The co-development of a behaviour change intervention to improve preconception health

Background: The intrauterine environment can influence the future health of the child and their likelihood of developing obesity. Behaviour change interventions conducted during pregnancy have limited effectiveness to improve health outcomes during and after pregnancy. The aim of this thesis was to co-develop a behaviour change intervention to improve health behaviours before conception. Methods: Four studies were conducted. Study one reviewed preconception health behaviour recommendations, examining consistency across Scotland, the UK, Europe and western international countries. Study two was a secondary analysis of survey data examining engagement in multiple health behaviours among preconception women in Scotland. The third study was a qualitative systematic review exploring preconception knowledge, beliefs and behaviours among people of reproductive age. Findings from these studies, alongside input from Patient and Public Involvement (PPI), informed the development of a theory-based intervention. The intervention, based on the information-motivation-behavioural skills model, was piloted in study four. Findings and conclusions: Preconception guidelines within Scotland were similar to comparable countries, with key behaviours such as folic acid, weight management, alcohol and smoking cessation addressed in all. In Scotland, there was a lack of engagement in health promoting behaviours, particularly among those not planning a pregnancy and those living in areas of socio-economic disadvantage. Findings from the systematic review indicated a lack of understanding of preconception health across the preconception population. These findings led to the prioritisation of raising awareness as the first step to behaviour change and, with PPI input, a theory-based awareness raising intervention video was developed. The pilot study evidenced the video’s acceptability and effectiveness at increasing knowledge. Future research could further develop the video by considering feasibility and implementation in primary care settings such as community pharmacy

Preconception knowledge, beliefs and behaviours among people of reproductive age: a systematic review of qualitative studies.

The health of parents before pregnancy influences the short- and long-term health of their offspring. This systematic review explored the preconception knowledge, beliefs and behaviours held by women and men of childbearing age. Databases were searched from 2009 to 2022 (MEDLINE, CINAHL Full-text, PsycINFO, EMBASE). Inclusion criteria specified qualitative research papers which recruited individuals of reproductive age (16–45 years) without existing chronic illnesses. Data were quality assessed and analysed using thematic synthesis. Twelve papers met inclusion criteria. Six themes were identified (cultural context, pregnancy planning, knowledge, gender roles and responsibility, information seeking, prior health behaviours) which relate to individual, social, psychological and cultural factors. Cultural context was related to all other themes. Pregnancy planners had greater motivation to optimise their health whereas those not actively planning were focused more on becoming financially stable. Women and men's knowledge of how and why to engage in health protective behaviours was limited, with health risks and behaviour change discussed in the context of pregnancy rather than preconception. Gender roles influenced individual responsibility for preparation for pregnancy, which in turn influenced information seeking behaviours and engagement in health behaviours. Online sources of support and information were seen as desirable, regardless of pregnancy planning stage. Our findings indicate that behaviour change interventions designed to support people to optimise health before conception should address cultural, individual, social and psychological factors to facilitate behaviour change. Development of online resources may help to increase accessibility for people across different cultural contexts and stages of pregnancy planning