Opportunities for preconception care in Australia: A qualitative study of the perspectives of primary care professionals

BackgroundPreconception care is well situated within primary care settings where pregnancy intention and preconception risk screening can occur routinely, along with coordinating preconception health interventions. Implementing preconception care into primary care practices has been challenging, as health professionals report multiple barriers preventing effective preconception care. A clearer insight into the scope of preconception care within Australian primary care settings is needed. Therefore, this study aimed to explore the beliefs and attitudes towards preconception care and describe the preconception care practices of general practitioners, midwives, and naturopaths in Australia to identify opportunities for preconception care. MethodsThis study employed a qualitative methodology involving interviews and focus groups with primary care health professionals (n=18) in clinical practice (> 5 years) within Australia. General practitioners (GPs) (n=6), midwives (n=5), and naturopaths (n=7) were recruited through professional organisations between May and August 2021. The fieldwork explored participants beliefs and attitudes towards preconception care and their preconception care practice behaviours. A thematic framework approach applicable to health services research was employed for data analysis. ResultsThe analysis identified three key themes about the participants perspectives on providing preconception care: Preconception health requires a population-level focus across the life stages (subthemes: public health focus on preconception health and care is insufficient, more public information on preconception health and care is needed, and public education on preconception health and care requires a life course approach), Men are being overlooked and women carry the burden of responsibility in preconception care (subthemes: men lack awareness of their role in preconception care, men are not usually a part of preconception care consultations, men have unique needs and require different approaches to engage in preconception care, and women are carrying the burden of responsibility in preconception care), and Coordination of preconception care among primary care providers (subthemes: GPs as primary care providers of preconception care, health professionals other than GPs as providers of preconception care, and health professionals other than GPs want greater coordination of preconception care). ConclusionsHealth professionals have identified that making the public more aware of preconception health and aligning clinical care and public health initiatives are important. Health professionals should think more carefully about engaging with men in preconception care. Encouraging men to participate in preconception care requires different information and approaches. While GPs are positioned in the healthcare system as responsible for the coordination of care, there are potential contributions to preconception care that other health professionals can make due to their position in the healthcare system, their skills and the populations they service. A complementary and collaborative whole healthcare system approach to preconception care is needed and may provide more opportunities to deliver preconception care to improve reproductive outcomes.