Knowledge, attitudes and behaviours surrounding preconception and pregnancy health: an Australian cross-sectional survey

Preconception health knowledge, attitudes and behavioural intentions among adults: a multi-country study

BACKGROUND

Preconception health-the health status of individuals prior to conception-is vital for positive pregnancy outcomes and long-term health. Despite its importance for maternal and infant well-being, it remains under-researched and often overlooked in global maternal and child healthcare.

METHODS

We conducted a cross-sectional online survey with adults (18-55 years old) from Kenya, South Africa, Malaysia, the United States, and the United Kingdom (n = 5000), gathering data on preconception health knowledge, attitudes, behavioural intent, and respondents' preferences regarding factors important before pregnancy and preferred sources of health information. A generalised structural equation model (gSEM) was constructed a priori to assess the relationship between socioeconomic position and preconception health knowledge, and whether this relationship was mediated by preconception attitudes and behavioural intent.

RESULTS

Preconception health knowledge, attitudes, and behavioural intent showed significant variation across the countries. Over half of the respondents reported having adequate preconception knowledge (50.3%), with the USA having the highest proportion of respondents with good knowledge (13.8%) and Malaysia having the highest proportion with poor knowledge (42.5%). In the pooled sample, physical health was considered the most important factor before pregnancy, followed by relationships and family. Clinic doctors were the most preferred source of information, followed by nurses and obstetricians/gynaecologists. The relationship between preconception knowledge and behavioural intent was fully mediated by a combination of preconception attitudes (71.7%).

CONCLUSION

Preconception health knowledge, attitudes, and behavioural intent differed across the five economically diverse countries. Pregnancy factors were prioritised differently across settings, likely reflecting disparities in culture, socioeconomic status, and healthcare access, with varying preferences for sources of preconception health information. These findings underscore the importance of designing tailored interventions that consider socioeconomic and cultural differences to enhance overall health outcomes.

Pregnancy intention, preconception health, health behaviours, and information and health advice seeking among expectant male partners

BACKGROUND

Attempting pregnancy as a conscious decision (pregnancy intention) can impact the likelihood that a future parent receives or seeks preconception health information, initiates discussions with health professionals, and ultimately optimises their health and behaviours in preparation for healthy pregnancy and child. Knowledge about the relationship between men's preconception health behaviours and their pregnancy intention is only emerging.

METHODS

This study aimed to describe the preconception health status, behaviours, information- and advice-seeking of male expectant partners, and to explore differences in these preconception factors based on pregnancy intention. An online retrospective cross-sectional survey was completed by male reproductive partners of pregnant females. Their pregnancy intention was assessed using the London Measure of Unplanned Pregnancy (LMUP). Participants were recruited via social media and all variables were self-reported by expectant partners. Chi-square tests examined differences by LMUP categories (planned or ambivalent/unplanned).

RESULTS

Of 156 expectant partners who consented to survey participation, 138 completed all LMUP questions and were included in analysis. Most expectant partners reported their partner's current pregnancy as planned (n = 90;65.2%), less than half reported looking for and finding information about becoming pregnant (40.0%). Expectant partners with planned pregnancy more often reported physical exercise three months before pregnancy compared with partners with unplanned/ambivalent pregnancy (p = 0.001). Expectant partners with ambivalent/unplanned pregnancy more often experienced longstanding illness, disability, or infirmity (p = 0.002) or disregarded contraception (p < 0.001). Despite perceiving good or excellent health, and undertaking physical exercise, numerous expectant partners with planned pregnancy had overweight. Further research exploring the reproductive life plan process for males with longstanding chronic illness or disability may help promote pregnancy planning and preconception health amongst this sub-population.

CONCLUSIONS

Further large-scale studies are needed to enable clinicians to better understand pregnancy intentions and preconception health of males and for policy makers to formulate health policies aimed at supporting male preconception health and awareness.

Determinants of knowledge of preconception care among healthcare providers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To assess the determinants of knowledge of preconception care (PCC) among healthcare providers in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

Comprehensive literature searches were conducted in PubMed, Scopus and Health Internetwork Access to Research Initiative (HINARI) published until 20 March 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary studies that reported the prevalence, determinants or associated factors were included.

DATA EXTRACTION AND ANALYSIS

Three authors extracted all the relevant data using a standardised Joanna Briggs Institute data extraction format. Meta-analysis was done using a random-effects model. A funnel plot and Egger's test were done to assess publication bias, which was corrected by trim and fill analysis.

RESULT

Out of 102 studies, the final analysis included six studies involving 2758 healthcare providers. The pooled knowledge of PCC among healthcare providers in Ethiopia was determined to be 51.43% (Adjusted OR), with a 95% CI ranging from 41.21% to 61.65%. Several factors were identified as determinants of healthcare providers' knowledge based on the pooled estimate. These factors include having an educational qualification above a BSc degree (OR=2.36, 95% CI 1.46, 3.08), the presence of guidelines in their institution (OR=2.07, 95% CI 1.37, 2.77), working in hospitals (OR=2.68, 95% CI 1.83, 3.53) and receiving training on PCC and related topics (OR=4.05, 95% CI 2.52, 5.59).

CONCLUSION

Healthcare professionals exhibited limited knowledge of PCC in Ethiopia. Key elements influencing their comprehension encompass advanced educational credentials beyond a BSc degree, adherence to institutional guidelines, employment in hospital settings and exposure to specialised training. The ORs linked to these factors highlight the substantial influence of education, institutional procedures, hospital roles and specific training in enhancing healthcare providers' expertise. Enhancing awareness and understanding among healthcare practitioners through customised educational programmes, institutional structures and organised training efforts stands out as a crucial approach to improve healthcare services and results throughout Ethiopia.

PROSPERO REGISTRATION NUMBER

CRD42024516077.

Awareness and Knowledge About Preconception Healthcare: A Cross-Sectional Study of Early Years UAE Medical Students

Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students' health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and 31 May 2024 among medical students at United Arab Emirates University. To determine awareness and knowledge of preconception health, we administered a survey consisting of an author's questionnaire with 35 questions covering sociodemographic characteristics and general knowledge of preconception health, as well as the WHO Quality of Life Scale-BREF (WHOQOL-BREF). Results: The participants were predominantly under 25 years old (98.5%), Emirati (91.1%), single (92.6%), and female (95.8%); only 3.4% had been pregnant before. Regarding health awareness and behaviors, a significant number of females (58.0%) had never visited a gynecologist. The majority of students (72.4%) participated in sports activities. The overall level of knowledge was low, with a mean level of 7.5 (SD = 6.36) out of 24. The Internet (webpages, blogs, webinars) (64.5%) was the major source of knowledge regarding healthcare information, followed by social media platforms (Twitter, Facebook, TikTok, Instagram) and mobile applications (57.5%), books (48.6%), and family members (57.0%). There was a statistically significant correlation between knowledge levels and the Internet (p < 0.004) or family (p < 0.001) as a source of knowledge. Additionally, there was a statistically significant positive correlation between knowledge and quality of life across all four WHOQOL domains. Conclusions: Medical knowledge might positively affect general well-being. Fostering stronger social networks and support systems could benefit preconceptional awareness and knowledge.

Smartphone pregnancy apps: systematic analysis of features, scientific guidance, commercialization, and user perception

BACKGROUND

Over 50% of pregnant women use pregnancy applications (apps). Some app s lack credibility, information accuracy, and evidence-based clinical advice, containing potentially harmful functionality. Previous studies have only conducted a limited analysis of pregnancy app functionalities, expert involvement/evidence-based content, used commercialization techniques, and user perception.

METHODS

We used the keyword "pregnancy" to scrape (automatically extract) apps and app information from Apple App Store and Google Play. Unique functionalities were derived from app descriptions and user reviews. App descriptions were screened for evidence-based content and expert involvement, and apps were subsequently analyzed in detail. Apps were opened and searched for used commercialization techniques, such as advertisements or affiliate marketing. Automated text analysis (natural language processing) was used on app reviews to assess users' perception of evidence-based content/expert involvement and commercialization techniques.

RESULTS

In total, 495 apps were scraped. 226 remained after applying exclusion criteria. Out of these, 36 represented 97%/88% of the total market share (Apple App Store/Google Play), and were thus considered for review. Overall, 49 distinct functionalities were identified, out of which 6 were previously unreported. Functionalities for fetal kick movement counting were found. All apps are commercial. Only 15 apps mention the involvement of medical experts. 10.3% of two-stars user reviews include commercial topics, and 0.6% of one-/two-/three-/five stars user reviews include references to scientific content accuracy.

CONCLUSION

Problematic features and inadequate advice continue to be present in pregnancy apps. App developers should adopt an evidence-based development approach and avoid implementing as many features as possible, potentially at the expense of their quality or over-complication ("feature creep"). Financial incentives, such as grant programs, could support adequate content quality. Caregivers play a key role in pregnant individuals' decision-making, should be aware of potential dangers, and could guide them to trustworthy apps.

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.

Preconception health and care policies, strategies and guidelines in the UK and Ireland: a scoping review

BACKGROUND

Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland.

METHODS

Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel.

RESULTS

The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours.

CONCLUSIONS

This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.

Impact of the COVID-19 pandemic on new parents enrolled in the 'BABY1000' birth cohort study in Sydney, Australia: A mixed-methods study

OBJECTIVE

The COVID-19 pandemic was, and continues to be, uniquely experienced by women in the perinatal period and their families. Whilst long-term impacts of the pandemic are unknown, exposures in pregnancy and early life have impacts across the life-course and future generations. The objective of this manuscript was to explore how the pregnancy, postpartum and parenting experiences of a subset of participants from the 'BABY1000' cohort in Sydney, Australia, were affected by the COVID-19 pandemic, and explore associations between these experiences and state anxiety.

METHODS

Mixed methods were used. Participants were requested to complete an online survey including the State-Trait Anxiety Inventory short form (STAI-6), followed by an invitation to participate in focus group discussions (FGDs).

RESULTS

From September to November 2021, 88 parents completed the survey (mean age 33.5 years, 60% born in Australia, 58% primiparous). Twenty-two parents participated in FGDs. Six themes were identified regarding the experience of parents: (1) Maternal support, (2) Family relationships, (3) Stress and mental health, (4) Healthcare, (5) Family lifestyle and routine, and (6) Long-term impacts. The mean STAI-6 score was 40 (SD 12.3), representing high anxiety. High anxiety was significantly associated with concern regarding COVID-19 and feeling overburdened and lonely.

CONCLUSIONS

The COVID-19 pandemic and associated public health orders significantly impacted participants' pregnancy, postpartum and parenting experiences. Whilst these experiences included some unexpected positives, for many, these were outweighed by negative impacts on mental health, social support, health behaviours, and family relationships.

IMPLICATIONS FOR PUBLIC HEALTH

Ongoing longitudinal research is imperative to identify potential long-term effects of the pandemic across the life-course, better support families in the short and long-term, and plan for public health crises in the future.

The MidPIC study: Midwives' knowledge, perspectives and learning needs regarding preconception and interconception care

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives' knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives' self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from (n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants (n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic (n = 244; 72%). Most (n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives' provision of pre and interconception care.

Exploring Health Behaviours, Attitudes and Beliefs of Women and Men during the Preconception and Interconception Periods: A Cross-Sectional Study of Adults on the Island of Ireland

Preconception health is increasingly seen as a key target for improving population health in the UK and Ireland, yet little is known about the attitudes and beliefs of adults regarding preconception care strategies. This online cross-sectional survey aimed to explore the health behaviours, attitudes and beliefs of adults of reproductive age in regard to preconception health and care. The survey was developed by reviewing the previous literature and engaging with those from the target group. It is one of the first surveys to assess the attitudes and beliefs of adults of reproductive age across the Island of Ireland regarding preconception health and care. Results from 386 individuals with a mean age of 29.9 ± 10.3 years were included. A variety of health behaviours, attitudes and beliefs were investigated, with differences being identified between women and men and between participants with or without children (i.e., in the preconception or interconception stage). The majority of respondents held beliefs that preconception care was important, but there was greater emphasis on women than men in terms of the need to engage in health-promoting preconception health behaviours. This study highlights the need to improve preconception health awareness in women and men in the preconception and interconception stage. Findings indicate that efforts to improve preparation for pregnancy among adults of childbearing age are needed, to ensure optimal engagement in preconception health behaviours, with efforts being tailored based on sex and parental status.

Safety considerations for assessing the quality of apps used during pregnancy: A scoping review

Objective

Pregnant women are increasingly turning to apps targeting knowledge and behaviour change for supporting healthy lifestyles and managing medical conditions. Yet, there is growing concern over the credibility and safety of content within mobile health (mHealth) apps. This scoping review aimed to systematically and thematically consolidate safety considerations described in reviews evaluating pregnancy-specific apps.

Methods

PubMed, Ovid MEDLINE® and EPub, CINAHL, Web of Science, Cochrane Libraries, and SCOPUS were systematically searched to identify reviews that assessed apps targeting pregnant women. Data related to safety were extracted and thematically analysed to establish a set of relevant safety considerations.

Results

Sixteen reviews met the inclusion criteria. The included reviews assessed an average of 27 apps each and targeted pregnancy topics, such as nutrition and physical activity. Five major and 20 minor themes were identified, including information, transparency, credibility, privacy and security, and app tailoring. Information, transparency, and credibility relate to the evidence base of information within the app, privacy and security of apps relate to the protection of personal information and data, and app tailoring relates to the consideration of contextual factors, such as local guidelines and digital health literacy.

Conclusions

Results present possible safety considerations when evaluating pregnancy-specific apps and emphasise a clear need for consumer guidance on how to make informed decisions around engagement and use of mHealth apps during pregnancy.