Empowerment for behaviour change through social connections: a qualitative exploration of women's preferences in preconception health promotion in the state of Victoria, Australia

What Does 'Preconception Health' Mean to People? A Public Consultation on Awareness and Use of Language

INTRODUCTION

There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health.

METHODS

A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers.

RESULTS

Fifty-four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness.

CONCLUSION

This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals.

PATIENT OR PUBLIC CONTRIBUTION

This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.

Are physicians creating a barrier to pre-conception care access? A qualitative study exploring patients' experiences and perspectives around pre-conception care

BACKGROUND

The pre-conception period is an unmissable opportunity to introduce preventive measures before pregnancy to improve maternal and fetal outcomes. Despite the global pre-conception initiatives and the 2030 Saudi national vision to promote maternal, fetal health and safety, various barriers still exist. This study focuses on exploring pre-conception care extensively from the patients' perspectives and their experience in accessing this type of care in the primary care setting.

METHODS

A qualitative study using interpretive thematic analysis was used to explore patients' perspectives, and experiences in accessing pre-conception care in the city of Riyadh from January 2019 to January 2020. A semi-structured interview guide and field notes were used to collect data. A step wise interpretive and iterative process was used for data analysis and thematic extraction. Theme saturation was achieved by the eleventh interview.

RESULTS

The participants' perspectives were influenced by their cultural beliefs, understanding of pre-conception, and their prevised barriers to approaching physicians. Three main themes emerged: A) Acceptance of pre-conception care; was heavily influenced by how they understood and defined per-conception care. B) Pre-conception health seeking behavior; demonstrated a clear disconnect between the patient and the physician. C) Expectation from health services; to raise awareness about pre-conception care and push physicians to initiate the conversation with their patients.

CONCLUSIONS

An appreciable gap in the patient-physician relationship was revealed as a source of inconsistency in accessing pre-conception care. Physicians are encouraged to take the first step in demonstrating to their patients both the importance of pre-conception care and their intent to offer respectful, empathetic, and culturally appropriate care.