Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley Hagaman

Second Advisor

Steven Schiff

Abstract

Neural tube defects (NTDs) such as spina bifida and secondary infection of hydrocephalus can have severe symptoms which dramatically reduce quality of life. NTDs have been shown to be effectively prevented via folic acid supplementation and fortification. Despite its success in the US and Europe, folic acid fortification has led to inconsistent results globally. Worldwide, health policy inaction has led to failure in preventing 90% of folic-acid-preventable spina bifida cases. Even though Việt Nam has supposedly fortified foods since 2003, it has only been able to produce a small reduction in NTD rates. This study aims to explore the barriers affecting folate fortification by assessing Vietnamese maternal and clinician perceptions of folate fortification through qualitative interviews. 24 semi-structured interviews (13 clinicians, 11 mothers) were completed, analyzed using thematic analysis, and presented using the Health Equity Implementation Framework (HEIF). Findings revolved around several key themes: 1) maternal cultural beliefs and clinicians’ knowledge fund of NTDs are recipient factors which impact behaviors and decision making, 2) clinical encounters tend to be clinician-centric due to high levels of trust which emphasizes the need for inter-disciplinary agreement on folic acid guidelines, and 3) rural participants experience structural barriers to accessing information regarding NTD prevention (eg. at in-person visits) which can be mitigated with tactical usage of technological communication platforms. Through a health equity lens, this study enables thematic data to be translated into practical and relevant strategies which can be utilized to advance maternal health in Việt Nam.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/16/2028

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