Consequences of surveying folate awareness

Objectives  To assess women's concerns when interviewed about the association between folate and neural tube defects (NTDs) and to determine how this is affected by time, being folate aware, having seen folate promotional material or being pregnant.
Design  As part of a community randomized trial outcomes evaluation, independent cross-sectional follow-up surveys were carried out in 1997 and 2000.
Setting and participants  Six local government areas in the state of Victoria, Australia; 2431 women aged between 15 and 44 years.
Main variables studied  Whether or not women knew of the association between folate and NTDs (i.e. were folate aware), whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them.
Results  In the 1997 survey, 36% of women said that the interview had raised concerns and this decreased to 26% in 2000. Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware (OR_adj= 0.38, 95% CI 0.24–0.60). In general, women who had seen promotional material were less likely to feel concern about the interview than those who had not, although this varied with whether or not the promotional material had raised concerns. These effects were greater in women who were pregnant.
Conclusions  Women had increased concerns having seen folate promotional material and after being interviewed about it. These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change.