2.2. Strategy 2: Prenatal Education in Medically Underserved Clinics

Recognizing that pregnancy is a preferred time for mothers to receive information about NBS [10], Navigate NBS staff developed an educational initiative designed to support sharing information and increasing knowledge of NBS prior to delivery. To increase awareness and to reach medically underserved expectant mothers, Navigate NBS staff developed, tested, and implemented an initiative providing NBS education in two community-based obstetrics and gynecology clinics using an informational “flip book”. The initiative began in June 2021 and was piloted in a high-risk obstetrics clinic in Houston, Texas that served primarily Spanish-speaking pregnant women. To scale this project, Navigate NBS subsequently modified and tested the flip book with a second pilot site in a community health clinic that engaged midwives who support an Amish/Mennonite (Plain) community in the U.S. Midwest. Navigate NBS staff worked with families from the clinic’s community, providers, and clinic staff to create a prenatal education flip book and recruited NBS partners to share and disseminate the flipbook.

During routine, third-trimester visits, clinic staff invited expectant mothers to participate in the educational initiative by giving them an informational card, which included a QR code directing them to the digital flip book, and/or providing a paper copy of the flipbook. The NBS Prenatal Education Initiative was approved as QI Project No. 2021-1018 under the Harris Health IRB.

Participants at both sites were asked five questions both prior to reviewing the flip book (pretest) and after their review (posttest). These questions were designed to have one right answer and test participants’ knowledge of NBS. Most questions on the pretest and posttest were true or false. We shared correct answers with participants at the end of the posttest. To assess participants’ understanding of the definition of NBS, the tests presented a series of options, including different time periods and types of testing.

In R statistical software (Version 2021.09.0 Build 351), we used a series of Wilcoxon signed ranked tests for nonparametric data to assess pre- and posttest differences for each item. We calculated a total knowledge score for pre- and posttests by summing the number of correct responses, and then conducted a dependent-samples t-test to determine statistical significance. All tests used an α = 0.05 as a threshold to assess statistical significance.