Preconceptional Health Promotion Among Low-income Rural Women: The Central Pennsylvania Women's Health Study

Because the determinants of adverse pregnancy outcomes include health-related behaviors and socially determined risk factors, opportunities exist to improve preconceptional health and pregnancy outcomes in community settings as well as in clinical care settings. The objective of this research was to test a multidimensional behavioral intervention to improve low-income rural Pennsylvania women's health-related behaviors. The Strong Healthy Women program was developed to modify behaviors related to stress management, nutrition, physical activity, alcohol/substance use, smoking, and prevention of gynecologic infections, all of which were prevalent risk factors identified in a population-based survey of the target population. The intervention was tested in a randomized trial with 692 pre- and interconceptional women aged 18-35. The intervention was conducted with small groups of women in six two-hour sessions held over a three-month period. Pre- and post-intervention measures of self-efficacy for behavior change, intent to change behavior, health-related behaviors, and biomarkers were analyzed, controlling for appropriate covariates. Intervention participants were more likely to exhibit self-efficacy for eating healthy foods (p=.018), and to express an intent to eat healthier foods (p=.008) and to be more physically active (p<001). Intervention participants were also more likely to report engaging in health behaviors including reading food labels for nutritional values (p=.001), meeting recommended exercise guidelines (p=.019), and taking a multivitamin with folic acid daily (p<.001). These results suggest that specific pre- and interconceptional health-related behaviors can be improved among low-income rural women.