Background Preconception planning enables women to optimize preconception health thereby reducing the risk of poor maternal and neonatal outcomes. Awareness and practice of preconception planning is generally low. In this rapid evidence review, we examined the barriers and facilitators to women choosing to plan and prepare for a healthy pregnancy.
Methods We searched MEDLINE, PsycINFO and CINAHL from 2009 to October 2019 and limited to English language. We included any publications that presented facilitators and barriers for women choosing to plan and prepare for pregnancy. We also included papers presenting barriers and facilitators to health care professionals supporting this behaviour and articles on relevant interventions although these data are not presented here. We contacted experts to identify grey literature. We extracted study characteristics using a pre-piloted data extraction form and assessed the quality of individual studies using the Mixed Methods Appraisal Tool. One reviewer performed title and abstract screening, data extraction and quality assessment with a sample checked by a second reviewer. Two reviewers screened full texts independently. Using NVivo, we coded information on barriers and facilitators from each study into themes under two subheadings; a) information seeking and b) preparing for a healthy pregnancy.
Results We screened 2679 citations, 54 full-text articles and included 24 articles for analysis. 18articles reported barriers and facilitators for women. The most frequently reported barriers to information seeking prior to conception were unintended pregnancy, information provoking anxiety, and belief that there is no need for preconception care. Facilitators included ad hoc prompts in health care settings, and opportunities to discuss pregnancy intentions (e.g. as part of care for a chronic condition). The most frequent barriers to preparing for a healthy pregnancy were: not knowing what recommended behaviours might be, lack of understanding or incorrect beliefs, information not appropriate for woman’s context, and lived experience (of self or in social circle) that appears to contradict health advice. Facilitators included knowledge of recommended behaviours, feelings of responsibility towards a potential baby, and confidence in ability to achieve health goals prior to conceiving.
Conclusion We will conduct a behavioural analysis and categorise the identified barriers and facilitators into the Theory and Techniques Tool (TaTT) mechanisms of actions (MoAs). We will then examine whether existing intervention content matches what is theoretically appropriate, therefore identifying opportunities for improvement of existing interventions and novel development to promote preconception planning and ultimately, better maternal and neonatal outcomes.
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