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Puliani R, Bhatt Y, Gupta S, R N A, B D T, Jayanna K. A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs. Asia Pac J Public Health 2024; 36:531-541. [PMID: 38736330 DOI: 10.1177/10105395241252867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examined the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.
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Affiliation(s)
- Reedhika Puliani
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Yogita Bhatt
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Soumya Gupta
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun, India
| | - Agnita R N
- Karnataka Health Promotion Trust, Bengaluru, India
| | - Tejaswini B D
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Krishnamurthy Jayanna
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
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Headen IE, Dubbin L, Canchola AJ, Kersten E, Yen IH. Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco. Prev Med Rep 2022; 27:101797. [PMID: 35656210 PMCID: PMC9152803 DOI: 10.1016/j.pmedr.2022.101797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/21/2022] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15-44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women's long-term health trajectories.
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Affiliation(s)
- Irene E. Headen
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market St., Nesbitt Hall Rm 451, Philadelphia, PA 19104, USA
| | - Leslie Dubbin
- University of California, San Francisco, Department of Social and Behavioral Sciences, School of Nursing, 490 Illinois St., San Francisco, CA 94158, USA
| | - Alison J. Canchola
- University of California, San Francisco, Department of Epidemiology and Biostatistics, 550 16th. Street, San Francisco CA 94158, USA
| | - Ellen Kersten
- Washington State Department of Social and Health Services, Research and Data Analysis Division (RDA), 14th & Jefferson St, PO Box 45204, Olympia, WA 98504, USA
| | - Irene H. Yen
- University of California, Merced, School of Social Sciences Humanities and Arts, Department of Public Health, 5200 N Lake Rd, Merced, CA 95343, USA
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Maas VY, Poels M, Hölscher IM, van Vliet-Lachotzki EH, Franx A, Koster MP. How to improve preconception care in a local setting? Views from Dutch multidisciplinary healthcare providers. Midwifery 2022; 107:103274. [DOI: 10.1016/j.midw.2022.103274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
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Meier S, Kasting ML, Liu SS, DeMaria AL. Shared decision-making among non-physician healthcare professionals: Enhancing patient involvement in women's reproductive health in community healthcare settings. PATIENT EDUCATION AND COUNSELING 2021; 104:2304-2316. [PMID: 33685762 DOI: 10.1016/j.pec.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is an important approach to patient-centered care in women's reproductive healthcare. This study explored SDM experiences and perceptions among non-physician healthcare professionals. METHODS We completed 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes. RESULTS Professionals noted community-based healthcare required contextualized decision-making approaches. Results identified listening, decisional ownership, and engagement strategies that enhanced SDM involvement. Findings suggested outcome-oriented SDM concepts, including decisional ownership and investigative listening to enhance SDM. Providers redefined 'challenging' patients as engaged in their healthcare and discussed ways SDM improved healthcare experience beyond one visit. CONCLUSION Findings offered insight into actionable and practical strategies for enhancing SDM in community-based women's reproductive healthcare. The findings offer strategies to improve SDM by addressing barriers and facilitators among professionals. This extends SDM beyond the patient-physician dyad and supports broader application of SDM. PRACTICE IMPLICATIONS Incorporating professionals' experiences into SDM concepts can enhance SDM in community-based women's healthcare practice, offering opportunities to support a culture of SDM across settings.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA.
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Sandra S Liu
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
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Poels M, Koster MPH, Franx A, van Stel HF. Parental perspectives on the awareness and delivery of preconception care. BMC Pregnancy Childbirth 2017; 17:324. [PMID: 28950838 PMCID: PMC5615801 DOI: 10.1186/s12884-017-1531-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The attention for Preconception Care (PCC) has grown substantially in recent years, yet the implementation of PCC appears challenging as uptake rates remain low. The objective of this study was to assess parental perspectives on how PCC should be provided. METHODS Recruitment of participants took place among couples who received antenatal care at a Dutch community midwifery practice. Between June and September 2014, five focus group sessions were held with 29 women and one focus group session with 5 men. Thematic analysis was conducted using NVivo 10 software. RESULTS Participants were generally unfamiliar with the concept of PCC. It was proposed to raise awareness by means of a promotional campaign, stipulating that PCC is suited for every couple with a (future) child wish. Suggestions were made to display marketing materials in both formal and informal (local community) settings. Addressing existing social networks and raising social dialogue was expected to be most efficient. It was recommended to make PCC more accessible by offering multiple forms and to involve male partners. Opportunistic offering PCC by healthcare providers was considered more acceptable when the subject was deliberately raised, for example while discussing contraceptives, lifestyle risks or drug prescriptions. GP's or midwifes were regarded the most suitable PCC providers, however provider characteristics such as experience, empathy and communication skills were considered more important. CONCLUSIONS This study showed that from the parental perspective it is recommended to address every couple with a (future) child wish by means of enlarging the awareness and accessibility of PCC. In order to enlarge the awareness, it is recommended to address social networks, to raise the social dialogue and to conduct promotional campaigns regarding PCC. In order to improve the accessibility of PCC, it was suggested to simultaneously offer multiple forms: group sessions, individual consultations, walk-in-hours and online sessions, and to involve male partners.
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Affiliation(s)
- M Poels
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands.
| | - M P H Koster
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands.,Present address: Department of Obstetrics and Gynecology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands
| | - H F van Stel
- Department of Healthcare Innovation and Evaluation, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
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Preconception healthcare delivery at a population level: construction of public health models of preconception care. Matern Child Health J 2015; 18:1512-31. [PMID: 24234279 DOI: 10.1007/s10995-013-1393-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.
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Dunlop AL, Logue KM, Thorne C, Badal HJ. Change in women's knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. Am J Health Promot 2013; 27:S50-7. [PMID: 23286664 DOI: 10.4278/ajhp.120116-quan-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore knowledge of general and personal preconception health risks among women in publicly funded clinics and whether brief counseling can improve knowledge. DESIGN Interventional cohort study. SETTING Five publicly funded primary care clinics. SUBJECTS Two cohorts of low-income, nonpregnant African-American and Hispanic women of reproductive age (300 in each cohort). INTERVENTION Targeted brief counseling based upon risks identified via preconception health risk assessment. MEASURES Correct responses on test of women's knowledge of general and personal preconception health risks pre-encounter vs. 3 to 6 months post-encounter. ANALYSIS McNemar's test to compare proportion of women in each cohort who correctly answer questions of preconception health knowledge pre-encounter vs. 3 to 6 months post-encounter. RESULTS Women in the intervention cohort experienced a significant increase in knowledge related to preconception health from baseline to 3 to 6 months post-encounter, including recognition of the importance of folic acid supplementation, seeking medical care for chronic conditions, and review of medication in the preconception period that was not observed for the comparison cohort. Among women with chronic medical conditions, those in the intervention cohort significantly increased their knowledge that the condition could lead to problems in pregnancy (+43%) relative to the lesser improvement in knowledge observed for those in the comparison cohort (+4%) (p < .05). CONCLUSIONS Women's knowledge of general and personal preconception health risks improved following screening and brief counseling in publicly funded primary care clinics.
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Affiliation(s)
- Anne L Dunlop
- Department of Family & Preventive Medicine, Emory University School of Medicine, 1256 Briarcliff Road, Atlanta, GA30322, USA.
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Cheng D. Preventing cardiovascular disease among low-income women of reproductive age. J Womens Health (Larchmt) 2013; 22:312-3. [PMID: 23586799 DOI: 10.1089/jwh.2013.4361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Opportunities and Challenges for Community Health Centers in Meeting Women’s Health Care Needs. Womens Health Issues 2012; 22:e119-21. [DOI: 10.1016/j.whi.2012.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/16/2022]
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Associations Between Preconception Counseling and Maternal Behaviors Before and During Pregnancy. Matern Child Health J 2011; 16:1854-61. [DOI: 10.1007/s10995-011-0932-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kiely M, El-Mohandes AAE, Gantz MG, Chowdhury D, Thornberry JS, El-Khorazaty MN. Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy outcomes among African-Americans in Washington, DC. Matern Child Health J 2011; 15 Suppl 1:S85-95. [PMID: 21785892 PMCID: PMC3220795 DOI: 10.1007/s10995-011-0856-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington, DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes; (2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.
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Affiliation(s)
- Michele Kiely
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver NICHD/NIH/HHS, 6100 Executive Blvd, Rockville, MD 20852-7510, USA.
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Harelick L, Viola D, Tahara D. Preconception Health of Low Socioeconomic Status Women: Assessing Knowledge and Behaviors. Womens Health Issues 2011; 21:272-6. [DOI: 10.1016/j.whi.2011.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 03/16/2011] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
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Core state preconception health indicators: a voluntary, multi-state selection process. Matern Child Health J 2011; 15:158-68. [PMID: 20225127 DOI: 10.1007/s10995-010-0575-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This report describes the consensus-based selection process undertaken by a voluntary committee of policy/program leaders and epidemiologists from seven states to identify core state indicators to monitor the health of reproductive age women (aged 18-44 years). Domains of preconception health were established based on priority areas within maternal and child health and women's health. Measures (i.e., potential indicators) addressing the domains were identified from population-based, state level data systems. Each indicator was evaluated on five criteria: public health importance, policy/program importance, data availability, data quality, and the complexity of calculating the indicator. Evaluations served as the basis for iterative voting, which was continued until unanimous consent or a super majority to retain or exclude each indicator was achieved. Eleven domains of preconception health were identified: general health status and life satisfaction; social determinants of health; health care; reproductive health and family planning; tobacco, alcohol and substance use; nutrition and physical activity; mental health; emotional and social support; chronic conditions; infections; and genetics/epigenetics. Ninety-six possible indicators were identified from which 45 core indicators were selected. The scope of preconception care and the public health components to address preconception health are still under development. Despite this challenge and other measurement limitations, preconception health and health care indicators are urgently needed. The proposed core indicators are a set of measures that all states can use to evaluate their preconception health efforts. Furthermore, the indicators serve as a basis for improving the surveillance of the health of reproductive age women.
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