Preconception care by family physicians and general practitioners in Japan

Knowledge and practices of preconception care among rural Japanese women: findings from a mixed methods investigation

BACKGROUND

Preconception care is not widespread in Japan and there is a pressing need to improve the practice. The present study assessed the knowledge and behavior of preconception care among women to seek effective intervention. Our research questions were: 1) How much do women know about preconception care? 2) How much are they practicing preconception care and what are the information sources of their behavior? 3) Do the women's preconception care behavior associated with accurate knowledge?

METHODS

The research was conducted in a rural town in central Japan. Using an exploratory sequential mixed methods design, we undertook interviews, developed a survey based on the qualitative results, and then conducted a survey. The interviews explored how preconception care was perceived and practiced in women of childbearing age. The survey was designed to investigate the knowledge of preconception care among women with and without pregnancy experience, their practice behavior of preconception care, and whether the behavior is associated with knowledge.

RESULTS

The participants were 13 for the interview and 232 for the survey. They had limited access to preconception care recommendations and advice for specific actions was given by obstetricians and gynecologists after pregnancy. There was a large gap in knowledge about preconception care between parous and nulliparous women, especially about the need for folic acid supplementation. Practices that were manageable in their daily lives, such as cessation of smoking and alcohol, diet, and weight management, were considered common sense. In contrast, recommended practices that require medical attention, such as screening for sexually transmitted diseases and cervical cancer, tended to be less accurately known and practiced. Participants' sources of information about preconception care were the Internet, family and friends and mass media.

CONCLUSION

In rural Japan, women of childbearing age lack knowledge about preconception care, especially before their first pregnancy. Primary care providers should try outreach to schools and women's groups in the community, promote information sharing among family and close friends, and utilize information technology to enhance the knowledge and practice of preconception care.

Preconception Care Recommendations, Training, and Competency of Primary Healthcare Nurses in South Africa: A Quantitative Descriptive Study

Introduction

There has been a growing interest in preconception care (PCC) as a primary means of tackling the high maternal and child mortality rates, as evidence has shown that the state of maternal health before conception can have a direct impact on the health of the mother and baby. Primary care nurses have been recognized as the highest providers of sexual and reproductive healthcare to the vulnerable population in resource-constrained settings.

Objective

This study aimed to examine and describe the PCC recommendations, training, and competency of primary healthcare (PHC) nurses in South Africa.

Methods

A cross-sectional descriptive study was conducted among 196 PHC nurses to examine the PCC recommendations, training, and competency. A self-administered survey tool was used for data collection.

Results

The self-reported PCC recommendations, training, and competency of PHC nurses were 63.3%, 88.3%, and 94.9%, respectively, in each aspect. The PCC training among the respondents was mainly in-service training. The only training that was indicated to have been done primarily at a pre-service level was training about reproductive life plan screening and brief counseling. Over 20% of the respondents indicated that they did not receive any training on how to provide alcohol, drug, or tobacco cessation services and how to conduct preconception risk assessments.

Conclusion

Although PHC nurses reported a high level of recommendation, training, and competency, their level of reported PCC practice is not equivalent to their provision, as they rendered PCC services to fewer women, and they also reported fewer women seeking PCC. A future longitudinal study is required to examine the reason for low PCC-seeking habits among those at high risk of adverse pregnancy outcomes and contextual factors influencing the provision of PCC services among healthcare workers.

Investigating women’s health issues and help-seeking intentions in primary care in Japan: a cross-sectional study

Background

Many women face a variety of barriers to seeing obstetricians and gynecologists (OB/GYNs). Primary care physicians (PCPs) in Japan are not well equipped to address and adequately handle women’s health issues. Hence, opportunities for women to consult PCPs about women’s health issues are often limited during busy outpatient encounters. It is essential to explore PCP’s roles in women’s health care by examining women’s health needs in a primary care setting. The aim of the study is to describe the prevalence and distribution of women’s health issues and help-seeking intentions among women visiting a primary care clinic.

Methods

This was a cross-sectional study using a questionnaire. We included women aged 20–60 years who visited a primary care clinic for any reason. The questionnaire comprised a list of women’s health issues, the General Help Seeking Questionnaire to assess help-seeking intentions, and participants’ demographics including their reasons for visiting and regularity of OB/GYN visits.

Results

We distributed the questionnaire to 294 women and analyzed 260 valid responses. The average age of the respondents was 40.5 years old, and they had an average of 5.2 clinic visits a year. Approximately half of them (50.4%) visited for their own care. One hundred thirty-nine (53.9%) reported at least one women’s health issue, and 73.9% of them had no regular visit to an OB/GYN. The major concerns of women’s health issues included gynecological cancer screenings and menstrual problems. The distribution of help-seeking intentions for each source of care appeared to be classified into three patterns. One fifth of the women indicated high help-seeking intentions for PCPs, and a greater number of women expressed higher help-seeking intentions for PCPs when they did not regularly see an OB/GYN.

Conclusions

A significant number of women who visited a primary care clinic had a specific concern about women’s health issues, and a majority of them had not regularly visited their OB/GYN. PCPs may have an important role in providing an opportunity for women to discuss their concerns about women’s health issues as part of comprehensive care during a daily clinical encounter.

Current practice and perspectives of healthcare providers regarding preconception care for women with type 1 diabetes in China

AIMS

We aimed to investigate the current practice and perspectives of healthcare providers (HCPs) regarding preconception care (PCC) for women with type 1 diabetes (T1D) in China.

MATERIALS AND METHODS

A questionnaire based on in-depth interviews with HCPs involved in PCC was released online and advertised via doctor unions in China. The data were categorical variables and were analysed by multivariable logistic regression, Chi-square test, or Wilcoxon rank-sum test.

RESULTS

From November 2016 to January 2017, 992 responses from 31 provinces of China were received (77.3% doctors and 22.7% nurses). Regarding the current status of PCC for T1D, 62.5% of HCPs treated ≤1 woman with T1D monthly on average. Only 16.5% thought they provided proper PCC, and 29.6% reported having sufficient knowledge. Regarding attitudes towards pregnancy with T1D, 92.2% were in favour of women with T1D getting pregnant after proper glycaemic control, and 94.7% perceived their worries regarding pregnancy. Regarding doctor-patient communication, 56.6% spent <10 min per visit, while 58.3% thought ≥20 min was required for adequate communication. HCPs emphasised the importance of multidisciplinary PCC, professional training, and social support. PCC practice was associated with hospital level (OR = 2.450, 95%CI: 1.580-3.799, p < 0.001), HCPs' experience of treating women with T1D (OR = 2.196, 95%CI: 1.516-3.180, p < 0.001), and their communication sufficiency (OR = 3.706, 95%CI: 2.550-5.387, p < 0.001).

CONCLUSIONS

The current PCC practice for T1D in China was suboptimal and it was associated with hospital level, HCPs' experience and communication. It is necessary to reinforce professional training and appeal for social resources to improve PCC.

Preconception care practices in Nigeria: a descriptive qualitative study

Background

Preconception care is a specialized care targeted at women of reproductive age before pregnancy to detect, treat or counsel them about pre-existing medical and social conditions that may militate against safe motherhood and positive pregnancy outcome. In spite of the known need for preconception care in Nigeria, routine preconception care services are not available in the country. This study explores existing preconception care practices in the country in order to encourage building on it and formalising it for inclusion in routine maternal and child health services in the country.

Methods

Forty-one in-depth interviews and 10 focus group discussions were conducted in this descriptive qualitative study to explore the existing preconception care services from the perspectives of community members (women and men in the reproductive age group), community and religious leaders, health care professionals as well as policy makers. Thematic analysis was carried out using MAXQDA 2018.

Results

Participants stated that there are no defined preconception care services in the health care system nor are there any structures or guidelines for preconception care in the country. Preconception care services are however provided when health workers perceive a need or when clients demand for it. The services provided include health information, education and counselling, treatment modification, medical check-up and screening. Outside of the health system, there are some traditional, religious and other practices with similar bearing to preconception care which the participants believed could be included as preconception care services. These include premarital counselling services by religious bodies, family life and HIV education within the secondary school system and some screening and outreach services provided by non-governmental and some governmental agencies.

Conclusion

There is a need to provide structure and guidelines for preconception care services in the country so that the services can be properly streamlined. This structure can also involve practices that are currently not within the health system.

Knowledge of preconception care among healthcare providers working in public health institutions in Hawassa, Ethiopia

Background

Preconception care (PCC) is an evidence-based health promotion intervention to prevent adverse pregnancy outcomes. Nevertheless, it is one of the missing elements within the continuum of maternal and child healthcare. Despite the WHO’s recommendation, most of the developing countries have not yet started implementing preconception care.

Objective

To determine the knowledge level of healthcare providers about PCCand to identify predictors of effective knowledge of preconception care.

Method

This is a cross-sectional study conducted among 634 healthcare providers (HCP) working in public health institutions of Hawassa. A pilot-tested and validated self-administered survey tool was used to collect data from individual healthcare providers who were selected randomly using a multistage sampling technique. The data entry and analysis were conducted using SPSS version 20 software. Frequency, proportions, means and standard deviations were used to describe the data. Bivariate and multivariate logistic regression models were implemented to determine the predictors of HCP’s PCC knowledge.

Results

Only a few (31%) of the healthcare providers demonstrated a good level of knowledge on preconception care. The odds of having good PCC knowledge was high among HCPs working in hospitals (AOR = 1.8, 95% C.I. 1.3–2.6), HCPs using their smart phone to access clinical resources (AOR = 1.4, 95% C.I. 1.1–2.0), among those HCPs ever have read PCC guideline prepared by organization outside of Ethiopia (AOR = 1.9, 95% C.I. 1.4–2.7), among those who claimed practicing PCC (AOR = 3.4, 95% C.I. 2.0–5.9), and among those who earn salary of ≥ 146.0 $(AOR = 1.5, 95% C.I. 1.1–2.1).

Conclusion

There is an unacceptably low level of knowledge about PCC among most of the healthcare providers in public health facilities in Ethiopia. The predictors identified in this study can be used to enhance the knowledge of healthcare providers about preconception care.

Developing social marketed individual preconception care consultations: Which consumer preferences should it meet?

Aims

Preconception care (PCC) is care that aims to improve the health of offspring by addressing risk factors in the pre‐pregnancy period. Consultations are recognized as a method to promote perinatal health. However, prospective parents underutilize PCC services. Uptake can improve if delivery approaches satisfy consumer preferences. Aim of this study was to identify preferences of women (consumers) as a first step to social marketed individual PCC consultations.

Methods

In depth, semi‐structured interviews were performed to identify women's views regarding the four components of the social marketing model: product (individual PCC consultation), place (setting), promotion (how women are made aware of the product) and price (costs). Participants were recruited from general practices and a midwife's practice. Content analysis was performed by systematic coding with NVIVO software.

Results

The 39 participants reflected a multiethnic intermediately educated population. Product: Many participants had little knowledge of the need and the benefits of the product. Regarding the content of PCC, they wish to address fertility concerns and social aspects of parenthood. PCC was seen as an informing and coaching service with a predominant role for health‐care professionals. Place: the general practitioner and midwife setting was the most mentioned setting. Promotion: A professional led promotion approach was preferred. Price: Introduction of a fee for PCC consultations will make people reconsider their need for a consultation and could exclude vulnerable patients from utilization.

Conclusion

This study provides consumer orientated data to design a social marketed delivery approach for individual PCC consultations.

Primary care patient experience and cancer screening uptake among women: an exploratory cross-sectional study in a Japanese population

BACKGROUND

Patient experience and clinical quality, which are represented by preventive care measures such as cancer screening, are both widely used for the evaluation of primary care quality. The aim of this study was to examine the association between patient experience and cancer screening uptake among women in a Japanese population.

METHODS

We conducted a cross-sectional mail survey. The questionnaire was sent to 1000 adult female residents randomly selected from a basic resident register in Yugawara town, Kanagawa, Japan. We assessed patient experience of primary care using a Japanese version of Primary Care Assessment Tool (JPCAT) and uptake of breast and cervical cancer screening.

RESULTS

The overall response rate was 46.5%. Data were analyzed for 190 female participants aged 21-74 years who had a usual source of primary care. Multivariate logistic regression analyses revealed that the JPCAT total score was significantly associated with uptake of breast cancer screening [odds ratio (OR) per 1 standard deviation increase = 1.63; 95% CI 1.11-2.41], but not with uptake of cervical cancer screening (OR per 1 standard deviation increase = 1.47; 95% CI 0.97-2.24).

CONCLUSIONS

Patient experience of primary care was associated with uptake of breast cancer screening among Japanese women. The results of our study might support the argument that patient experience of primary care and the clinical process of preventive care, such as breast cancer screening, are linked.

A systematic review of women's and health professional's attitudes and experience of preconception care service delivery

BACKGROUND

The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services.

METHODS

A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery.

RESULTS

The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC.

CONCLUSIONS

Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.

Prevention of birth defects in the pre-conception period: knowledge and practice of health care professionals (nurses and doctors) in a city of Southern Brazil

BACKGROUND

Some congenital defects can be prevented in the pregestational stage. However, many health professionals are not prepared to provide counselling to couples regarding the same.

OBJECTIVE

This study aimed to assess the performance of doctors and nurses from a primary health-care unit in Florianopolis, Brazil, in preventing birth defects in the preconception period based on the recommendations of the Control Center of Disease Prevention.

MATERIALS AND METHODS

This descriptive cross sectional study was performed at a tertiary referral center. In this study, a semi-structured questionnaire was provided to 160 health professionals comprising doctors and nurses who were actively involved in providing primary health care in family health programs. The non-parametric Chi-square (χ(2)) test was used to analyse the data obtained through multiple choice questions.

RESULTS

Our results showed that although 81.9% of health professionals provided health-care assistance based on protocols, and only 46.2% professionals were aware of the presence of the topic in the protocol. Of the recommendations provided by the Control Center of Disease Prevention, the use of folic acid was the most prescribed. However, this prescription was not statistically different between nurses and doctors (P=0.85).

CONCLUSION

This study identified the fragile nature in these professional's knowledge about the prevention of birth defects in pre-conception period, as evidenced by the inconsistency in their responses.

Preconception care in diabetic women

INTRODUCTION

Diabetes is increasingly becoming prevalent worldwide. Pregnancy with diabetes is prone to maternal and fetal complications. Preconception care (PCC) is an important factor in alleviating gestational complications in those women who suffer from diabetes. This study seeks to gain insight into experiences of diabetic women and providers about PCC.

SUBJECTS AND METHODS

The present research was a qualitative research conducted on eight women with diabetes during the reproductive age and 15 health care providers of the public and private medical centers, which provide health care for women with diabetes in Isfahan (Iran), with a qualitative approach. Based on the aims of research, purposive sampling was done through semi-structuralized individual interview. Data were analyzed using conventional qualitative content analysis method.

RESULTS

Data analysis revealed three major categories: (1) Health centers weakness in providing PCC for diabetic women, (2) lack of a comprehensive PCC plan for diabetic women and (3) diabetic women's negligence about having planned pregnancy.

CONCLUSION

In order to improve diabetic women's health, precise training of students, health care providers and patients themselves with respect to PCCs should be taken into account. Designing diabetic PCC system is an essential factor to succeed in this trend.

A community-based intervention in middle schools to improve HPV vaccination and cervical cancer screening in Japan

AIM

Japan has low rates of cervical cancer screening and Human papilloma virus (HPV) vaccination. This research examines the effectiveness of a family medicine resident-led, intervention in increasing knowledge about HPV and cervical cancer in middle school-girls and increasing knowledge and intention to have cervical cancer screening in their mothers.

METHODS

We utilized a pre-test/post-test intervention design in three rural middle schools with 7(th) grade middle school-girls and their mothers. A school-based activity educated girls about HPV and cervical cancer. A home-based activity utilized a homework assignment for girls and their mothers. Pre/post intervention surveys were completed by the girls and their mothers. Major outcomes included changes in knowledge among girls and mothers and barriers to be screened for cervical cancer among mothers.

RESULTS

Sixty-five students and sixty-three mothers completed the study. Two out five mothers were not in compliance with current screening recommendations. Identified barriers included: embarrassment (79%), poor access (56%), fear of having cancer (52%), and cervical cancer screening being an unknown procedure (46%). Forty-four percent of mothers deemed their daughters to be at risk for cervical cancer. Trusted sources of information included: doctors (97%), newspapers/television (89%), government (79%), the Internet (78%), and friends (62%). Student knowledge scores (7-point scale) improved significantly from pre- to post-intervention (4.8 vs. 5.9, p < 0.001). Knowledge scores (14-point scale) among mothers also significantly improved (11.7 vs. 12.0, p = 0.024).

CONCLUSIONS

These data suggest a community-based intervention on a sensitive topic by family medicine residents can be implemented in middle schools, can improve school-girls' knowledge about HPV and cervical cancer, and can reach their mothers. Additional research could examine whether those intending to be screened receive screening and how to reach women who still resist screening.

Hypertensive patients' perceptions of their physicians' knowledge about them: a cross-sectional study in Japan

Background

In order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians' comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals.

Methods

Patients with prescriptions for hypertensive drugs were approached sequentially at 13 pharmacies, and were administered a questionnaire on their perception of their physician's knowledge about them. Data were obtained for 687 patients (362 from clinics and 325 from hospitals). A physician's knowledge of his or her patients was assessed according to six aspects: their medical history, their current medications, history of allergy, what worries patients most about their health, patients' values and beliefs on their health, and patients' roles and responsibilities at work, home, or school. Responses were scored from 1 through 6 (1: knows very well; 6: doesn't know at all).

Results

Patients treated in clinics were seen more frequently, for a longer period, and had fewer complications than the patients who were treated in hospitals. Among the six aspects of physicians' knowledge assessed, 79.3% of the patients reported that their physicians knew their complete list of medications "very well or well," while 28.3% reported the same about their roles and responsibilities at work, home, or school. Physicians in clinics were considered to know their patients' worries about their health (p = 0.004) and the roles and responsibilities of the patients at work, home, or school (p = 0.028) well. Multiple regression analysis showed that the type of medical institutions remained as a significant variable only for the aspect of patients' worries about their health. The factor that consistently affected the patients' perception of physicians' knowledge about them was the patients' age.

Conclusions

Hypertensive patients' perceptions of their physicians' knowledge about them did not differ significantly between clinics and hospitals in Japan for most of the aspects. In order to differentiate the roles of physicians in hospitals and clinics better and ensure the quality of primary care, the establishment of a standardized educational system to train primary care physicians better is recommended.