Running head: FOLIC ACID 1

Increase Folic Acid Use in Women of Childbearing Potential

Allison Rogers

King University
FOLIC ACID 2

Increase Folic Acid Use in Women of Childbearing Potential

Objective Selection

The objective chosen for this project is to increase the proportion of women of

childbearing potential with intake of at least 400 micrograms (mcg) of folic acid from fortified

foods or dietary supplements (U. S. Department of Health and Human Services, Office of

Disease Prevention and Health Promotion [USDHHS, ODPHP], 2016). Significant amounts of

data show this recommendation has considerably decreased the development of neural tube

defects early in pregnancy, but there continues to be poor adherence to this recommendation.

This objective was chosen in hopes to educate the patient population in rural Southwest Virginia

served by The Health Wagon. This patient population is 100% indigent, having little or no other

means of delivery of health care, or health related education.

Objective Research

The first twenty-two to twenty-eight days after fertilization of the egg is when neural tube

defects, such as spina bifida, anencephaly, and encephalocele typically occur (Koken et al.,

2013). Studies show that adequate folic acid consumption decreases the likelihood of these

defects from forming (Fehr, 2011; Koken et al., 2013; Oza-Frank et al., 2015). Studies have

shown that diet alone does not usually provide enough folic acid in the average person, and

recommend supplementation with 400 mcg daily (Fehr et al., 2011; Koken et al., 2013). One-

half of the pregnancies in the United States are unplanned (Centers for Disease Control and

Prevention [CDC], 2016a; Fehr et al., 2011; Koken et al., 2013; Oza-Frank et al., 2015).

Therefore beginning the supplementation before conception is crucial to prevent these defects.

Data has shown that counseling women of childbearing age, about the importance of folic acid
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consumption, whether or not they plan to get pregnant, has improved compliance with daily

vitamin use (Koken et al., 2013; Oza-Frank et al., 2015)

Intervention Permission

In order to obtain permission to implement this process, a meeting with the clinical

supervisor, Paula Meade, will be set. All pertinent supportive data will be presented, as well as

the plan, estimated cost of implementation at this site, and how the cost will be covered. After

permission is granted, a short presentation will be provided to the nursing staff reinforcing the

urgency for this patient population to receive teaching on this subject each visit.

Implementation Plan

Each woman, from the ages of fifteen to forty-four, seen at the clinic will be provided a

handout, as well as instruction on the importance of folic acid supplementation, during review of

home medications. In order to reinforce information provided to the patient, flyers will be

printed, and posted in the waiting area and examination rooms. At each visit the health care

provider will discuss the importance of folic acid supplementation. After consultation with the

provider and proper understanding has been verified, folic acid 400 mcg will be provided with

dosage instruction, free of charge, to all female patients of childbearing potential if not currently

taking.

The area has an upcoming Remote Area Medical (R. A. M.) clinic serving the

community. Medically trained, as well as non-medical, volunteers are abundant at the event.

Volunteers will be asked to distribute preprinted handouts during the event, and advise that free

supplementation will be given after consultation with a health care professional at the event.

Plan Evaluation
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The plan for evaluation of learning is the teach-back method. At the end of each clinic

visit or consult at the R. A. M. clinic, the affected patient population will be able to demonstrate

competency of the information provided. Folate levels will be checked at each well-woman visit

in order to check for compliance with treatment regimen and gain insight if further teaching

needs to be implemented.

Plan Cost

Printable patient education materials are available, free of charge, on this subject material

from MedlinePlus and Centers for Disease Control websites (Centers for Disease Control,

2016b; MedlinePlus, 2016). The cost of the paper and ink needed to print handouts and flyers,

along with folic acid supplementation that will be provided to the patients, will be covered

through federal grants, such as Healthy Tomorrows Partnership for Children Program, and

donations made from local business and medical centers (U. S. Department of Health and Human

Services, Rural Health Information Hub, Health Resources and Services Administration, 2016).
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References

Centers for Disease Control and Prevention, National Center on Birth Defects and

Developmental Disabilities, Division of Birth Defects (2016a). Folic acid: Data and

statistics [Reviewed 2016, March 30]. Retrieved from:

http://www.cdc.gov/ncbddd/folicacid/data.html

Centers for Disease Control and Prevention, National Center on Birth Defects and

Developmental Disabilities, Division of Birth Defects (2016b). Folic acid: Facts about

folic acid [Reviewed 2016, April 28]. Retrieved from:

http://www.cdc.gov/ncbddd/folicacid/about.html

Fehr, K. R. S., Fehr, K. D. H., & Protudjer, J. L. P. (2011). Knowledge and use of folic acid in

women of reproductive age. Canadian Journal of Diabetic Practice and Research 72(4),

197-200. Doi: 10.3148/72.4.2011.197

Koken, G. N., Derbent, A. U., Erol, O., Saygin, N., Ayik, J., & Karaca, M. (2013). Awareness

and use of folic acid among reproductive age and pregnant women. Journal of Turkish-

German Gynecological Association 14, 187-191. Doi: 10.5152/jtgga.2013.81594

MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US) (2016). Folic Acid

[updated 2016, June 15]. Retrieved from:

https://www.nlm.nih.gov/medlineplus/folicacid.html#cat69

Oza-Frank, R., Kachoria, R., Keim, S. A., & Klebanoff, M. A. (2015). Provision of specific

preconception care messages and associated maternal health behaviors before and during

pregnancy. American Journal of Obstetrics & Gynecology, March 2015, 372.e1-372e8.

Doi: 10.1016/j.ajog.2014.10.027
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U. S. Department of Health and Human Services, Office of Disease Prevention and Health

Promotion [Internet]. (2016, June 18). Maternal, infant, and child health. Retrieved from

HealthyPeople.gov website: https://www.healthypeople.gov/2020/topics-

objectives/topic/maternal-infant-and-child-health/objectives

U. S. Department of Health and Human Services, Rural Health Information Hub, Health

Resources and Services Administration [Internet]. (2016). Healthy tomorrows

partnership for children program. Retrieved from:

https://www.ruralhealthinfo.org/funding/986