Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

Family Planning and Preconception Care Service Management: The Key Role of Bulgarian GPs

Assisting women in attaining their reproductive goals is crucial for improving the well-being of families and children. As the first point of contact for healthcare, general practitioners (GPs) are ideal for family planning (FP) and preconception care (PCC). However, primary care interventions' efficacy is unclear. The aim of this study was to examine GPs' knowledge, attitudes, and perspectives on FP and PCC service management. Most GPs were aware of FP and PCC services and held a firm conviction that they should be primarily accountable together with obstetrician-gynaecologists. However, it is worth noting that less than 50% of respondents reported receiving thorough and comprehensive knowledge of their respective specialities. Those with general medicine qualifications demonstrated a high level of commitment to providing such services. The women's GPs and those with training in general medicine prescribed birth control pills and emergency contraception three times more frequently than the other doctors who suggested condoms or traditional methods or referred patients to another specialist (p < 0.05). In conclusion, PCC is of the utmost importance, and its effective implementation demands the collaboration of policymakers, healthcare providers, and individuals. GPs are essential in managing FP and PCC. They must incorporate more in-depth PCC into their clinical practice.

Self-reported Provision of Preconception Care and Associated Factors

Background

Preconception care (PCC) is the provision of health interventions to women and couples before conception occurs and is valuable in promoting healthy maternal, birth, and neonatal health outcomes. In Africa, more so in Kenya, maternal and neonatal health indicators have remained poor. The key constraint limiting progress is the gap between what is needed and what exists in terms of skills and availability of human resources & infrastructures in the face of increased demand. This gap was yet to be measured for PCC in Kenya, more so in Kisumu County.

Methods

Using a cross-sectional design, this study specifically sought to determine the rate of self-reported PCC provision and to illustrate how it is influenced by health provider characteristics. Structured interviews were conducted with health providers (n=476) to ascertain their knowledge, perceptions and practice of PCC care. The significance of the differences in means was determined by the Student's t test and linear regression were used to show the relationship between the health provider characteristics and the PCC provision rate.

Results

Self-reported PCC provision was estimated at 39%. There was a significant difference in the mean for cadres {nurses (M=70.04, SD=8.951) and non-nurses (M=71.90, SD=8.732); t (473) =-2.23, P=.026)}, years of experience up to 5 years (M=72.04, SD=8.417) and more than 5 years (M=69.89, SD=9.283); t (465) =2.63, P=.009, the mean provision per level (M=60.21, SD=4.902; t (26)=-5.06, P<.001) and type of service (M=69.36, SD=4.924; t (26) =4.63, P<.001). A significant regression model was found, and the model statistics were F (2,464) =5.97, P=.003, R2=.03. Only cadre (b=0.01, t (464) =2.23, P=.026) and years of experience (b=-0.13, t (464) =-2.79, P=.005) were significant determinants of PCC provision. The health workers felt PCC was an important service whose provision was low due to inadequate human capital investment.

Conclusion

Self-reported provision of PCC by health workers was relatively low and was influenced by the cadre of health workers and their years of experience. It specifically demonstrated the importance of various aspects of human capital, i.e., knowledge, perceptions, competence and adequacy of training in the provision of this care. Furthermore, it showed that the nursing cadre has a higher probability of providing this care. Investing in on-the-job training for health providers, especially nurses, and providing care in primary health facilities in rural areas can improve PCC service delivery.

Preconception care: what do reproductive-aged women know and think in a community? A community-based, cross-sectional study at Mizan Aman town, Ethiopia

OBJECTIVES

To assess factors associated with knowledge and attitudes towards preconception care among reproductive-aged women in Mizan Aman town, southwest, Ethiopia.

DESIGN AND METHODS

A community-based cross-sectional study was conducted from 1 November to 25 November 2021. The data were entered into Epidata V.3.1 and exported to SPSS V.26. Binary logistic regression analyses were performed to identify factors associated with outcome variables.

SETTING AND PARTICIPANTS

The study was conducted in Mizan Aman town, Southwest, Ethiopia. A total of 422 reproductive-aged women were enrolled in the study.

OUTCOME

Knowledge and attitude towards preconception care, associated factors of preconception care.

RESULTS

168 (39.8%) study subjects had good knowledge about preconception care, and 52.4% of the study subjects had a favourable attitude. Knowledge of preconception care was significantly associated with educational status (adjusted OR, AOR=6, p=0.01), marital status (AOR=1.47, p=0.001) and a positive attitude (AOR=1.8, p=0.08). Preconception care attitude was strongly associated with the maternal age group of 25-35 years (AOR=5.4, p=0.001), maternal age group of 36-42 years (AOR=3.5, p=0.02), source of income (AOR=5.3, p=0.01) and occupation (AOR=13.9, p=001).

CONCLUSION

The study revealed that knowledge about preconception care was significantly lower. Disseminating preconception education and incorporating preconception care into the maternal continuum of care was the most important to boost the knowledge and attitude level of women towards preconception care.

Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study

Preconception care (PCC) is the provision of biomedical, behavioural, and social health interventions to women and couples before they fall pregnant. The World Health Organization (WHO) developed PCC recommendations in 2013, which were included in the South African maternity care guidelines in 2016. The purpose of PCC is to lessen behaviours and environmental factors leading to maternal ill-health, thus reducing maternal and perinatal mortality rates.

OBJECTIVE

To determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo Province and the associated factors.

METHODS

A qualitative exploratory design was used. Nonprobability, purposive sampling was used to sample 29 professional nurses (PNs), and 51 women of childbearing age (WCBA) (19-35 years) from clinics and community health centres (CHCs). Data were collected through in-depth interviews with the professional nurses and focus group discussions with the WCBA. Data analysis was performed through open coding. Measures of trustworthiness were adhered to. Permission to conduct the study was obtained from relevant stakeholders, participation was voluntary and participants signed a consent form prior to data collection.

RESULTS

The findings of the study revealed that there was partial implementation of the PCC recommendations in the selected districts of Limpopo Province, PCC provision was dependent on clients' initiation, a knowledge gap regarding PCC recommendations was identified from the professional nurses, and a lack of awareness regarding PCC from the WCBA.

CONCLUSION

The preconception period is an important determinant of the pregnancy outcome; therefore, focus should be redirected to the pre-pregnancy period and not only to when the woman is already pregnant. However, to achieve this, professional nurses and WCBA should be empowered regarding PCC and its benefits.

Preconception care knowledge and information delivery modes among adolescent girls and women: a scoping review

Purpose: The aim of this study was to conduct a scoping review of knowledge and information delivery modes related to preconception care (PCC) among adolescent girls and women Methods: A scoping review was performed on studies selected from five electronic databases (Cochrane Library, PubMed, Science Direct, CINAHL/EBSCO, and ProQuest), published between 2012 and 2022, with predetermined keywords and criteria. We included English-language research articles available in full text and excluded irrelevant articles.Results: This study included eight articles, comprising seven quantitative studies and one qualitative study conducted among adolescent girls and women. Five were from low- and middle-income countries and three were from high-income countries. The synthesized themes generated from the data were PCC knowledge and PCC information delivery modes and effectiveness. In general, adolescent girls and women were found to have basic PCC knowledge, including risk prevention and management and a healthy lifestyle, although more extensive knowledge was found in higher-income countries than in lower-income countries. The delivery modes of PCC information have grown from individual face-to-face conventional methods, which are used predominantly in lower-income countries, to more effective digital mass media.Conclusion: Globally, many women still have insufficient knowledge regarding PCC, as not all of them receive access to PCC information and support. PCC promotion efforts should be initiated earlier by involving a wider group of reproductive-age women and combining individual, in-group, face-to-face, and electronic delivery modes.

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.

Preconception care practices among primary health care nurses working in public health facilities in KwaZulu-Natal

BACKGROUND

Preconception care (PCC) is necessary to identify and deal with all the risk factors before conception. Some aspects of PCC, like folic acid supplementation, would be relevant to people desiring a pregnancy. Alternatively, PCC could provide contraceptive support to those with no pregnancy intention. In South Africa, primary healthcare nurses provide a comprehensive package of essential services in public health facilities to about 90% of the population at no cost. Therefore, they are the key providers of promotive, preventive, and curative services, including PCC.

OBJECTIVE

This study aimed to determine the level of PCC practice among primary healthcare nurses and identify determinants of effective practice.

METHODS

This cross-sectional descriptive survey was conducted among 196 nurses undertaking a specialisation Primary HealthCare program in a selected higher education institution. A pretested questionnaire was used to collect data that were analysed with SPSS version 27 software.

RESULTS

The overall practice of PCC was 87.8%. Older participants were significantly less likely to exhibit good PCC practice than their younger counterparts. Female participants were also less likely to have good PCC practices than their male counterparts. Married participants were significantly more likely to practice PCC than their unmarried counterparts. Participants practicing in rural areas were also less likely to have good PCC practices than their urban counterparts.

CONCLUSION

The PCC practice of most primary healthcare nurses in the study is relatively high. The study also identified the determinants of good PCC practice that can enhance its practice. There is a need to revisit the PCC training of healthcare workers, as most indicated the need for further training.