Objectives:

• To increase the number of women who recognise that folic acid is safe, both for them and for their unborn child.
• To increase awareness of the importance of taking folic acid in preventing neural tube defects.
• To increase awareness about the need to take folic acid before conception and up to the end of the twelfth week of pregnancy.
• To increase awareness that the recommended level of folic acid cannot be obtained from food alone and a daily folic acid supplement is also needed.
• To increase the number of women who would take folic acid during pregnancy.
• To not make anyone feel guilty or responsible if they have a child with a neural tube defect or cause anxiety among women who are already pregnant and have not taken folic acid because they did not know about it.

Background:
Research shows that by increasing the amount of folic acid taken before and during pregnancy, the number of babies born with neural tube defects could be greatly reduced. A review of public knowledge, attitudes and behaviour in relation to folic acid in Northern Ireland was undertaken by the Agency in 1996. It showed that while awareness of folic acid was high, knowledge of the benefits of taking folic acid supplements was limited and there was some confusion over when these supplements should be taken.

In response to these findings the Agency was commissioned in February 1998 to prepare and implement a public information campaign on folic acid for Northern Ireland.

The campaign:
The campaign was launched in October 1998 and comprised television and cinema advertising, leaflets, posters, a magazine and guidance notes for professionals. It carried the strapline 'Folic acid - one of life's essentials'.

The television advertisement highlighted that folic acid is a vitamin that helps prevent conditions such as spina bifida and should be taken before becoming pregnant and until the 12th week of pregnancy. It was pretested with focus groups.

Click here to view the 'Folic acid' television advert

The leaflets and posters gave information on the importance of taking folic acid and were distributed to health service facilities, pharmacies, and supermarkets.

Because it was unlikely that women who were not thinking about pregnancy would pick up a leaflet about folic acid, a magazine in the style of popular women's magazines was produced. The magazine entitled It's You, contained celebrity interviews, real life stories, puzzles and general features on health as well as information on folic acid. It was inserted into local newspapers and sent to hairdressing salons, dental surgeries and health centres for their waiting areas.

The guidance notes produced for health professionals included sources of folic acid/folate, dosage and timing information, questions and answers and contact addresses for specialist advice. The guidance notes, produced in a flip-over format, were sent to GPs, practice nurses, pharmacists, family planning staff, health visitors, midwives and dietitians.

The campaign was used as an example of how to plan, develop and deliver a health promotion campaign in the publication Campaigning for health. This was produced for teachers and students particularly of GNVQ Health and Social Care courses.

In November 2000 the Agency and the Department of Health and Children, Republic of Ireland launched the campaign on an all-island basis. The 1998 television and radio advertisements developed by the Agency were broadcast on UTV and RTE and the public information leaflet was reprinted and distributed to pharmacies in Northern Ireland and the Republic of Ireland.

Evaluation:
One thousand adults were interviewed for the evaluation of the 1998 campaign carried out in February 1999. A similar survey conducted in 1996 allowed for pre- and post-campaign comparison. The evaluation indicated that awareness of folic acid had risen from 45% pre-campaign to 73% post-campaign. Knowledge of the benefits of folic acid had also risen from 60% to 83%.

The main source of awareness about folic acid was the television advertisement which had a prompted recall of 70%.