General practitioners’ knowledge, attitudes and views of providing preconception care: a qualitative investigation

Obiamaka Ojukwu,Dilisha Patel,Judith Stephenson,Beth Howden,Jill Shawe

doi:10.1080/03009734.2016.1215853

Obiamaka Ojukwu, Dilisha Patel + Show 3 more

Open Access

https://doi.org/10.1080/03009734.2016.1215853

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Abstract

Background: Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Little is known about the preconception interventions that general practitioners (GPs) provide. The aim of this study was to examine GPs’ knowledge, attitudes, and views towards preconception health and care in the general practice setting.Methods: As part of a large mixed-methods study to explore preconception care in England, we surveyed 1,173 women attending maternity units and GP services in London and interviewed women and health professionals. Seven GPs were interviewed, and the framework analysis method was used to analyse the data.Findings: Seven themes emerged from the data: Knowledge of preconception guidelines; Content of preconception advice; Who should deliver preconception care?; Targeting provision of preconception care; Preconception health for men; Barriers to providing preconception care; and Ways of improving preconception care. A lack of knowledge and demand for preconception care was found, and although reaching women before they are pregnant was seen as important it was not a responsibility that could be adequately met by GPs. Specialist preconception services were not provided within GP surgeries, and care was mainly targeted at women with medical conditions. GPs described diverse patient groups with very different health needs.Conclusion: Implementation of preconception policy and guidelines is required to engage women and men and to develop proactive delivery of care with the potential to improve pregnancy and neonatal outcomes. The role of education and of nurses in improving preconception health was acknowledged but remains under-developed.

Highlights

Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention
The seven general practitioners (GPs) (4 male and 3 female) who agreed to be interviewed were all partners in their practices with the exception of one who was a part-time salaried GP
Seven main themes emerged from the data: [1] Knowledge of preconception guidelines; [2] Content of preconception advice; [3] Who should deliver preconception care?; [4] Targeting provision of preconception care; [5] Preconception health for men; [6] Barriers to providing preconception care; and [7] Ways of improving preconception care

Summary

Introduction

Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Recommendations incorporate promotion of health-related behaviours including reducing the incidence of neural tube defects through folic acid supplementation; reducing preterm births, low birth weight, and poor neonatal and maternal outcomes through smoking cessation, alcohol reduction, and achievement of healthy weight and nutrition prior to conception; reducing infections through screening and vaccination; and identifying medications and occupational and environmental hazards that could be teratogenic. This is reinforced by the recommendation for couples to plan their pregnancies in order to improve maternal outcomes [9]

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