Computerized Counseling for Folate Knowledge and Use: A Randomized Controlled Trial
Background
Periconception folate supplementation significantly reduces the risk of neural-tube defects, but few U.S. women start folate supplementation before pregnancy, and the amount of clinician time available to counsel patients about folate is limited. This study evaluated whether computer-assisted counseling and the provision of free folate tablets increases women's knowledge and use of folate supplements.
Design
Randomized controlled trial; follow-up began 6 months after enrollment and was completed on average 7 months after enrollment.
Setting/participants
A total of 446 women, aged 18–45 years, were recruited from two urgent care clinics in San Francisco from March to July 2005 (data collection was completed in 2006; data were analyzed in 2007).
Intervention
Participants received a 15-minute computerized educational session and 200 folate tablets.
Main outcome measures
The primary outcome was the knowledge that folate can prevent birth defects; secondary outcomes included the self-reported use of a folate supplement at follow-up.
Results
At follow-up, women in the intervention group were more likely to know that folate prevents birth defects (46% vs 27%, relative risk [RR]=1.72, 95% CI=1.32, 2.23); to know that folate is most important in early pregnancy (36% vs 17%, RR=2.11, 95% CI=1.50, 2.97); and to report the recent use of a folate supplement (32% vs 21%, RR=1.54, 95% CI=1.12, 2.13).
Conclusions
A one-time, brief, computerized counseling session about folate with the provision of free folate tablets increased the knowledge and use of folate supplements among women ≥6 months later.
aCenter for Research on Health Care—Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
bDepartment of Obstetrics, Gynecology, and Reproductive Sciences and Magee-Womens Research Institute—School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
cDivision of General Internal Medicine, Montefiore Medical Center, New York, New York
dDivision of General Internal Medicine–Department of Medicine, University of California San Francisco, San Francisco, California
eDivision of Behavioral Sciences–Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California
Address correspondence and reprint requests to: Eleanor Bimla Schwarz, MD, MS, University of Pittsburgh, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh PA 15213
ABSTRACT