Gerald McGwin, Jr., M.S., Ph.D.

1. Gerald McGwin, Jr., M.S., Ph.D. Associate Professor Departments of Epidemiology, Surgery, and Ophthalmology University of Alabama at Birmingham

2. An Educational Intervention to Promote Proper Seat Belt Use During Pregnancy

3. Background • Restraint use during pregnancy contributes to improved maternal and fetal survival after MVCs. • Research suggests 25% to 50% do not follow guidelines for seatbelt use during pregnancy. • Discomfort and concerns about harm to themselves or fetus common reasons for lack of restraint. • Few interventions to improve seat belt knowledge and practices during pregnancy.

4. Purpose To evaluate an education intervention focused on increasing the proper use and knowledge regarding seat belt use during pregnancy.

5. Methods • Phase I Collect baseline information regarding seat belt use knowledge and behaviors • Phase II Developing and implementing educational intervention • Phase III Evaluating impact of educational intervention

6. Methods – Phase I & III • The Jefferson County Alabama Department of Health operates nine health centers distributed throughout the county; seven of these centers provide prenatal care. • To qualify for services at the County health centers, patients need to be residents of Jefferson County, Alabama or have Medicaid; indigent patients also qualify for services.

7. Methods – Phase I & III • Research team visited County health centers and approached all pregnant women for participation in the study (Phase I: 6-8/2001; Phase III: 10-12/2002) • Staff members rotated among all seven centers in a manner that provided a random sample of all women seeking prenatal care. • Patients given description of study and asked if they were willing to participate.

8. Methods – Phase I & III • Self-administered questionnaire collected demographic and pregnancy information and restraint use characteristics. • Information on restraint use in previous pregnancies and under different driving situations also collected. • Patients asked whether they had received any information regarding restraint use from a variety of sources. • Survey available in both English and Spanish.

9. Methods – Phase II • Data from Phase 1 identified gaps in knowledge and behavior as targets for educational material. • Focus groups conducted with clinic patients and staff to identify barriers regarding proper seat belt use during pregnancy and techniques for addressing these issues. • Collectively, this information was used to create a variety of material for distribution to prenatal care clinics, patients, and staff.

10. Methods – Phase II • Posters depicting proper seat belt placement created and installed at prenatal care clinics. • All patients given gift bag containing brochure explaining benefits and correct use of seat belts. • Clinic staff provided buttons encouraging proper seat belt use. • All material was available in both English and Spanish.

11. Methods – Summary Baseline Intervention Intervention Post-Invention Survey Development Dissemination Survey 6/2001 1/2002 3/2002 10/2002

15. FIGURE 2A. Knowledge of seat belt effectiveness for a non- pregnant woman among pre- and post-intervention groups. (p=0.005)

16. FIGURE 2B. Knowledge of seat belt effectiveness for a pregnant woman among pre- and post-intervention groups. (p<0.0001)

17. FIGURE 2C. Knowledge of seat belt effectiveness for a baby among pre- and post-intervention groups. (p=0.0009)

19. Conclusions • Although frequency of seat belt use high, many not wearing seat belts properly. • This study demonstrated potential for educational tools to change knowledge and behavior. • Education regarding proper seat belt use is now a regular component of pre-natal care at county health department pre-natal care clinics.

20. An Educational Intervention to Promote Proper Seat Belt Use During Pregnancy