Dr. Adejoke Ayoola

Nearly half of all pregnancies in the United States are unplanned,1,2 a higher rate than that of other developed countries.2 Unplanned pregnancy  in the U.S. was highest among poor and low-income women and minorities regardless of income.3 Unplanned pregnancy regardless of income has been associated with negative maternal behaviors and birth outcomes including poor preconception care, smoking and drinking during pregnancy, delayed initiation of prenatal care, preterm births and low birth weight.2,4 Even starker outcomes are reported among low income women and minority groups,5,6  who do not adequately receive routine and specialized prenatal care services,7 including preconception services.8 This research is to promote women’s reproductive health and positive pregnancy outcomes by reducing the risk of unplanned pregnancy and delayed pregnancy recognition.

This study proposes that women with knowledge of reproductive changes and high self-efficacy about their pregnancy planning will most likely follow through with actual planning. Albert Bandura’s social cognitive theory on self-efficacy9,10and Nola Pender’s health promotion model11 guide this assumption. Several studies have identified knowledge and self-efficacy as important determinants of many health behaviors.11–14  For example, Weisman, et al15 concluded that women who perceive they can control future birth outcomes are more likely to use preconception interventions. This study will be one of the very few studies which will focus on reducing the risk of unplanned pregnancy and promoting early recognition of pregnancy by actively involving low-income women in their reproductive care, through monitoring of menstrual cycle & ovulation time, with the use of ovulation test kits during the preconception period.

This study is a community-driven health promotion effort that builds on previously conducted Calvin College Department of Nursing (CCDON) community needs assessments in three partnering low-income neighborhoods in Grand Rapids. In community surveys and focus group discussions, women identified unplanned pregnancies as a top health concern. Our prior work has shown that women often are not fully informed about their reproductive health. In our analysis of the Pregnancy Assessment Monitoring Survey (PRAMS) on reasons for unplanned pregnancy, 33% of the women felt they could not get pregnant at the time of conception.16 In fact, our focus group discussions in 2008 in the nursing program partnering neighborhoods showed that women want to “know their bodies” before they are pregnant.17 A pilot study was conducted during the spring semester in 2010 to address the issues identified by the women in the focus group discussions in the CCDON partnering neighborhoods.  This pilot study titled “Knowing your body” was to establish the feasibility of conducting a study on increasing women’s knowledge of the reproductive changes occurring in their bodies as an important means to reduce the risk of unplanned pregnancy and to promote early pregnancy recognition.

This current study titled the Preconception Reproductive Knowledge Promotion (PREKNOP) addresses two key areas of interest in the U.S. National Institute of Nursing Research’s strategic plan: 1) Promoting Health and Preventing Disease: Design intervention studies using community-based approaches and 2) Eliminating Health Disparities: Identify strategies that will reduce the long-term adverse consequences of poor maternal and reproductive health in minorities and underserved populations. Women of childbearing age, especially minorities and the low-income, need continuous monitoring and on-going educational approach to reduce disparity in health and improve pregnancy outcomes. This study is foundational for designing interventions among low-income women for whom regular monitoring of menstrual changes is incorporated as part of healthy lifestyle practice.

Calvin's research has been recognized on a national level when three Calvin nursing majors received awards for their research at the Midwest Nursing Research Society (MNRS) conference—one of the biggest conferences of its kind in the country- in spring 2014. Read the full story.


Funding: Robert Woods Johnson Foundation; Calvin College Science Division, Calvin College Alumni Association


1. Finer LB, Henshaw SK. Disparities in Rates of Unintended Pregnancy In the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health. 2006;38(2):90–96.

2. Feenstra C, Gordon B, Hansen D, Zandee G. Managing community and neighborhood partnerships in a community-based nursing curriculum. J Prof Nurs. 2006;22(4):236–241.

3. Finer LB, Kost K. Unintended pregnancy rates at the state level. Perspect Sex Reprod Health. 2011;43(2):78–87.

4. Dott M, Rasmussen SA, Hogue CJ, Reefhuis J. Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997-2002. Matern Child Health J. 2010;14(3):373–381.

5. Afable-Munsuz A, Braveman P. Pregnancy intention and preterm birth: differential associations among a diverse population of women. Perspect Sex Reprod Health. 2008;40(2):66–73.

6. Besculides M, Laraque F. Unintended pregnancy among the urban poor. J Urban Health. 2004;81(3):340–348.

7. Gavin NI, Adams EK, Hartmann KE, Benedict MB, Chireau M. Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women. Matern Child Health J. 2004;8(3):113–126.

8. Frey KA, Files JA. Preconception Healthcare: What Women Know and Believe. Matern Child Health J. 2006;10(Suppl 1):73–77.

9. Bandura A. Social Learning Theory. 1st ed. Prentice Hall; 1976.

10. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. 1st ed. Prentice Hall; 1985.

11. Center for Disease Control and Prevention. Contraceptive methods available to patients of office-based physicians and title X clinics --- United States, 2009-2010. MMWR Morb. Mortal. Wkly. Rep. 2011;60(1):1–4.

12. Ironson G, Weiss S, Lydston D, et al. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women’s Project. AIDS Care. 2005;17(2):222–236.

13. Kang S-Y, Deren S, Andia J, Colón HM, Robles R. Effects of changes in perceived self-efficacy on HIV risk behaviors over time. Addict Behav. 2004;29(3):567–574.

14. Tavares LS, Plotnikoff RC, Loucaides C. Social-cognitive theories for predicting physical activity behaviours of employed women with and without young children. Psychol Health Med. 2009;14(2):129–142.

15. Hillemeier MM, Weisman CS, Chase GA, Dyer A-M, Shaffer ML. Women’s preconceptional health and use of health services: implications for preconception care. Health Serv Res. 2008;43(1 Pt 1):54–75.

16. Nettleman MD, Chung H, Brewer J, Ayoola A, Reed PL. Reasons for unprotected intercourse: analysis of the PRAMS survey. Contraception. 2007;75(5):361–366.

17. Ayoola, Adejoke B., Zandee, Gail Landheer, Brewer, Jennifer R. Exploring the Pregnancy Recognition Process using Group Interviews. 2009. Available at: http://www.nursinglibrary.org/vhl/handle/10755/148591. Accessed February 21, 2012.


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