Women’s knowledge, attitudes and views of preconception health and intervention delivery methods: a cross-sectional survey

Abstract

Background Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated women’s knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. Methods Seven primary care centres in the West of England posted questionnaires to 4330 female patients aged 18 to 48 years. Without providing examples, we asked women to list maternal preconception exposures that might affect infant and maternal outcomes, and assessed their knowledge of nine literature-derived risk factors. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes. Results Of those who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%), advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18–24-years (compared to 40–48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10–8.80], gravidity: aOR 2.48 [1.70–3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21–0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30–2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65–5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90–6.00]). The most acceptable information delivery methods were websites/apps (99.5%), printed healthcare materials (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8–97.0%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable. Conclusions Our findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.

How, when, and who should ask about pregnancy intentions in primary care? A qualitative study of women’s preferences

“…While women in online discussions were not keen on being asked in pharmacies, 9 as in some other studies, 35 this does not preclude any role for pharmacists. However, consideration needs to be given to ensuring privacy, as women do not want to be ‘outed’ by accessing services.…”

Women’s views on content and delivery methods for interventions to improve preconception health: a qualitative exploration

“…This exploratory qualitative study constituted the second phase of a mixed methods project investigating acceptable preconception health intervention designs ( 31 ) and involved semi-structured, in-depth interviews with women aged 18–48 years. The study was undertaken from a position of critical realism ( 32 ).…”

“…Participants were eligible for inclusion ( Table 1 ) if they participated in our prior survey of women registered with seven general practices in the West of England ( 31 ), and expressed interest in being interviewed about their responses. Further information on the survey’s sampling methods is available elsewhere ( 31 ).…”

“…To promote diversity between participants ( 36 ) and enhance the transferability of our findings ( 37 ), we used a maximum variation purposive sampling approach ( 38 ). Our sampling criteria ( 39 ) ( Supplementary Material S1 ) were informed by our survey findings ( 31 ). The strongest correlates of low knowledge and less positive attitudes toward preconception health were younger age, lower household income and nulligravidity; we aimed to achieve an approximately even split for these criteria.…”

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“…• Результаты нашего мониторинга демонстрируют необходимость повышения осведомленности будущих родителей о факторах риска и мотивации для изменения здоровья и образа жизни до зачатия. Вмешательства по улучшению здоровья до зачатия должны быть сосредоточены на общении медицинских работников, школ, членов семьи и средств массовой информации (Daly et al, 2022).…”