Folate knowledge, intake from fortified grain products, and periconceptional supplementation patterns of a sample of low-income pregnant women according to the Health Belief Model

Objective. This study assessed folate-related knowledge and behaviors and folate intake from grain products, assuming 1998 fortification requirements, of socioeconomically disadvantaged pregnant women. Design. Interviews (based on the Health Belief Model) concerning folate,and neural tube defects were conducted in a prenatal care clinic. Subjects/setting. The convenience sample of 251 low-income, predominantly minority, pregnant women received services in an Atlanta, Georgia, public hospital. All subjects were eligible for or enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. Statistical analyses. Frequency counts, means, and standard multiple linear regression. Results. More than 80% of subjects did not take supplements preconceptionally. Many subjects (57%) had heard of folate, but fewer could correctly define folate (26%) or list any food sources of folate (30%). Most subjects (77%) will be able to achieve the goal of 400 mu g folate per day exclusively through intake of fortified grain products. Approximately 20% of subjects will consume in excess of 1,000 mu g folate per day solely through intake of fortified grains. Preconceptional use of supplements and several indicators of subjects' knowledge about folate were correlated with Health Belief Model constructs in manners consistent with the model framework. Applications/conclusions. This population of low-income women is likely to benefit substantially from folate fortification of grain products. However, health education remains essential for those women who ate still unable to meet their folate requirements. The Health Belief Model may serve as an effective framework for tailoring folate educational interventions to high-risk populations. Research must be conducted into the risks of long-term high intakes of folate.