Special Projects: PRAMS and Zika

At a glance

CDC funded the Puerto Rico Department of Health (PRDH) to conduct a rapid assessment of Zika virus awareness and use of preventive measures among a representative sample of Puerto Rican residents giving birth to live infants in Puerto Rico from 2016 to 2018.

Overview

This study was conducted in two phases. Each phase had a hospital-based survey and a telephone follow-up survey. Phase I was conducted in the fall of 2016 and spring of 2017. Phase II was conducted in the fall of 2017 and spring of 2018.

Phase 1: PRAMS-ZPER 1.0

Part 1. PRAMS-ZPER 1.0 hospital-based survey—fall 2016

Overview and methods

The PRAMS-ZPER 1.0 hospital-based survey was conducted from August to December 2016. The study used methods modified from PRAMS to do in-person data collection in maternity hospitals. Field staff visited women in their hospital rooms 24 to 36 hours after delivery and invited them to complete a self-administered survey either on a paper form or on a tablet. Among 2,933 selected women, 2,364 completed the survey for an overall response rate of 81%.

Questionnaires

The PRAMS-ZPER 1.0 hospital-based questionnaire covered topics related to maternal knowledge and concern about Zika virus infection, discussions with health care providers during pregnancy about Zika, testing for Zika during pregnancy, use of measures to prevent mosquito-borne transmission of Zika during pregnancy, and use of measures to prevent sexual transmission of Zika during pregnancy.

ZPER 1.0 Maternal Hospital Survey—English

Findings

Results from the PRAMS-ZPER 1.0 hospital-based survey can be found here:

D'Angelo DV, Salvesen von Essen B, Lamias MJ, Shulman H, Hernandez-Virella WI, et al. Measures Taken to Prevent Zika Virus Infection During Pregnancy – Puerto Rico 2016. MMWR Morb Mortal Wkly Rep 2017; 66(22);574–578.

Part 2: PRAMS-ZPER 1.0 telephone follow-up survey—Spring 2017

A subset of women who participated in the PRAMS-ZPER 1.0 hospital-based survey was randomly selected and re-contacted by telephone 8 to 10 months after delivery to learn about their experiences after hospital discharge. Of 1,535 women selected for the follow-up, 1,175 completed the survey for an overall response rate of 77%.

Questionnaires

ZPER 1.0 Telephone Followup Survey—English

Phase 2: PRAMS-ZPER 2.0

PRAMS-ZPER 2.0 hospital-based survey—Fall 2017

Overview and methods

The second PRAMS-ZPER in-hospital survey was conducted from November to December 2017. The study methods were similar to the first study with a few modifications to adjust for the situation following Hurricanes Irma and Maria. Some adjustments included reducing the sample size and eliminating the 24- to 36-hour waiting period before contact. Among 1,545 selected women, 1,482 completed the survey for an overall response rate of 96%.

The separate partner survey was available for completion by infants’ fathers or mothers’ partners. Partners were approached in the hospital following the birth of their infant during the same timeframe as the mothers. Among 1,545 eligible partners, 1,182 completed the survey for an overall response rate of 77%.

Questionnaires

The maternal questionnaire was similar to the questionnaire from PRAMS-ZPER 1.0. In addition to the original questions, more detailed information about testing during pregnancy was captured on the 2.0 version of the survey.

ZPER 2.0 Maternal Hospital Survey—English

The partner questionnaire covered topics related to knowledge and concern about Zika virus infection, interactions with health care providers, measures to prevent mosquito-borne and sexual transmission of Zika during the pregnancy of their partner, and involvement in the pregnancy.

ZPER 2.0 Partner Hospital Survey—English

Supplementary activity

To address the need for further information about Zika virus prevention and newborn care for new mothers and fathers, the PRDH developed a short educational presentation to share with women and their partners who were eligible for the study.

The PRDH field staff workers who administered the survey also provided the educational presentation following completion of the survey. Sampled individuals who elected not to participate in the survey could also receive the educational presentation, if interested.

For more information about the educational presentation, contact the PRAMS project in the PRDH's Division of Maternal, Child, and Adolescent Health.

Materials used in PRAMS-ZPER project
Materials used in PRAMS-ZPER project

PRAMS-ZPER 2.0 Telephone Follow-up Survey—Spring 2018

The second PRAMS-ZPER telephone follow-up survey was conducted from February to March of 2018. All women who responded to the PRAMS-ZPER 2.0 hospital-based questionnaire were re-contacted and invited to participate. Among 1,482 eligible women, 1,200 completed the survey for an overall response rate of 81%. There was no telephone follow-up survey for partners.

Questionnaires

ZPER 2.0 Telephone Survey—English

To request PRAMS-ZPER data for analysis, please contact the PRAMS proposal mailbox.