Promotora de Salud: Promoting Folic Acid Use Among Hispanic Women

Abstract

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.

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

“…Further, the women who received the intervention were provided with a 90-day supply of multivitamin supplements. The cost of vitamins was mentioned in the pre-test as a barrier to vitamin use in both this study as well as in the earlier North Carolina-based pilot study, 7 and has been noted as a barrier in other studies as well. 23 The distribution of free supplements, then, provided a convenient way for these women to obtain supplements, while also removing the potential barrier of the cost of purchasing them.…”

“…The provision of the multivitamins as part of the study design was done to be consistent with the earlier North Carolina-based pilot intervention project mentioned above. 7 Finally, the promotora informed participants that she would follow-up via telephone at two months to confirm their contact information, and at four months to conduct a final assessment.…”

“…16 Such programs have been successful in providing important information to sub-segments of the broader population in a culturally-appropriate manner. 17–21 A recent study examined the potential use of the Promotora de Salud model for reaching Hispanic women in North Carolina with the folic acid message, 7 and found it to be a successful model for NTD prevention education and outreach efforts. Building on the North Carolina pilot study, the objective of the current study was to examine the impact of the intervention in three additional counties in the United States.…”

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities

“…Hispanic women are more likely to have a baby born with an NTD (Williams et al, 2015), and less likely to know about the benefits of folic acid in the prevention of NTDs (deRosset et al, 2014). Post-fortification studies found that Hispanic women were less likely to consume folic acid from either fortified foods or supplements (Hamner et al, 2013a; Hamner et al, 2011; Yang et al, 2007) and had lower overall median serum folate concentrations (Pfeiffer et al, 2012) than non-Hispanic white women, indicating that this group of Hispanic women might not be benefitting from the success of wheat and other cereal grain fortification as much as their non-Hispanic counterparts.…”

Discussing Appropriate Medication Use and Multivitamin Intake with a Healthcare Provider: An Examination of Two Elements of Preconception Care Among Latinas

“…Hispanic women report lower knowledge about the benefits of folic acid and lower folic acid consumption than women of other ethnic groups. 20,30–32 Hispanic women also have higher rates of certain types of NTDs. 17,33–35 …”