Abstract
Preconception care (PCC) has the potential to optimize pregnancy outcomes. However, awareness of PCC among the target population is generally limited, and the use of PCC remains low. The objective of this study was to review the literature on women's perceptions regarding barriers and facilitators for the use of PCC. A systematic search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO for published studies until February 2015. Original qualitative and quantitative peer-reviewed studies from Western countries in English, holding women's perceptions regarding barriers and facilitators for the use of PCC. Data extraction and analysis were performed using NVivo version 10 software. A coding frame was derived from the findings and applied by 2 authors. Thematic analysis was used to identify key topics and themes. Twenty-one good-quality articles were included, of which 10 qualitative and 11 quantitative studies. Seven main themes were identified: preconditions, emotions and beliefs, perceived need, knowledge and experience, social structure, accessibility, and provider characteristics. "Not (fully) planning pregnancy", "perceived absence of risks", "lack of awareness", and "pregnancy experiences" were the most frequently identified barriers and "believing in the benefits" and "availability of PCC" the most frequently identified facilitators for PCC use. Women perceive more barriers than facilitators related to PCC uptake, which explains why the use of PCC remains low. Our results provide a starting point to refocus interventions and strategies, aiming on enlarging the awareness, perceived importance, and accessibility of PCC to improve its uptake.
Highlights
Importance: Preconception care (PCC) has the potential to optimize pregnancy outcomes
Our findings indicate that perceived absence of risks is one of the most important barriers for PCC use, evidence shows that almost all couples planning for pregnancy have at least one risk factor for adverse pregnancy outcomes.[9]
Our findings suggest that promotional messages should focus on highlighting possible risks and emphasizing on the benefits associated with PCC, which was indicated as the most important motivator for women to engage in PCC
Summary
Importance: Preconception care (PCC) has the potential to optimize pregnancy outcomes. The key components of PCC include risk assessment, health promotion, and medical and psychosocial interventions.[4] Individual PCC counseling may encompass information about lifestyle, obstetrical history, hereditary diseases, immunization, and medication use.[5] The attention for PCC has grown substantially over the past decades and national guidelines and recommendations have been developed in many western countries.[2,6,7] PCC is increasingly being offered, awareness of PCC among the target population is generally limited and the use of PCC remains low.[8] Research indicates that almost all couples planning pregnancy have at least one risk factor for adverse pregnancy outcomes, and most of these risk factors continue to be prevalent during pregnancy.[9,10] Preconception care has demonstrated to improve knowledge and change risk behaviors to optimize future pregnancy outcomes and future health.[11,12,13] Yet, the percentage of couples seeking or receiving PCC is disappointing. Our study builds on their previous work by examining what factors women perceive as barriers and facilitators for the use of preconception care
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