Measurement of Preconception Health Knowledge: A Systematic Review

Abstract

Objective: Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges. Data Source: MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018. Study Inclusion and Exclusion Criteria: Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men. Data Extraction: Two independent reviewers completed data extraction and quality appraisal using standardized instruments. Data Synthesis: Due to measurement heterogeneity, a narrative synthesis was performed. Results: The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men’s health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools. Conclusions: This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.

Development and Psychometric Evaluation of the Preconception Health Knowledge Questionnaire

“…Development of the PHKQ was informed by a systematic review on preconception health knowledge tools. 9 The PHKQ adapted 8 items from the Locally Driven Collaborative Project Healthy Pregnancy Knowledge Survey, 15 which assessed pregnancy, lifestyle, and breastfeeding knowledge in women attending prenatal programs, and 2 items from a study by Coonrod et al , 16 which used a 15-item tool to evaluate knowledge on maternal age, family and genetic history, medication use, tobacco use, alcohol and substance use, infectious disease, immunization, psychosocial stressors, nutrition, physical activity, and environmental exposures. Based on consultation with 6 public health nurses, one health promotion specialist, and 2 family physicians, 15 items were added related to interconception health, men’s health, mental health, specific immunizations, and weight changes.…”

“…One commonly used outcome for evaluating such efforts is preconception health knowledge. 9 While knowledge must be considered within the context of the social determinants of health and the systemic barriers that affect individuals’ abilities to act on their knowledge, Social Cognitive Theory and the Theoretical Domains Framework 10 -13 show that lack of knowledge is an obstacle to health behavior change. 14 Knowledge can be measured with simple, efficient, and cost-effective methods, making it a more accessible indicator of changes related to preconception health than long-term behavior change or incidence of rare outcomes such as congenital anomalies.…”

“…Previous assessments of preconception health knowledge have been limited in their comprehensiveness, omitting questions about men’s health, the interconception period, and psychosocial stressors. 9 A comprehensive measure of preconception health knowledge is needed for evaluation of health interventions.…”

­Knowledge and behaviour about preconception care among women desiring conception, from tribal and non-tribal areas; a qualitative study using focused group discussions

“…Sporadic efforts are made to provide information about preconception care. A systematic review revealed the tools used impart knowledge usually focus on fertility, folic acid supplementation, alcohol consumption, mental health and some questions about men's health [15]. In a study in the US, lack of knowledge was identified as the biggest barrier to the practice of preconception behaviour, the second most important barrier being the cost [16].…”

“…Knowledge or awareness about PCC differs widely in different countries. A systematic review of 34 studies from 14 countries with data collected in 2000 to 2017 revealed the preconception health knowledge tools usually focus on fertility, folic acid supplementation, alcohol consumption, mental health and some issues about men's health [11,15,20,21]. Another systematic review of studies done during 1998 and 2008 focusing on factors related to preconception health behaviors among childbearing age women in the United States, developed countries, and developing countries identified six major thematic areas: frequency of alcohol intake prior and during pregnancy, glycemic control/diabetes management, physical activity before and during pregnancy, pregnancy planning behavior, cystic fibrosis carrier screening, and other risk factors [22].…”