The Role of a State Public Health Initiative in Shaping Provider Knowledge, Beliefs and Practices

Congenital cytomegalovirus (cCMV) is the leading cause of viral birth defects and developmental delays in newborn infants in the U.S., infecting an estimated 0.4-0.8% of babies. While there is no cure for CMV, there are hygiene measures that can potentially reduce the risk of infection. The aim of this dissertation is to explore the impact of Utah's public health education intervention to increase pregnancy care provider awareness of cCMV preventative hygiene measures, knowledge, and counseling behaviors through a comparison to a similar comparison state without an intervention (Nevada). This observational study employed a mixed methods approach that utilized surveys and semi-structured interviews to explore: 1) What are the cCMV prevention counseling practices and knowledge among pregnancy care providers in Utah and Nevada? 2) What are providers' perceptions of barriers to educating patients about cCMV?

Pregnancy care providers (OB/GYNs, Maternal Fetal Medicine Physicians, Midwives, Family Medicine Physicians, Nurse Practitioners) in Utah and Nevada were surveyed (Utah n=110, Nevada n=68) and interviewed (Utah n=15, Nevada n=1). I performed descriptive statistical analysis of survey results and thematic analysis of the semi-structured interviews. Survey results showed that Utah pregnancy care providers were 16% more likely to counsel their patients regarding cCMV (p<0.05) when compared to providers in Nevada. Providers in Utah who received cCMV public health initiative materials were 26% more likely to provide patient cCMV counseling (p<0.01) than those in Utah who did not receive the materials. Providers in the interviews reported that a lack of cCMV treatment options created uncomfortable conversations around cCMV counseling with patients. Additionally, providers perceived cCMV preventative measures especially for mothers of small children as unrealistic with the potential to create unnecessary maternal anxiety and guilt.

Based on findings from my study, this public health approach offers a potential partial solution to increasing patient cCMV counseling. Several barriers were identified that inhibit providers from counseling their patients regarding cCMV preventative measures. Further work is needed to reduce systemic barriers in parallel with any potential public health efforts to increase cCMV preventative counseling by pregnancy care providers for women of childbearing age.