Data to Action Success Story: Oklahoma

Using Oklahoma PRAMS Data to Influence Preconception and Interconception Care

Problem Overview

In 2006, the Centers for Disease Control and Prevention (CDC) published the journal article “Recommendations to Improve Preconception Health and Health Care for Women” in the United States. The premise of these recommendations is that improving women’s health, including management of chronic health conditions and reduction of health risk behaviors, could lead not only to healthier women, but could also improve infant outcomes in the event of a pregnancy. In Oklahoma, only 12% of new mothers reported receiving advice or counseling to help them prepare for becoming pregnant before their most recent pregnancy according to 2005-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) data. 

Program Activity Description

Following an evaluation of preconception health indicators in 2009 using Oklahoma PRAMS data, the Oklahoma Department of Health established the Preparing for a Lifetime, It's Everyone's Responsibility initiative, which included a Preconception/Interconception Care and Education Workgroup. The workgroup was charged with developing initiatives to improve preconception health. 

Program Activity Outcomes

The Preconception/Interconception Care and Education Workgroup has spearheaded several activities to promote preconception health. The Workgroup used PRAMS data to identify target populations in greatest need of preconception counseling and advice. “Before and Between Pregnancy,” public service announcement (PSA) for television and radio, was developed to increase awareness about the importance of being healthy before getting pregnant. In anticipation of the need to evaluate the campaign, supplemental questions were added to the 2010 PRAMS survey to collect baseline data before the statewide airing of the PSA in January and February of 2011. A second preconception PSA ran in late 2014 and 2015.

A preconception health tool to help women and their providers identify preconception health risks before pregnancy and understand how those risks might influence future pregnancies was implemented in 2013. The tool is being used by family planning clinics within county health departments; private clinics; tribal health facilities; and by Children First, the nurse home visiting program. The tool is also available upon request for others to use. An adolescent-focused version of the tool, called My Life. My Plan was also developed and pilot tested with a physicians’ group at the University of Oklahoma Medical Center. The adolescent-focused tool is intended to promote healthy lifestyles before adulthood, and to help teens set life goals related not only to family planning, but also for education and careers beyond high school. 

PRAMS data were used to affirm the need for preconception/interconception health care in Oklahoma and to identify populations most in need. The work informed practice, with the development of a preconception health tool targeting family planning clients in local health departments, federal qualified health centers (FQHCs), private and tribal clinics; policy in the development of an Oklahoma Health Improvement Plan (OHIP) measure to increase preconception health in the state; and awareness through the development of a television and radio PSA on the importance of preparing for pregnancy BEFORE becoming pregnant. In turn, the PRAMS survey tool was revised to incorporate the necessary elements to measure the American Congress of Obstetricians and Gynecologists (ACOG) standards recommended by OHIP for preconception care and an insert was developed to collect baseline data before the PSA aired and the tool went to clinics for testing. The Phase VII Oklahoma PRAMS survey includes those data elements needed to measure comprehensive and ACOG recommended preconception/interconception care for all new mothers in the state. The partnership with the Preconception/Interconception Care and Education Workgroup of the Preparing for a Lifetime, It’s Everyone’s Responsibility initiative has been invaluable in terms of meaningful data collection for states that have improved their Preconception/Interconception programs.