternal experiences and behaviors during pregnancy was administered to new mothers in all Iowa hospitals providing maternity care following the birth of their baby. Sample sizes ranged from 16,714 to 19,421 over the 5 years included in this analysis (1997 to 2001), and response rates ranged from 44% to 53%. RESULTS: The study sample closely matched the overall statewide profile of women in this age group. In each of the 5 years, about one third of the mothers giving birth indicated that they did not intend to become pregnant at that time, and another 4% to 5% indicated that they did not want to be pregnant at that time or in the future. There were no substantive variations across years. Maternal age, race/ethnicity, income, and education were significantly related to intendedness of pregnancy. CLINICAL IMPLICATIONS: The findings underscore the continuing challenge of unintended pregnancy, despite recent national attention to this issue. All women of childbearing age should be considered at risk for unintended pregnancy. Additional work is needed to examine reasons, attitudes, and behaviors associated with unintended pregnancies and to determine the relative predictive strength of key demographic variables to improve interventions aimed at decreasing unintended pregnancy rates.

Content validity and nursing sensitivity of community-level outcomes from the Nursing Outcomes Classification (NOC).

PURPOSE: To evaluate the content validity and nursing sensitivity of six community-level outcomes from the Nursing Outcomes Classification (NOC; Johnson, Maas, & Moorhead, 2000). DESIGN AND METHODS: A survey research design was used. Questionnaires were mailed to 300 public health nursing experts; 102 nurses responded. Experts evaluated between 11 and 30 indicators for each of the six outcomes for: (a) importance of the indicators for measuring the outcome, and (b) influence of nursing on the indicators. Content validity and nursing sensitivity of the outcomes were estimated with a modified Fehring technique. FINDINGS: All outcomes were deemed important; only Community Competence had an outcome content validity score < .80. The outcome sensitivity score for Community Health: Immunity was .80; other outcome scores ranged from .62-.70. Indicator ratios for all 102 indicators met the study criterion for importance, with 87% designated as critical and 13% as supplemental. Sensitivity ratios reflected judgments that 45% of the indicators were sensitive to nursing intervention. CONCLUSIONS: The study provided evidence of outcome content validity and nursing sensitivity of the study outcomes; further validation research is recommended, followed by testing of the study outcomes in clinical practice. Community-level nursing-sensitive outcomes will potentially enable study of the efficacy and effectiveness of public health interventions focused on improving health of populations and communities.

WIC providers' perspectives on offering smoking cessation interventions.

PURPOSE: To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. STUDY DESIGN AND METHODS: Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. RESULTS: Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. CLINICAL IMPLICATIONS: WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.