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Strengthening the evidence for maternal and child health programs

Evidence Tools
NPM 1

young doctor talking with two womenWell-Woman Visit

Significance

The Title V Maternal and Child Health Services Block Grant to States Program guidance defines the significance of this goal as follows:

A well-woman or preconception visit provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunizations, which can lead to appropriate identification, treatment, and prevention of disease to optimize the health of women before, between, and beyond potential pregnancies. For example, screening and management of chronic conditions such as diabetes, and counseling to achieve a healthy weight and smoking cessation, can be advanced within a well woman visit to promote women's health prior to and between pregnancies and improve subsequent maternal and perinatal outcomes. The annual well-woman visit has been endorsed by the American College of Obstetrics and Gynecologists (ACOG). See their updated committee opinion (Number 775; September 2018).

NPM 1 Tools

Introductory Resources

Summary of the Evidence

Current evidence has not focused on effective strategies to increase well-woman visits overall. Thus, proxy strategies to increase receipt of two preventive services that could be delivered in the context of a well-woman visit – cervical cancer screening and human papillomavirus (HPV) vaccination – have been reviewed. The following trends have emerged from this analysis.7

  • There is strong evidence to suggest that patient reminders/invitations are effective, both on their own and in combination with other strategies.
  • Other interventions targeting the patient/consumer that appear to be effective are community- based group education and patient navigation.
  • Home visits (1-2 total visits) targeting patients/consumers do not appear to be effective.
  • On the provider/practice-level, provider reminder/recall systems, provider education, and implementation of a designated clinic/extended hours appear to be effective.
  • On the community-level, television media appears to be effective.
  • Of interventions targeting payers, expanded insurance coverage appears to be effective.
  • Using multicomponent interventions is more effective to increase uptake of other screenings.
  • Findings from the literature on components of the well-woman visit can be applied to the implementation of multicomponent interventions that target various audiences.

Access the published evidence.

Evidence Analysis Reports

Promising Practices

You can access strategies from AMCHP’s Innovation Station that have shown promise in advancing your NPM below. While these strategies may not completely align with your current activities, they can be used to help guide further development and measurement of your ESM.

Practice Name Primary Interest State Level of Evidence
Super Babies Program Birth Defects Prevention MN Emerging
Body & Soul: A Faith Based Initiative Women's Health FL Promising
Healthy Women, Health Futures Women's Health OK Promising
PowerMeA2Z Preconception Health TX Promising
Pathways Community HUB Access to Health Care OH Promising
Nurse Family Partnership Home Visiting National Best
Perinatal Depression Screening/ Referral Mental Health CT Emerging
Welcome Family Health Promotion MA Promising

Sample ESMs

Domain and National Performance Measure: Percent of women with a past year preventive medical visit

Strategy [Source] Evidence-based/-informed Strategy Measure (ESM)

Work with Medicaid to improve the process of auto-enrollment into additional coverage after Medicaid coverage expires postpartum [4]

Medicaid extends automatic eligibility beyond current state standard ; #/% women automatically enrolled in Medicaid postpartum
Offer enabling services through community organizations to facilitate access to preventive visits [3] #/% of community health centers and family planning clinics agencies offering language and translation services
Host a webinar for providers about annual preventive visits and strategies to address missed opportunities [4] # of participants attending webinar
Convene task force comprised of agencies focused on women’s health # of task force meetings in past year

[3] Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health. Environmental Scans.
[4] Association of Maternal and Child Health Programs & Johns Hopkins Bloomberg School of Public Health. Taking Action with Evidence: Implementation Roadmap Webinars.

Source: Sample Strategies and Evidence-based/informed Strategy Measures (ESMs) (WCHPC). A list of sample strategies and ESMs for each of the 15 NPMs. Sources are provided at the end of the document. 


Related ESMs. Access ESMs being implemented by other states/jurisdictions that may serve as models for future work with NPM 1.

Additional Learning

  • NPM 1 Transformation Tools (MCH Navigator and National MCH Workforce Development Center). Learning resources, implementation strategies, and links to the evidence base for the competencies needed to carry out NPM 1 activities.
  • Taking Action with Evidence Implementation Roadmap (Association of MCH Programs (AMCHP) and WCHPC). Archived webinars and additional learning and implementation resources.
  • Historical Resources from the MCH Digital Library (NCEMCH). This bibliography is automatically generated to pull resources from MCHLine, the MCH Library's online catalog of seminal resources, in support of NPM 1. Coming soon.

Additional Resources

  • Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.
  • Well-Woman Visit: Resource Overview: The American College of Obstetricians and Gynecologists (ACOG) has identified the following resources that may be helpful for ob-gyns, other health care providers, and patients related to the well-woman visit.
  • AMCHP Resources:
    • Health for Every Mother: A Maternal Health Resource and Planning Guide for States. This guide for Title V programs and their partners provides a synthesis of program and policy recommendations and offers a framework to support states in identifying next steps. Contents include strategies and planning tools for strengthening maternal data systems, increasing the value of an investment in maternal health, enabling healthy living, improving access to care, ensuring high quality health care for women, and ensuring readiness and response to obstetric emergencies.
    • Implementation Toolkit for National Performance Measure 1. This toolkit contains examples of state strategies being used to address NPM 6 in Title V programs. It focuses on (1) strengthening data systesms and expand the evidence base; (2) enabling healthy living; (3) improving access to care; (4) ensuring high quality health care for women; (5) ensuring high quality maternity care; and (6) other program strategies.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.