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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Early Prenatal Care.

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Strategy. Provision of Resources and Education

Approach. Provide resources and education to facilitate access to preconception healthcare for all persons capable of becoming pregnant to manage and address chronic diseases and SDOH.

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Overview. Preconception care is critical in identifying, managing, and modifying health behaviors and conditions, prior to pregnancy, that may increase poor maternal and infant outcomes.[1] Healthcare providers can increase access to and utilization of preconception healthcare by providing resources and education to people capable of becoming pregnant to help minimize risk.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

PROCESS MEASURES:

  • Number of preconception health resources and education programs offered. (Availability of preconception care support)
  • Number of individuals supported by Title V receiving preconception health resources and education. (Reach of preconception care support)

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

PROCESS MEASURES:

  • Percent of individuals supported by Title V receiving preconception health resources and education. (Reach of preconception care support)
  • Percent of preconception care providers trained in available preconception health resources. (Provider capacity for preconception care)

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

PROCESS MEASURES:

  • Number of individuals reporting increased capability in managing preconception health following participation in an educational program. (Impact on preconception health management)
  • Number of individuals with improved preconception health knowledge and behaviors following participation in an educational program. (Impact on preconception health literacy and practices)

OUTCOME MEASURES:

  • Number of communities with sustained improvements in preconception health. (Population-level impact of preconception care)
  • Number of initiatives supporting preconception health. (Field-building for preconception care)

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

PROCESS MEASURES:

  • Percent of individuals reporting increased capability in managing preconception health following participation in an educational program. (Impact on preconception health management)
  • Percent of individuals with improved preconception health knowledge and behaviors following participation in an educational program. (Impact on preconception health literacy and practices)

OUTCOME MEASURES:

  • Percent of communities with sustained improvements in preconception health. (Population-level impact of preconception care)
  • Percent of initiatives supporting preconception health. (Field-building for preconception care)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1]Atrash HK, Johnson K, Adams M, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J. 2006 Sep;10(5 Suppl):S3-11. doi: 10.1007/s10995-006-0100-4. Epub 2006 Jun 14. PMID: 16773452; PMCID: PMC1592246. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592246/

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.