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Feeling immune to risk may explain poor adherence to periconceptional health guidelines [Abstract]

Fulford, Bethan and Boivin, Jacky 2013. Feeling immune to risk may explain poor adherence to periconceptional health guidelines [Abstract]. Human Reproduction 28 (S1) , P-377. 10.1093/humrep/det218

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Abstract

Study question Why do women fail to follow health advice, such as guidelines for folic acid supplementation, during the periconceptional period? Summary answer Women may not comply with periconceptional health recommendations because their mental models make them view pregnancy as immune to internal or external threats. What is known already Women do not comply with periconceptional advice. One example is folic acid supplementation, which is as low as 31% despite being the best way of avoiding neural tube defects. Non-compliance is strongly linked to maternal characteristics. Psychological theory suggests that non-compliance is due to mental models that make people feel immune or insusceptible to poor health outcomes. However research is lacking on the role of perceived susceptibility in periconceptional health behaviour or folic acid supplementation. Study design, size, duration Cross-sectional international survey (n = 651) implemented in four European countries (France, Germany, Belgium, and Poland) via a social research panel. Participants/materials, setting, methods Participants were women planning a pregnancy (n = 325) or in the first trimester of pregnancy (n = 326). Survey items measured maternal characteristics, beliefs, barriers and behaviour in relation to pregnancy preparation and folic acid supplementation and were generated based on a review and the Health Belief Model. Main results and the role of chance Overall most women (82.8%) had heard of folic acid but only 45.5% were taking folic acid supplements. Folic acid supplementation was highest in Poland (63.8%) and lowest in France (26.8%) and was neglected in favour of other beneficial but less effective periconceptional health preparations (e.g., 82% eating more healthily). Further there was evidence that maternal background characteristics shaped women's mental models of pregnancy. Women who believed they had good general and obstetric health (e.g., no history of illness or miscarriage) and those living in adverse health environments (e.g. smoking and drinking during pregnancy, living in poverty) were the poorest users of folic acid supplements (p<.01; p<.001) and felt the least susceptible to the health consequences of folic acid deficiency (p<.001). Limitations, reason for caution The data are cross-sectional so causality cannot be inferred. Online samples tend to have higher socio-economic status and education. Replication using a prospective study in the general population is needed to address these issues. Wider implications of the findings The ‘Robust Mum’ mental model views pregnancy as protected from threat via the mother's good health whereas the ‘Robust Pregnancy’ model views pregnancy as naturally invulnerable, evidenced by observations of healthy births occurring despite adverse health conditions. Healthy mothers and pregnancies may be robust but babies are not immune to threats such as neural tube defects. The challenge for the practitioner is to elicit and correct patients' erroneous mental models of the invulnerability of pregnancy. Study funding/competing interest(s) J Boivin has received speaker fees, honorarium and/or research funding from Weber Shandwick. Weber Shandwick funded the research project. B Fulford is funded by an ESRC/Medical Research Council PhD studentship.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Psychology
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
Additional Information: Abstract presented at 29th Annual Meeting of the European Society of Human Reproduction and Embryology
Publisher: Oxford University Press
ISSN: 0268-1161
Last Modified: 04 Jun 2017 05:35
URI: http://orca.cf.ac.uk/id/eprint/52216

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