Introduction

This proposal is submitted by Westminster University’s Public Health program. Westminster University was founded in 1875 and is a private liberal arts college located in Salt Lake City, Utah. It is the only liberal arts college in the state of Utah and offers more than 70 academic programs and 15 specialized graduate programs. The program includes 16 core competencies such as the ability to assess, monitor, and review the health status of populations; identify causes of social and behavioral factors that affect health, and apply theoretical constructs to planning interventions. The program utilizes a curriculum that emphasizes applied learning and multidisciplinary approaches to teaching (Westminster University, n.d.).

The Public Health Program is part of the School of Nursing and Health Sciences. The Public Health Program has historically been involved in numerous community activities. Examples of activities include a city-wide texting and driving campaign, several service projects and international projects in both graduate and undergraduate classes.

The proposed intervention includes working/partnering with the Utah Department of Health's (UDOH) Bureau of Maternal and Child Health (MCH). The Bureau includes five major programs that address the health needs of the maternal and child populations in Utah. These programs include Maternal and Infant Health Program (MIHP), Data Resources, Oral Health, Pregnancy Risk Line, and Women, Infants and Children. The Bureau will provide programmatic support in the implementation of the intervention on the Westminster University campus.

Intent of Proposal

The Health Promotion Coordinator of MIHP at the UDOH's Bureau of MCH and the researcher are interested in targeting college-age (18 to 24 years of age) males and females specifically in Westminster University. This proposal will address health behaviors of women and their male partners before becoming pregnant in aim to reduce the rate of unintended pregnancies and improve pregnancy outcomes in the long term.

Background

It has been demonstrated that about half of all pregnancies in the United States are not planned (CDC, 2016a; Guttmacher Institute, 2016). Actually, the rate of unintended pregnancy in the United States is significantly higher than in many other developed countries (Sedgh, Singh, & Hussain, 2014). Unintended pregnancy rates are highest among women aged 18-24, poor and low-income women, minority women, and cohabitating women (Finer & Zolna, 2016). The average woman is fertile for thirty-nine years and spends three decades trying to avoid an unintended pregnancy (Sonfield, Hasstedt, & Gold, 2014). Women with unintended or mistimed pregnancies tend to begin the pregnancy less healthy, have a high risk of preterm births, and are less likely to seek prenatal care. They are also more likely to smoke or drink during pregnancy, less likely to initiate or maintain breastfeeding, and have higher rates of adverse health outcomes during and after pregnancy (UDOH, 2016a).

In Utah, during the years 2012 and 2013, 23.8% of women reported that their birth resulted from an unintended pregnancy and 31.5% of women aged 18 to 24 years reported their pregnancies as unintended (UDOH, 2016a). Of women who reported their pregnancies as unintended, 62.7% said they were using some method to avoid pregnancy at the time of conception (UDOH, 2016a). The relatively high percentage of an unplanned pregnancies with a large proportion of contraception failure means that there is a possibility of misinformation or misuse of contraception methods. It is crucial to provide all women, particularly childbearing women, and their male partners with information to make the right decisions about their reproductive futures. Education on preconception health (PCH), which deals with unplanned pregnancies as well as unhealthy behaviors before becoming pregnant is needed, especially among the college-age population age (18-24 years). This will significantly increase the probability of a healthy infant(s), especially in Utah where the birth rate is higher than the birth rate in the US (UDOH, 2017a).

To accomplish the education on PCH, the researcher proposes the Preconception Peer Educators (PPE) Program, which is vital to help young women and their partners plan for and have healthier pregnancies and infants. This intervention will take place on the Westminster University campus.

The PPE Program

The PPE program has launched by the Office of Minority of Health (OMH) of Department of Health and Human Services since 2007 and has been implemented in universities and colleges across the country (HHS OMH, 2017b). It began as a way to educate on infant mortality, particularly in African-American communities. The PPE program applies curriculum to prepare college students with targeted health messages that they can spread throughout their campuses and communities. These health messages aim to reduce infant mortality rates among all people, specifically high-risk populations. Part of its efforts is to end health disparities among racial and ethnic minorities. For that, Office of Minority Health has launched A Healthy Baby Begins with You, which is a national campaign to promote awareness of infant mortality within the African American community.

Currently, the PPE program works with the college students to prepare them as peer educators on campuses to emphasize PCH messages that could be misinformed or even seem foreign especially for people who are not ready to start a family. Locally, the PPE program has been adapted by the MIHP at the UDOH to fit the Utah population and to focus more on PCH and planning pregnancies. The MIHP has launched a website named PowerYourLife.org, which includes information about being in optimal health before becoming pregnant. Besides, the website has information and tools about family planning and birth control as well as PCH. During the summer of 2017, the researcher developed a training manual that will be used as a guide for the peer educators in the PPE program. Currently, the researcher is partnering with the MIHP to design a PPE program directed at college age populations. This program will be implemented on colleges and universities across Utah starting with Westminster University.

Target Population

The target population is specifically college students ages 18 to 24. Since research has shown that health before becoming pregnant has many benefits on maternal and infant outcomes, the researcher plans to start this project at an earlier stage in the lives of women and men, specifically college students at Westminster University. Another reason why this intervention is significant is that Utah has the highest birth rate in the United States (UDOH, 2017a).

The PPE program will help in raising the awareness and knowledge levels about PCH among this population in which many may not be actively seeking to start a family. This program will not exclude any student by race, ethnicity, income level, marital status, or residency status.

Demographics

According to College Factual (n.d.) and Westminster University (n.d.), Westminster University has high racial, ethnic and geographic diversity. Westminster University total enrollment is about 2,692. Of those, 2,127 are undergraduate students, and 565 are graduate students. Westminster University ethnic diversity is similar to the national average. White makes up 72.5% followed by, Hispanic/Latino (9.6%), non-resident alien, unknown ethnicity, two or more races, Asian, black or African American, American Indian or Alaska Native, then Native Hawaiian or other Pacific Islander. The school has a balance of male to female student ratio (40:60). More than half of the students attending Westminster University come from within Utah. Also, about 48.8% of students are between the age of 18 to 22 years. Income levels seem not to be diverse.

Rationale

The researcher believes that the PPE program is an effective intervention to increase awareness and provide the knowledge and skills to college students about PCH. This intervention will ultimately reduce the rate of unintended pregnancies and improve pregnancy outcomes. Therefore, the researcher proposes this program due to the following:

Preconception Health (PCH)

PCH is the health of women and men during their reproductive years when they are able to conceive. PCH aims to help women and their partners to prevent unintended pregnancies, identifying risk factors that could affect reproductive outcomes before pregnancy and then ultimately improve maternity and child health outcomes in both the short and long term. There are several healthy habits that support PCH. Family planning, prevention and management of sexually transmitted diseases (STDs) including HIV, and folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality (Lassi, Mansoor, Salam, Das., & Bhutta, 2014). Women of childbearing age may perceive PCH incorrectly. For example, according to a study by Squiers et al. (2013) based in Atlanta, Georgia, in women aged 18 to 44, lack of awareness about PCH was one of the barriers to PCH. Participants’ thoughts about PCH were for promoting a healthy baby rather than preventing an unhealthy pregnancy outcome. This means there is insufficient awareness about PCH, particularly among childbearing age women.

Epidemiological assessment

The United States’ infant and maternal mortality rates, which could be result of unhealthy pregnancy, are higher than most other countries in the developed world (AMCHP, 2015; MacDorman, Mathews, Mohangoo, & Zeitlin, 2014). Three of the top five leading causes of infant mortality in the United States include birth defects, preterm birth (birth before 37 weeks’ gestation) and low birth weight, and maternal complications of pregnancy, which could be consequences of unplanned or unhealthy pregnancy. These causes in addition to the other two, Sudden Infant Death Syndrome (SIDS) and injuries, account for over half (57%) of all infant deaths that happened in the United States in 2014 (CDC, 2016b). On the other hand, according to WHO (2015), the maternal mortality rate for the United States has more than doubled between 1990 and 2013. One of the major factors that has contributed to this upward trend is the high number of women who have chronic conditions that affect the pregnancy such as hypertension, diabetes, and obesity, which also could be results of unplanned pregnancy or other unhealthy behaviors that can be addressed through PCH.

In Utah, the infant mortality rate has been declining throughout the past 20 years. Regardless of this decline, infant mortality remains significant. In 2015, 257 infants died during their first year of life (UDOH, 2016b). Additionally, despite the decrease in Utah's rate of maternal mortality, the rate has increased from a rate of 9.8 in 2013 to 15.6 maternal deaths per 100,000 births in 2014 (UDOH, 2016c). In fact, risk of all of the previous causes of infant mortality and maternal mortality could be lowered or prevented by maintaining health before and during pregnancy. Again, education on PCH certainly needed to increase awareness and provide the knowledge and skills to made sound family planning decisions.

Furthermore, the rate of preterm births for racial and ethnic groups in the United States is higher than in other developed countries (MacDorman, & Mathews, 2011). Preterm birth affected about one of every 10 infants born in the United States in 2015 (CDC, 2017a). Locally, the preterm birth rate increased from 9.1% in 2014 to 9.3% in 2015. This increase was the first increase seen in six years (UDOH, 2016d).

Finally, the limited awareness about PCH plays a major role in having nationally higher rates of infant and maternal mortality as well as a higher preterm birth rate than most other countries in the developed world (MacDorman, & Mathews, 2011; AMCHP, 2015; MacDorman et al., 2014). Also, the deficient awareness about PCH could be one of the factors for rising the maternal mortality rate locally in the recent years (UDOH, 2016c).

Social/Economic Impact

Unplanned pregnancy could lead to adverse outcomes for not only individual women but also for their families and the society as a whole. It has been demonstrated that unintended pregnancies have many social and economic impacts (Sonfield, Hasstedt, Kavanaugh, & Anderson, 2013).

At the national level, despite the substantial decline in the rate of unintended pregnancy in the United States between 2008 and 2011, nearly half (45%) of all pregnancies in 2011 were still unintended (Finer, & Zolna, 2016). The highest rate was seen in women 18 to 29 years of age (Finer, & Zolna, 2016). Relationship status has also been found as a contributor for the variety in the rate of unintended pregnancy. Women who were married had a lower rate than those who were unmarried. Another association has been found between both income level and educational standard and the rate of unintended pregnancy. Besides, the unintended pregnancy rate among poor and less-educated females was higher than the rate among females with a higher education and better income. Based on race and ethnic group, white non-Hispanics had the lowest rate while black non-Hispanics had the highest rate. In particular, poor, black, and Hispanic females presented much higher rates of unintended pregnancy than did whites and those with higher incomes.

Also, in the United States, more than 19 million women need publicly supported contraceptive services. Of those in need, 30% are uninsured (Sonfield, Hasstedt, & Gold, 2014). Finally, unintended pregnancies cost nearly $21.0 billion in public expenditures in 2010 (Sonfield, & Kost, 2015).

At the state level, according to the Guttmacher Institute (2017) in 2010, 53.3% of unplanned pregnancies were publicly funded, compared with 68% nationally. The federal and state governments spent $158.0 million on unintended pregnancies. Particularly, for each woman aged 15–44 in Utah, the total public costs for unintended pregnancies was $262 in 2010 compared with $201 per woman nationally. In Utah, there are limited studies that show the variety in unintended pregnancies based on race and ethnic group. According to a study by Flores, Turok, and Jacobson (2012), of women who gave birth to a singleton infant, United States’ born Latinos were more likely to experience unintended pregnancies and less likely to use contraception than foreign-born Latinos or whites.

It is estimated that in the United States in 2012, the costs of maternity care for women who suffer complications during pregnancy or childbirth exceeded $60 billion (WHO, 2015). Also, preterm births alone cost the United States $26.2 billion in 2005 when accounting for health care along with other costs according to the Institute of Medicine (Behrman & Butler, 2007).

In conclusion, unintended pregnancies and pregnancy complications are costly to the federal and state governments both nationally and locally. Education on PCH could be a key component to lowering the rates of unintended pregnancy and pregnancy complications for many college female students.

Behavioral and Environmental Assessment

Another issue concerning PCH is that many of childbearing age women are involved in unhealthy and risky behaviors, which could increase their risk for a broad range of health complications for the baby and the mother if she becomes pregnant. A significant example is obesity. Pre-pregnancy obesity is a risk factor for gestational diabetes (GDM), preeclampsia, labor induction, cesarean for fetal distress and wound infection (Ahmed, Ellah, Mohamed, & Eid, 2009). According to the State of Obesity (n.d.), in the United States, nearly one in four women are obese before becoming pregnant. More than 6% of those obese women have or develop GDM during pregnancy.

In Utah, the percentage of women with a healthy body mass index (BMI) before pregnancy in 2013 was 53.5%, meeting the new Healthy People objective (UDOH, 2015). BMI is a person's weight in kilograms divided by his or her height in meters squared. However, the percentage of women with a normal pre-pregnancy BMI has decreased over the last decade. However, the proportion of women with an obese pre-pregnancy BMI increased from 16.7% in 2010 to 18.5% in 2013. Also, in Utah, the percentage of births with GDM increased 280% since 1997. It has risen from 1.5% of all births to 5.7% of births in 2015 (UDOH, 2017b). Regarding diet, according to UDOH (2017d), the rate of women aged 18 to 24 years who reported that they were taking the multivitamin before they get pregnant in Utah has declined from 63.25% in 2013 to 59.69% in 2015. Folic acid helps prevent neural tube birth defects, which affect the brain and spinal cord. It is estimated that folic acid supplementation has reduced the occurrence of neural tube defects by almost half in the United States (CDC, 2014).

Another significant example of unhealthy or risky behavior that impacts the pregnancy outcome is binge drinking. Binge drinking is a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams’ percent or above. Binge drinking is associated with many health problems for childbearing women such as unintended pregnancy, STDs, chronic diseases such as high blood pressure that could affect pregnancy. It is most common among younger adults aged 18–34 years (CDC, 2017b). In Utah, 29.5% of women aged between 18 and 24 reported that they drank three months before pregnancy in 2014 (UDOH, 2017a). Again this means education and awareness are needed.

Overall, there are many unhealthy behaviors among women of childbearing age both nationally and locally, which could increase the risks of several negative pregnancy outcomes such as diabetes, neural tube defects, cesarean section, preterm delivery, and hypertensive and thromboembolic disease. We believe that education on PCH will help to lower or even prevent pregnancy outcomes those related to unhealthy behaviors.

Significance of the Program

In Utah, the MIHP at the UDOH’ Bureau of MCH publishes information and tools on its website about family planning and birth control as well as PCH. Utah also has family planning centers such as Planned Parenthood that focus more on sexual health education and increasing the access to contraception methods to prevent unintended pregnancy. HER Salt Lake is a research partnership between the University of Utah Family Planning Research Group and Planned Parenthood Association of Utah. HER Salt Lake City provide free birth control to people in Salt Lake County (HER Salt Lake, 2016). Overall, there are no available specific interactive educational programs that are directed at increase the awareness toward PCH which address not only unintended pregnancy but also the unhealthy behaviors that could lead to the adverse pregnancy outcomes. Also, since Utah has the highest birth rate in the United States and the research has shown that PCH has many benefits on maternal and infant health, this project is also considered necessary (UDOH, 2017a).

Moreover, this program is significant because multiple studies have shown potential savings by preventing the unintended pregnancies as well as the negative consequences of pregnancy. For example, by averting all unintended pregnancies in 2010 in the United States, the potential savings would have been $15.5 billion (Sonfield, & Kost, 2015). Also, it has been demonstrated that publicly funded family planning services saved taxpayers $13.6 billion in 2010, or $7.09 for every $1 spent in helping women avoid unintended pregnancies as part of family planning program (Frost, Sonfield, Zolna, & Finer, 2014). Locally, if we look at family planning, publicly funded family planning centers in Utah helped avert 10,900 unintended pregnancies in 2014, so our program will increase the benefit.

Multiple studies have shown a positive impact of PCH education on individuals’ behaviors as well as on pregnancy outcomes. For example, a study by Bastani, Hashemi, Bastani, and Haghani (2010) has evaluated the impact of PCH education on self-efficacy in women. The study concluded that short-term health educational intervention may empower women to adopt healthy lifestyles. Another study by Moss and Harris (2015) has demonstrated that both maternal and paternal preconception health conditions and behaviors influenced infant birth outcomes.

The PPE program will train and use peer educators as local experts on PCH at Westminster. It has been shown that peer educators can communicate and understand with their peers in a way better than the adults and can serve as role models for change. Peer educators can also help raise awareness and aid their peers in changing their behavior. School-Based peer education is useful, particularly for young people according to UNICEF (2012). Peer educators also can gain the respect of their peers. They can foster fulfilling relationships between teachers and students.

Theoretical Foundations

The PPE program is based on Health behavior change. Health behavior change is a central objective in public health interventions with an increased focus on prevention prior to the onset of disease. Health behavior change through the Health Belief Model, which is a psychological model that attempts to explain and predict health behavior, can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities. Peer educators will apply this theory/model in providing the sessions to their peers. Peers will be engaged in preventive health behaviors against unplanned pregnancy as well as the undesirable pregnancy outcomes. Engagement of childbearing women in self-management behaviors is seen as the short-term outcome influencing the long-term distal outcome of preventing unintended pregnancies and improving the health status of the mother and the baby.

Literature Review

A review of the literature was conducted to review the data on unplanned pregnancies and pre pregnancy unhealthy behaviors associated with adverse pregnancy outcome. A literature search was conducted using The US National Library of Medicine as our primary search engine to ascertain the most recent and most relative findings. The US National Library of Medicine (PubMed) comprises more than 26 million citations for biomedical literature from MEDLINE, life science journals, and online books. Our literature search included expert review groups, including the UDOH, World Health Organization (WHO), Guttmacher institute, and Centers for Disease Control and Prevention (CDC).

Contribution to Public Health

This program has shown to be effective in raising the awareness and providing the knowledge and skills in making reproductive decisions, particularly among college students. This program has the potential to reduce unexpected pregnancies and provide knowledge in areas that include family planning, contraception methods, healthy diet and exercise, high-risk behaviors, sexual health, mental health, as well as role of men in PCH to improve pregnancy outcomes in the long-term.

Program Design

The PPE program will adhere to the following mission, goals, objectives, and activities to increase awareness about PCH in an aim to reduce the rate of unintended pregnancies as well as unhealthy behaviors that could affect pregnancy outcomes.

Mission Statement

The PPE program’s mission is to promote PCH among college-age population through peer to peer education that allows all peers to learn successfully then ultimately aims to reduce the risk of unintended pregnancy and pre pregnancy unhealthy behaviors thereby improving pregnancy outcomes.

Program Goals

As established previously, unplanned pregnancies as well as pre-pregnancy unhealthy behaviors pose a risk for both maternal and infant health outcomes. The PPE program will address health behaviors of college-age women and their male partners at Westminster University before becoming pregnant to reduce the rate of unintended pregnancies as well as improve pregnancy outcomes.

Health educator from the UDOH’s Bureau of MCH will conduct a training to teach the participating students from Westminster University on PCH and prepare them for educating their peers about it. They will be provided with the training manual (developed by the researcher during the summer of 2017) as a guide and reference. Then the peer educators will apply their new training skills to the Westminster college’s campus in a peer to peer campaign. The intervention will establish the efficacy of the program to increase the knowledge about PCH and recognition of pre-pregnancy unhealthy behaviors among the college-age population.

The research studies include survey to measure the peer educators’ satisfaction with the training as well as a quantitative non-randomized observational study in the form of pre and post questionnaires to assess the PCH knowledge of the participating students in the campaign. The pre and post questionnaires are adapted from the A Healthy Baby Begins with You, which is a national campaign that aims to promote awareness of infant mortality within the African American community (mentioned earlier under the background of PPH program), and modified by the researcher to focus more on PCH and planning pregnancies.

As mentioned earlier, the program will be first implemented on the Westminster University campus. The next generation/cohort of graduate students will continue implementing the program in Westminster University in the following years and also in other colleges and universities across Utah.

Spring Semester Plan

A peer educators’ training followed by a peer to peer campaign, in form of educational sessions, will be conducted during the spring semester, 2018. After the trainees complete the training, they will implement the campaign on campus and will assist in evaluating the PCH knowledge by the end of the campaign. Review the logic model of the PPE program in Appendix G.

This timeframe is tentative due to the primary tasks of peer educators training and the peer to peer campaign. These two tasks are dependent on campus schedules, health educator, and availability or rooms. Although the intent of this intervention is to complete all goals and objectives by April 2017, due to factors that may be outside of the researcher’s control, this intervention may not be completed 100% by April 2018. 

The following program goals and objectives will outline how the PPE intervention will accomplish our mission:

Goal 1: Train Students from Westminster University to Become Peer Educators on PCH.

Process objectives:

• By mid of January 2018, the manual will be reviewed and, if necessary, adjusted in collaboration with the health promotion coordinator of the MIHP at the UDOH’ Bureau of MCH. Meeting with the health promotion coordinator of the MIHP will take place to ensure the contents of the manual are appropriate, particularly the teaching guide section.

• By the end of January 2018, announcement methods and resources of the peer educators’ training and the peer to peer campaign will be identified and arranged.

Ideas from the health promotion coordinator of the MIHP, the dean of students, and the faculty members of the MPH have to be considered. Such ideas for the announcements include e-mails to Westminster University students, posts on the Westminster University group’s Facebook site, and hang on posters on campus boards and residents’ halls.

• By February 2018, the announcement about the peer educators’ training will be made and will continue until the day before the training.

• Qualifications for peer educators include undergraduate students with nursing or public health majors.

• The program coordinator can arrange for passing by the undergraduate public health and nursing classes to give the students idea about the program and provide them with some options of dates and time of the training, then ask those who are interested about their best options. The program coordinator can then arrange for reserving a room for the training at Westminster college. After identifying the dates, times and place of the training, the program coordinator can start the process of the advertising. He, or anyone else, will communicate with the respondents via emails to enroll the qualified ones.

• By the end March 2018, the peer educators’ training will be conducted and approximately six college age students will be recruited and trained.

  • The training is two-day training, one week apart. It will be conducted by the health promotion coordinator of MIHP at the UDOH's Bureau of MCH. The first day of training will be completed in about four hours and will educate the participants on PCH. By the end of day one, each trainee will be assigned to a specific part of what have been covered to educate the peers about it during the campaign. The second day of training will last for about two hours during which the trainees will be given the opportunity to practice delivery of the training content.

Outcome objectives:

• The trainees will, during the training, increase their knowledge of about PCH.

• The trainees will learn how to educate their peers about methods to lower the risk of unintended pregnancies and adverse pregnancy outcomes.

• The trainees will successfully implement the campaign’s educational sessions on campus.

Resources, incentives and activities:

• Program coordinator

• Health educator

• Resources for the training announcement

• Person to process the training announcement

• Person to enroll the peer educators.

• Meeting space for the training at Westminster University

• Compensation for the training participants (such as food, snack, and beverages).

• The PPE training manuals for the peer educators to be used as a guide.

• Resources to support the training

• Training coordinator

• Feedback by the health educator for the trainees to develop peer leaders’ educator skills.

• Incentives for the peer educators targeted toward completion of the training and the satisfaction survey (such as gift cards).

• Research coordinator to evaluate the trainees’ satisfaction about the training.

Evaluation:

• Process objective 1, 2, and 3: Evaluated by successful recruitment of approximately six college age students from Westminster Collage.

• Process objective 4, and outcome objective 1, 2, and 3: Evaluation based on feedback from the trainees on the content and the pace of training. This will be done by end of training in form of a survey (see Appendix A) as a descriptive study with a qualitative assessment/analysis to measure the trainees’ satisfaction about the training. This will help to adjust the lessons, if necessary, for the future applications of the program. These objectives will be also evaluated by non-randomized observational study in form of pre and post questionnaires which will be given later to the peer to peer campaign attendants to assess the impact of the intervention on their knowledge about PCH. The pre and post results will be analyzed by applying proportions and a 95% chi square test with a Fisher’s exact when necessary. (See Appendix B - Preconception Pre Test -, Appendix C – Preconception Post Test -, and Appendix D - Preconception Test Answer Key -). Feedback from the health educator will be also considered.

Goal 2: Increase Knowledge toward PCH among College-Age Population in Westminster University.

Process objectives:

• By mid of March 2018, and while the peer educators’ training is going on, the announcement about the peer to peer campaign will be made and will continue until the end of the campaign. The campaign will be conducted on two days.

  • The class schedules of undergraduate students and their availability on campus as well as the availability of the rooms must be considered before selecting the dates and times of the campaign to increase the chance of having some participants during the campaign’s educational sessions. Also, the peer educators can be asked during the first day of the training about their preferences.

  • An arranging for having a booth with sign-up sheets one day before the campaign initiated as well as on each day of the campaign, prior to start the sessions, in addition to the other methods of advertising, can be considered to increase the chance of having more participants during the event.

• By the beginning of April 2018, the campaign will be conducted including two educational sessions and approximately 15 students will be recruited. The campaign will be conducted in two days with one session on each day that will last for about one and half hours including the lunch break.

• By the end of April 2018, the impact of the intervention will be identified through the evaluation methods.

Outcome objectives:

• Peer educators will explain and practice all activities within the structured sessions.

• The campaign participants will Increase their knowledge about PCH

Resources and Activities:

• Program coordinator

• Resources for the campaign announcement

• Person to process the campaign announcement

• Resources to support the campaign

• Space for the campaign at Westminster University.

• Campaign coordinator

• Incentives for the campaign participants targeted toward completion of the pre and post questionnaires (such as gift cards)

• Compensation for the campaign participants (such as food and beverages)

• Research coordinator to evaluate the impact of the program.

Evaluation:

• Process objective 1, 2 and 3, and outcome objective 1 and 2: Evaluated by successful recruitment of approximately 15 students from Westminster Collage. They will also be evaluated by non-randomized observational study in form of pre and post questionnaires that previously mentioned to be given to each participant immediately by the start and end of each session to assess the impact of the intervention on their knowledge about PCH. The pre and post results will be analyzed by applying proportions and a 95% chi square test with a Fisher’s exact when necessary. (See Appendix B - Preconception Pre Test -, Appendix C – Preconception Post Test -, and Appendix D - Preconception Test Answer Key -)

Timeline for Implementation:

October 2017:

Gain IRB approval (approved)

January 2018:

Complete review of the manual

February 2018:

Arrange for and prepare materials of the announcement about the peer educators’ training and the peer to peer campaign

Identify dates, time, and location the peer educators’ training

Make the announcement about the peer educators’ training

March 2018:

Train the peer educators

Identify dates, time, and location of the peer to peer campaign

Make the announcement about the peer to peer campaign

April 2018:

Conduct the peer to peer campaign

Identify the impact of the intervention

Research Plan:

The following question is necessary to consider in order to implement this program: Is the PPE program effective in rising the knowledge about PCH among college age population at Westminster University in Utah?

The expected outcomes:

• 90% of participants in the peer educators’ training will be satisfied by the training.

• 90% of participants in the peer to peer campaign will increase their knowledge by end of the campaign’s educational sessions.

Study Methodology

The main research method for our study is quantitative non-randomized observational study, which will be conducted in the form of pre and post intervention questionnaires (See Appendix B and Appendix C). The data will be collected from the participants at the start and end of the peer to peer campaign, the same participants will serve as their own controls. As mentioned earlier, this type of study will be performed to evaluate the difference caused by the intervention by assessing the students’ knowledge of PCH before and after the campaign. Demographic questions will be included in the pre-questionnaire in order to make sure that the participants are from our target population. Another secondary method includes a descriptive study with a qualitative assessment/analysis in the form a survey (See Appendix A) to be given by the end of the training in order to assess the peer educators’ satisfaction with the training to improve it, if necessary, in the future applications. All participants who will attend the training and the peer to peer campaign will sign a consent form (See Appendix E and F) to participate and will be thoroughly briefed on the study. The questionnaire consists of nine questions. All of them were multiple choice questions concerning the PCH knowledge. The pre questionnaire contains additional information about gender, age, race/ethnicity, and educational level. The survey consists of seven questions, question 4 is comprised of five questions about the degree of satisfaction participants felt in the meetings.

Types of questions in the survey include rating scale questions, open ended questions, and dichotomous questions

Data Collection Methods

As mentioned above, a volunteer will communicate with the respondents to the announcement of the peer educator’s training to recruit the qualified ones. The consent forms will be handed out to the participants at the start of the training and the campaign’s educational sessions before given them the pre questionnaire. The preliminary demographic questions will be collected in the first part of the pre-questionnaire. The second part of the pre-questionnaire, as well as the post-test, will include questions about PCH. The aim for the training is to recruit approximately six college-age students. Qualifications for peer educators include undergraduate students with nursing or public health majors. The aim for campaign’s educational sessions is to have approximately 15 students. Inclusion criteria for the peer to peer campaign include any college-age student at Westminster University. No one will be excluded by race, ethnicity, income level, marital status, or residency status. The satisfaction surveys will be handed out to the peer educators by the end of training.

Statistical Methodology

Statistical test that the researcher will apply are descriptive statistics and a 95% chi square with a Fisher’s exact (if numbers are 5 or less).

Human Subjects

No human subjects will be tested. Satisfaction surveys and pre and post questionnaires will be administered by the program coordinator, the health educator and the peer educators. No anticipated adverse health effects only mild stress.  

Children’s Health Considerations

One of the greatest concerns to public health is the unique vulnerabilities of infants and children. Infants and children are at a greater risk than adults as their bodies are constantly changing. The specific intervention will neither directly nor indirectly adversely impact children. No children will be included.

Barriers and Limitations

Limitations within the study are likely to occur through the sampling and advertisement phase. The goal is to achieve a representative sample of our target population by implementing the program on Westminster University’ campus, in which nearly 50% of the students are between age of 18 to 22. With sufficient numbers, the study can be more accurate. Foreign language needs are another limitation of the study. Also, there is a possibility of a drop of students during the study. The campaign participants might not complete the educational sessions or fill out the post test, this might affect the evaluation.

Conclusion

It has been established that college-age population have high birth rate and high risk of unintended pregnancies and pre pregnancy unhealthy behaviors. With the support of Westminster University administration and its public health program as well as UDOH’s Bureau of MCH, the PPE program will engage the students in interactive educational sessions, that are going to be conducted by trained peer educators in an aim to increase knowledge and awareness about PCH. This program is vital to help young women and their male partners plan for and have healthier pregnancies and infants. It has the potential to reduce unexpected pregnancies

and pre pregnancy unhealthy behaviors thereby improving the pregnancy outcomes.

Administrative Responsibilities

All data collected will be stored in a password-protected folder within a computer. All data will be kept confidential. Only the Principal Investigators, Dr. John Contreras and Nikki Palacios, MS, CHES, and the co-investigator Dr. May Samkari will have access to the data collected. Results will be shared with the UDOH and the Masters of Public Health Program.

Qualifications of Investigators

Dr. John R. Contreras is the faculty Director of the Masters in Public Health Program at Westminster University and has significant experience and expertise within epidemiology,

biostatics, program planning, and population-based research and will supervise and help carry out the focus groups and thematic analysis.

Nickee Palacios, MS, CHES is the health promotion coordinator of Maternal and Infant Health Program at Utah Department of Health’s Bureau of Maternal and Child Health, and she is also a Health Educator for the Maternal and Infant Health Program. She collaborates with local universities to implement a Peer Preconception Health Program. She also works with internal Utah Department of Health workgroups to educate women on importance of well-woman visit and preconception health. See resume attached.

Dr. May Samkari is a Masters of Public Health candidate in her second year at Westminster University. She has received a Certificate of Public Health from Westminster University and the NIH Protecting Human Subjects Research Subjects training certification. She has completed all the core MPH courses. She is also a trained physician.

 

References

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• Association of Maternal and Child Health Programs (AMCHP). (2015). Opportunities and strategies for improving preconception health through health reform. Retrieved from http://www.amchp.org/Transformation-Station/Documents/AMCHP%20Preconception%20Issue%20Brief.pdf
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• Bastani F1, Hashemi S, Bastani N, & Haghani H. (2010). Impact of preconception health education on health locus of control and self-efficacy in women. East Mediterr Health J.16(4), 396-401.
• Behrman, R. E., & Butler, A. S. (2007). Preterm Birth: Causes, consequences, andprevention. Washington, DC: Institute of medicine, The national academies press.
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• Centers for Disease Control and Prevention (CDC). (2016a). Preconception health and health care. Retrieved from https://www.cdc.gov/preconception/women.html
• Centers for Disease Control and Prevention (CDC). (2016b). Infant mortality. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
• Centers for Disease Control and Prevention (CDC). (2016c). Health equity. Retrieved from https://www.cdc.gov/family/college/index.htm
• Centers for Disease Control and Prevention (CDC). (2016d). Maternal health. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/aag/maternal.htm
• Centers for Disease Control and Prevention (CDC). (2016e). Reproductive health - CDC preterm birth activities. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
• Centers for Disease Control and Prevention (CDC). (2017a). Preterm birth. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
• Centers for Disease Control and Prevention (CDC). (2017b). Alcohol and public health. Retrieved from https://www.cdc.gov/alcohol/factsheets/binge-drinking.htm
• Centers for Disease Control and Prevention (CDC). (2017c). Folic acid. Retrieved from https://www.cdc.gov/ncbddd/folicacid/about.html
• Centers for Disease Control and Prevention (CDC). (2017d). Smoking & tobacco use - Quitting smoking. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm
• College Factual. (n.d.). Westminster University Utah diversity: How diverse is it, really?. Retrieved from https://www.collegefactual.com/colleges/westminster-college-utah/student-life/diversity/#secOverall
• Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine 374(9), 843–852. doi: 10.1056/NEJMsa1506575=-
• Flores, M. E. S., Turok, D. K., & Jacobson, J. (2012). Differences in birth control use and unintended pregnancy among Latina and white populations giving birth in Utah, 2004–2007. In Contraception 85(3), 321. doi: 10.1016/j.contraception.2011.11.036
• Frost, J. J., Sonfield, A., Zolna, M. R., & Finer, B. F. (2014). Return on investment: A fuller assessment of the benefits and cost savings of the US publicly funded family planning program. Milbank Quarterly 92 (4): 696–749. doi: 10.1111/1468-0009.12080
• Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education theory: research, and practice (Fourth ed.). San Francisco, CA: Jossey-Bass.
• Guttmacher Institute. (2017). State facts about unintended pregnancy: Utah. Retrieved from https://www.guttmacher.org/geography/northern-america/united-states/utah
• Guttmacher Institute. (2016). Unintended Pregnancy in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states#8
• U.S. Department of Health and Human Services Office of Minority Health (HHS OMH). (2017a). A healthy baby begins with you. Retrieved from https://www.minorityhealth.hhs.gov/omh/content.aspx?ID=8394&lvl=3&lvlID=8
• HHS OMH. (2017b). Preconception peer educators. Retrieved from https://www.minorityhealth.hhs.gov/omh/content.aspx?ID=10240&lvl=3&lvlID=9
• HER Salt Lake. (2016). Retrieved from http://www.hersaltlake.org/
• Lassi, Z. S., Mansoor, T., Salam, R. A., Das, J. K., & Bhutta, Z. A. (2014). Essential prepregnancy and pregnancy interventions for improved maternal, newborn and child health. Reproductive Health 11(1), pp. S2. doi: 10.1186/1742-4755-11-S1-S2
• MacDorman, M. F., & Mathews, M.S. (2011). Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS Data Brief 74.
• MacDorman, M. F., Mathews, M.S., Mohangoo, A. D., & Zeitlin, J. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010. National Vital Statistics Reports 63(5).
• Moss, J. L., & Harris, K. M. (2015). Impact of maternal and paternal preconception health on birth outcomes using prospective couples’ data in Add Health. Archives of Gynecology and Obstetrics 29(2), 287–298.
• National Institutes of Health (NIH). (2017). Neural tube defects. Retrieved from https://medlineplus.gov/neuraltubedefects.html
• Planned Parenthood Association of Utah. (n.d.). Planned parenthood association of Utah. Retrieved from https://www.plannedparenthood.org/planned-parenthood-utah
• Sedgh, G., Singh, S., & Hussain, R. (2014). Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in Family Planning 45(3), pp. 301-314.
• Singh S, Sedgh G., & Hussain R. (2010). Unintended pregnancy: Worldwide levels, trends and outcomes. Studies in Family Planning 41(4), 241–250.
• Sonfield, A., Hasstedt, K., and Gold, R. B. (2014). Moving forward: Family planning in the era of health reform. Guttmacher Institute.
• Sonfield, A., Hasstedt, K., Kavanaugh, M. L., & Anderson, R. (2013). The Social and economic benefits of women’s ability to determine whether and when to have children.
• Sonfield, A., & Kost, K. (2015). Public costs from unintended pregnancies and the role of Public insurance programs in paying for pregnancy-related care: National and state estimates for 2010. Guttmacher Institute
• Squiers, L., Mitchell, E. W., Levis, D. M., Lynch, M., Dolina, S., Margolis, M., … Levis, D. M. (2013). Consumers' perceptions of preconception health. American Journal of Health Promotion 27, S10-S19. 20p. doi: 10.4278/ajhp.120217-QUAL-95
• The State of Obesity. (n.d.). Prenatal and Maternal Health. Retrieved from https://stateofobesity.org/prenatal-maternal-health/
• United Nations International Children's Emergency Fund (UNICEF). (2012). Peer education. Retrieved from https://www.unicef.org/lifeskills/index_12078.html
• Utah Department of Health (UDOH). (n.d.a). Before pregnancy. Retrieved from https://mihp.utah.gov/before-pregnancy#
• Utah Department of Health (UDOH). (n.d.b). Maternal and infant health program –Before Pregnancy. Retrieved from https://mihp.utah.gov/before-pregnancy#
• Utah Department of Health (UDOH). (n.d.c). Power your life. Retrieved from http://poweryourlife.org/
• Utah Department of Health (UDOH). (2015). Health indicator report of obesity in pregnancy. Retrieved from https://ibis.health.utah.gov/indicator/view/ObePre.html
• Utah Department of Health (UDOH). (2016a). Health indicator report of births from unintended pregnancies. Retrieved from https://ibis.health.utah.gov/indicator/view/UniPreg.html
• Utah Department of Health (UDOH). (2016b). Health indicator report of infant mortality. Retrieved from https://ibis.health.utah.gov/indicator/view/InfMort.html
• Utah Department of Health (UDOH). (2016c). Health indicator report of maternal mortality. Retrieved from https://ibis.health.utah.gov/indicator/view/MatMort.YearIntrvls.html
• Utah Department of Health (UDOH). (2016d). Health indicator report of preterm birth. Retrieved from https://ibis.health.utah.gov/indicator/view/PreBir.html
• Utah Department of Health (UDOH). (2017a). Complete health indicator report of birth rates. Retrieved from https://ibis.health.utah.gov/indicator/complete_profile/BrthRat.html
• Utah Department of Health (UDOH). (2017b). Health indicator report of diabetes: Gestational diabetes. Retrieved from https://ibis.health.utah.gov/indicator/view/DiabGestDiab.html
• Utah Department of Health (UDOH). (2017c). Query results for Utah's Pregnancy Risk Assessment and Monitoring Survey (PRAMS) query Module - Diet before pregnancy (2009 and later). Retrieved from https://ibis.health.utah.gov/query/result/prams/PreDiet/PreDiet.html
• Utah Department of Health (UDOH). (2017d). Query builder for Utah's pregnancy Risk Assessment and Monitoring Survey (PRAMS) query module - Taking multivitamin. Retrieved from https://ibis.health.utah.gov/query/result/prams/Vit/Vit.html
• Utah Department of Health (UDOH). (2017e). Query results for Utah's Pregnancy Risk Assessment and Monitoring Survey (PRAMS) query module - Drank 3 months before pregnancy. Retrieved from https://ibis.health.utah.gov/query/result/prams/Drank3MonthBefPreg/Drank3MonthBefPreg.html
• WebMD. (n.d.). Pregnancy and prenatal vitamins. Retrieved from http://www.webmd.com/baby/guide/prenatal-vitamins#1
• What is Preconception Peer Educators. (2015). Retrieved from https://preconceptionpeereducators.wordpress.com/category/ppe-program-2/
• World Health Organization (WHO). (2015). Maternal mortality and morbidity in the United States of America. Retrieved from http://www.who.int/bulletin/volumes/93/3/14-148627/en/

 

Appendix A

Peer Educators’ Satisfaction Survey

We want to know what you think about the Peer Educators’ Training that you attend. Your answers will help us to hold meetings that are helpful to you and your peers. Your responses are greatly appreciated. (All submissions are anonymous.)

1. Have you attended a peer educators meeting before?

1. Yes

2. No

1. How comfortable are you in the Preconception Peer Educators’ Training meetings?

1. Not at all

2. Moderately

3. Quite comfortable

1. How would you rate the quality of the training you attended?

1. Poor

2. Okay

3. Good

4. Excellent

1. Would you recommend the Preconception Peer Educators’ Training to others?

1. Would not

2. Probably would

3. Definitely would

1. Please let us know how satisfied you are with the Preconception Peer Educators’ Training you attended:

1. The times of the meetings

   1. Satisfied

   2. Dissatisfied

2. The tone or atmosphere of the group (do I feel welcome?)

   1. Satisfied

   2. Dissatisfied

3. The support I got from training members that helps me cope with stressful events

   1. Satisfied

   2. Dissatisfied

4. How the training was run

   1. Satisfied

   2. Dissatisfied

5. What training members talked about

   1. Satisfied

   2. Dissatisfied

1. How confident are you right now that you can work as a peer educator on preconception health?

1. Somewhat confident

2. Confident

3. Not confident

4. Somewhat not confident

1. What do you like most about the Preconception Peer Educators’ Training?

1. What direction would you would like to see the Preconception Peer Educators’ Training take in the future?

 

Appendix B

Preconception Pre Test

Part 1: Demographic Questions:

Circle the most applicable answer(s) to each statement or fill in the blank.

1. What is your gender?

1. Male

2. Female

3. Other

1. Are you of a Hispanic, Latino or of Spanish origin

   1. Yes

   2. No

2. How would you describe yourself?

1. Native American or Alaskan Native

2. Asian

3. Native Hawaiian or other Pacific Islander

4. Black or African American

5. White

6. Other (Please specify) ______________

1. How old are you? ____________

2. What is your level of education? ________________

Part 2: Preconception Health Questions:

Circle the correct answer to each statement

1. What do you think the percentage (%) of pregnancies are unplanned?

a. 25%

b. 50%

c. 75%

d. 100%

2. What is the crucial period of fetal development?

a. Second trimester of pregnancy

b. Last month of gestation

c. First 3 months of gestation

d. All of above

3. Neural tube defects are conditions that can be often prevented by:

a. Exercising

b. Increasing folic acid consumption before conception

c. Wearing face mask around toxic chemicals

d. Vitamin D supplement

4. Unplanned pregnancies are at greater risk of

1. Preterm births

2. Low birth weight

3. Smoking or drinking during pregnancy

4. All of the above

5. Women who __________ need to take folic acid.

a. Are pregnant

b. Plan to become pregnant

c. Do not plan to become pregnant

d. All of the above

6. Men who __________ can have problems with their sperms, and these might cause women to have problems getting pregnant.

a. Drink a lot

b. Smoke

c. Use drugs

d. all of the above

7. Women should make an appointment with their doctors to discuss their preconception health at least _________ before becoming pregnant.

a. Three months

b. Seven days

c. Two weeks

d. All of the above

8. The best way to reduce the risk of unintended pregnancy among women who are sexually active is:

1. Hormonal Methods

2. Barrier Methods

3. Withdrawal Method

4. Using the birth control method correctly and consistently

9. Overweight or obese women are encouraged to reach a healthy body weight before

becoming pregnant to prevent:

a. Difficulties conceiving

b. Small-for-gestational age infants

d. Maternal health problems during pregnancy

e. A & D

 

Appendix C

Preconception Post Test

Circle the correct answer to each statement.

1. What do you think percentage (%) of pregnancies are unplanned?

a. 25%

b. 50%

c. 75%

d. 100%

2. What is the crucial period of fetal development?

a. Second trimester of pregnancy

b. Last month of gestation

c. First 3 months of gestation

d. All of above

3. Neural tube defects are conditions that can be often prevented by:

a. Exercising

b. Increasing folic acid consumption before conception

c. Wearing face mask around toxic chemicals

d. Vitamin D supplement

4. Unplanned pregnancies are at greater risk of

1. Preterm births

2. Low birth weight

3. Smoking or drinking during pregnancy

4. All of the above

5. Women who __________ need to take folic acid.

a. Are pregnant

b. Plan to become pregnant

c. Do not plan to become pregnant

d. All of the above

6. Men who __________ can have problems with their sperms, and these might cause women to have problems getting pregnant.

a. Drink a lot

b. Smoke

c. Use drugs

d. All of the above

7. Women should make an appointment with their doctors to discuss their preconception health at least _________ before becoming pregnant.

a. Three months

b. Seven days

c. Two weeks

d. All of the above

8. The best way to reduce the risk of unintended pregnancy among women who are sexually active is:

1. Hormonal Methods

2. Barrier Methods

3. Withdrawal Method

4. Using the birth control method correctly and consistently

9. Overweight or obese women are encouraged to reach a healthy body weight before

becoming pregnant to prevent:

a. Difficulties conceiving

b. Small-for-gestational age infants

d. Maternal health problems during pregnancy

e. A & D

 

Appendix D

Preconception Test Answer Key

Correct answers are bolded below.

1. What do you think percentage (%) of pregnancies are unplanned?

a. 25%

b. 50%

c. 75%

d. 100%

2. What is the crucial period of fetal development?

a. Second trimester of pregnancy

b. Last month of gestation

c. First 3 months of gestation

d. All of above

3. Neural tube defects are conditions that can be often prevented by:

a. Exercising

b. Increasing folic acid consumption before conception

c. Wearing face mask around toxic chemicals

d. Vitamin D supplement

4. Unplanned pregnancies are at greater risk of

1. Preterm births

2. Low birth weight

3. Smoking or drinking during pregnancy

4. All of the above

5. Women who __________ need to take folic acid.

a. Are pregnant

b. Plan to become pregnant

c. Do not plan to become pregnant

d. All of the above

6. Men who __________ can have problems with their sperms, and these might cause women to have problems getting pregnant.

a. Drink a lot

b. Smoke

c. Use drugs

d. All of the above

7. Women should make an appointment with their doctors to discuss their preconception health at least _________ before becoming pregnant.

a. Three months

b. Seven days

c. Two weeks

d. All of the above

8. The best way to reduce the risk of unintended pregnancy among women who are sexually active is:

1. Hormonal Methods

2. Barrier Methods

3. Withdrawal Method

4. Using the birth control method correctly and consistently

9. Overweight or obese women are encouraged to reach a healthy body weight before

becoming pregnant to prevent:

a. Difficulties conceiving

b. Small-for-gestational age infants

d. Maternal health problems during pregnancy

e. A & D

Appendix E

Consent Form for the Peer Educators’ Training Participants

Institutional Review Board (IRB)

For the Protection of Human Subjects

Consent Form for Adults

Before agreeing to participate in this study, it is important that the following explanation of the proposed procedures be read and understood.  It describes the purpose, procedures, benefits and risks of the study. It also describes alternative procedures available and the right to withdraw from the study at any time. It is important to understand that no guarantee or assurance can be made as to the results.  See below.

You have been invited to participate in a research study, the purpose of which is to address health behaviors of women and their male partners before becoming pregnant in an aim to reduce the rate of unintended pregnancies and improve pregnancy outcomes in the long term. Then, assessing the impact the program on the knowledge about preconception health among the college-age population at Westminster University in Utah.

The study procedure has been identified as training the participants as peer educators on preconception health. The training is a two-day training. The first day of training will be completed in four and half hours, while the second day of training will last for two hours. The training will be conducted by the health promotion coordinator of maternal and infant health program at Utah department of health. After completing the training, the peer educators will implement a two-day peer to peer campaign, which involves conducting educational sessions on Westminster college campus during the spring semester, 2018.

The study will be accomplished within the spring semester, 2018. You will be notified of any significant variance from the stated duration of the study.

If you decide to participate in this study as a peer educator, we will ask you to fill out the satisfaction survey at the end of training. The survey will include questions to assess the participants’ satisfaction and the effectiveness of training to ensure conducting the best training in the future applications.      

Benefits that may occur from participation in this study are that it is an effective way of raising the awareness, the knowledge, and skills in making reproductive decisions. It has the potential to reduce unexpected pregnancies and improve pregnancy outcomes in the long-term.

Incentives will be given to student participants in the form of gift cards and foods.

INVESTIGATORS:

There are no foreseeable side effects/ risks associated with this project, other than the possibility of mild stress. However, some side effects/risks may be unforeseeable.

Your participation in this study is entirely voluntary, and you may withdraw from the study any time you wish without any penalty to you.  

If you have any questions about this study or wish to withdraw, please contact:

Dr. John Contreras 1-801-832-2179

Nikki Palacios              1-801-273-2869 

If you have any questions regarding your rights as a research participant, please contact:

Sheryl Steadman 1-801.832.2164

Chair of IRB   Phone:

All personally identifiable study data will be kept confidential.  However, the results of this study may be made available to you upon request or used in formal publications or presentations.

If you feel that you have received a satisfactory explanation as to the risks and benefits of this study as well as your rights as a research participant and you would like to participate, please sign and date below.  You will be given a copy of this form for your records.

Appendix F

Consent Form for the Peer to Peer Campaign Participants

Institutional Review Board (IRB)

For the Protection of Human Subjects

Consent Form for Adults

Before agreeing to participate in this study, it is important that the following explanation of the proposed procedures be read and understood.  It describes the purpose, procedures, benefits and risks of the study. It also describes alternative procedures available and the right to withdraw from the study at any time. It is important to understand that no guarantee or assurance can be made as to the results.  See below.

You have been invited to participate in a research study, the purpose of which is to address health behaviors of women and their male partners before becoming pregnant in an aim to reduce the rate of unintended pregnancies and improve pregnancy outcomes in the long term. Then, assessing the impact the program on the knowledge about preconception health among the college-age population at Westminster University in Utah.

The study procedure has been identified as training the participants as peer educators on preconception health. Then the trainees will implement a peer to peer educational campaign during the spring semester, 2018, which will involve educational sessions that last for about one and half hours.

The study will be accomplished within the spring semester, 2018. You will be notified of any significant variance from the stated duration of the study.

If you decide to participate in this study as a campaign participant, we will ask you to fill out a questionnaire at the start of sessions, and then fill out the same questionnaire at the end of sessions. The questionnaire will include questions about preconception health to assess the knowledge before and after the educational sessions to help identify the impact of the program. It will also include preliminary demographic questions in order to make sure that the participants are from our target population.                  

Benefits that may occur from participation in this study are that it is an effective way of raising the awareness, the knowledge, and skills in making reproductive decisions. It has the potential to reduce unexpected pregnancies and improve pregnancy outcomes in the long-term.

Incentives will be given to student participants in the form of gift cards and foods, backpacks, folic acids, and condoms.

INVESTIGATORS:

There are no foreseeable side effects/ risks associated with this project, other than the possibility of mild stress. However, some side effects/risks may be unforeseeable.

Your participation in this study is entirely voluntary, and you may withdraw from the study any time you wish without any penalty to you.  

If you have any questions about this study or wish to withdraw, please contact:

Dr. John Contreras 1-801-832-2179

Principal Investigator Phone:

Nikki Palacios              1-801-273-2869 

If you have any questions regarding your rights as a research participant, please contact:

Sheryl Steadman 1-801.832.2164

Chair of IRB   Phone:

All personally identifiable study data will be kept confidential.  However, the results of this study may be made available to you upon request or used in formal publications or presentations.

If you feel that you have received a satisfactory explanation as to the risks and benefits of this study as well as your rights as a research participant and you would like to participate, please sign and date below.  You will be given a copy of this form for your records.

Appendix G

The PPE Program Logic Model

---

Master’s in Public Health

Makkah, Saudi Arabia

Maternal and child health is May’s passion and field of interest. She also loves traveling and exploring different cuisines, and self describes as obsessed with décor and beauty. She started work on this program last summer as her practicum project when her advisor recommended it to her. May worked closely with the health promotion coordinator of the maternal and infant program at the UDOH Bureau of Maternal and Child Health, who gave her the opportunity to continue working on this project as a capstone in school. As a medical graduate in Saudi Arabia, May worked as a pediatric resident. She is also a mom to a 3 year old boy, and so spreading awareness surrounding maternal and child health is very close to May’s heart.