Using the Wilder Collaboration Factors Inventory to Strengthen Collaborations for Improving Maternal and Child Health.

INTRODUCTION: The Wilder Collaboration Factors Inventory is a free, publicly available questionnaire about the quality and context of community collaboration. The purpose of this article is to share lessons from using this questionnaire in a North Carolina maternal and child health initiative. METHODS: In 2015, the State's General Assembly funded five local health departments to implement evidence-based strategies for improving maternal and child health. Each health department formed a community action team for this purpose. Members of each community action team completed the Wilder Collaboration Factors Inventory (Inventory) in the first year of funding and again 1 and 2 years later. Technical assistance coaches also asked community action team conveners to complete a brief questionnaire annually, and used these as well as Inventory results to plan for improvements. RESULTS: During the first year, community action teams emerged as strong in seeing collaboration in their self-interest. A primary challenge noted by conveners was engaging consumers on the community action teams. Strategies to address this included using social media and compensating consumers for attending meetings. By the second year, teams' average scores in engaging multiple layers of participation increased, and eight additional factors became strengths, which generally continued in year three. The most consistent challenge was supporting community action teams administratively. DISCUSSION: The Wilder Collaboration Factors Inventory provided a feasible tool for identifying opportunities for improvement in several local, cross-sector partnerships, suggesting promise for other communities seeking to enhance their collective impact on maternal and child health.

Folic Acid Education for Hispanic Women: The Promotora de Salud Model.

BACKGROUND: Although rates of neural tube defects (NTDs) have declined in the United States since fortification, disparities still exist with Hispanic women having the highest risk of giving birth to a baby with a NTD. The Promotora de Salud model using community lay health workers has been shown to be an effective tool for reaching Hispanics for a variety of health topics; however, literature on its effectiveness in folic acid interventions is limited. MATERIALS AND METHODS: An intervention using the Promotora de Salud model was implemented in four U.S. counties with large populations of Hispanic women. The study comprised the following: (1) a written pretest survey to establish baseline levels of folic acid awareness, knowledge, and consumption; (2) a small group education intervention along with a 90-day supply of multivitamins; and (3) a postintervention (posttest) assessment conducted 4 months following the intervention. RESULTS: Statistically significant differences in pre- and posttests were observed for general awareness about folic acid and vitamins and specific knowledge about the benefits of folic acid. Statistically significant changes were also seen in vitamin consumption and multivitamin consumption. Folic acid supplement consumption increased dramatically by the end of the study. CONCLUSIONS: The Promotora de Salud model relies on interpersonal connections forged between promotoras and the communities they serve to help drive positive health behaviors. The findings underscore the positive impact that these interpersonal connections can have on increasing awareness, knowledge, and consumption of folic acid. Utilizing the Promotora de Salud model to reach targeted populations might help organizations successfully implement their programs in a culturally appropriate manner.

Developmental origins of chronic inflammation: a review of the relationship between birth weight and C-reactive protein.

PURPOSE: The developmental origins of adult disease hypothesis suggests that the intrauterine environment may program postnatal health outcomes through mechanisms such as chronic inflammation. The purpose of this article was to review the literature on the association between infant birth weight and C-reactive protein (CRP), markers of the fetal environment and inflammation, respectively. METHODS: We used PubMed, Google Scholar, Web of Science, ScienceDirect, the citation lists of the reviewed literature, and recommendations from experts in the field to identify potential articles. Inclusion criteria for the studies, regardless of study design, included human subjects, documented or self-reported infant birth weight, and a minimum of one measurement of CRP (during childhood, adolescence, or adulthood). RESULTS: Several studies demonstrated a statistically significant inverse association between birth weight and CRP in adulthood, although in many cases only after controlling for markers of current adiposity. No studies significantly linked birth weight to CRP in childhood or adolescence. CONCLUSIONS: Longitudinal studies, including multigenerational studies, are needed to further understand whether adult CRP has origins in the fetal environment.

Promotora de salud: promoting folic acid use among Hispanic women.

BACKGROUND: The U.S. Public Health Service recommends that all women in the United States capable of becoming pregnant consume 400 µg of folic acid daily to reduce their risk of having a pregnancy affected by a neural tube defect (NTD). However, disparities exist in the consumption of folic acid, with Hispanic women having lower rates of folic acid consumption than non-Hispanic white women. METHODS: A community-based feasibility study was designed to assess the utility of the promotora de salud model to promote consumption of multivitamins containing folic acid for the prevention of NTDs among Spanish-speaking Hispanic women in North Carolina. The study consisted of an educational intervention given by a promotora (a lay, community health worker), with data collection occurring at baseline and four months post-intervention to measure changes in knowledge and behavior. Overall, 52% (n=303) of participants completed all components of the study. RESULTS: Self-reported daily multivitamin consumption increased from 24% at baseline to 71% four months post-intervention. During the same time frame, awareness of folic acid increased from 78% to 98% and knowledge of the role of folic acid in the prevention of birth defects increased from 82% to 92%. CONCLUSIONS: The results of this study indicate that the promotora de salud model may be effective in reaching a subpopulation of women with the folic acid message. Additional studies with larger population sizes are warranted to validate these findings.

Family planning intentions: a qualitative exploration of postpartum women of Mexican descent in North Carolina.

BACKGROUND: North Carolina has one of the fastest growing Mexican-American populations, yet health care providers have minimal information on how to address the family planning needs of this population. STUDY DESIGN: We conducted semistructured interviews with postpartum Mexican-American women, aged 18-35 years, within 1 month of delivery. Salient themes were identified, coded and analyzed. RESULTS: Twenty women were interviewed. The majority had firmly held family size intentions: most desired to have 2 to 4 children with 2 to 5 years between births. Partners' preferences and the family size in which the participant was raised were factors that most influenced their family size preference. First-generation Mexican-American participants were more likely to have a partner whose intentions are influenced by the gender(s) of their children compared with participants born in Mexico. Participants desired longer intrapartum intervals for optimal infant development, with financial considerations cited less frequently. CONCLUSION: Postpartum women of Mexican descent articulate consistent family planning intentions. Partners' desires may challenge the achievement of these intentions. Providers can encourage the most effective forms of contraception to promote ideal and intended family size.

Mama sana usted sana: lessons learned from a postpartum weight loss intervention for Hispanic women with infants six months or less.

The purpose of this feasibility study was to assist limited English proficiency women predominately from Mexico (N = 24) to lose weight postpartum and establish effect sizes to power a randomized controlled pilot study. At 3 months, a small (0.20) effect size was noted in the experimental group compared to the control group in exercise, stress, and both the subscales of the eating self-efficacy scales. There was a medium (0.50) effect size noted in the experimental group compared to the control group in body mass index (BMI), nutrition, and exercise self-efficacy. There was a large (0.80) effect size noted in the experimental group compared to the control group in subscapular skinfolds and health responsibility.