Associate Professor Danielle Mazza

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Associate Professor Danielle Mazza Ms Anna
Chapman Dept of General Practice School of
Primary Care Monash University

• Improving the Uptake of Periconceptional Folate
  Supplementation What Do Women Think?

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Background

• Pregnancy is "a window of opportunity" for health
  promotion
• strong evidence exists that preconception
  interventions improve pregnancy outcomes
• Australian and international studies demonstrate
  low levels of knowledge and behaviour related to
  preconception care in women of reproductive age
• less than 50 of women supplement their diet with
  folate in the periconceptual period
• General Practitioners (GPs) do not routinely
  address preconception care in practice.

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Aim

• We aimed to determine the views of women of
  reproductive age regarding barriers and enablers
  to uptake of preconception care and
  periconceptional folate supplementation.

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Method

• Setting metropolitan Melbourne and rural
  Victoria, Australia
• Focus groups of women aged 18-45 years
• Low socioeconomic
• High socioeconomic
• Rural

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Barriers Enablers

• Degree of receptivity
• Conception as a normal event
• Nature and symbolism of folate supplements
• Perceived risk and lack of awareness of the need
  for preconception care
• Service provider issues

• High motivation to optimise pregnancy outcomes
• Proactive promotion by GPs

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Degree of receptivity

• Women had to be receptive to the information in
  order to act upon it.
• You have to be in the zone
• Women who had already had a child felt they
  already knew about preconception care issues and
  didnt need to access preconception care.

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Conception is a normal event

• Women felt that conception was normal and natural
  and that there was no need for medical attention
  or intervention prior to it occurring.
•  
• My mother said you just go ahead and get
  pregnant
•  contrasting with womens sense that it was
  important to present to a GP as soon as they knew
  they were pregnant

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Nature and symbolism of folate supplements

• confusion about folate supplementation the dose,
  timing, benefits and efficacy of branded
  preconception products
• concern about the cost of vitamins.
• purchase of folate supplements was a clear marker
  of intent to conceive - keeping them at home was
  a sign to their partners that they were intending
  to conceive.

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Perceived risk and lack of awareness of the need
for preconception care

• Women were unaware of the need for preconception
  care
• general practitioners did not offer preconception
  care or inform them of its availability.
• surprise at the breadth of issues that could
  comprise a preconception care consultation.
• Poor understanding of reasons for folate use
•  Ive always bought them and had them ready to
  go but never really knew why
•  It felt like taking folate was immunization,
  something that actually prevented itso it wasnt
  something I questioned doing because thats what
  you do and it prevents it

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Service Provider Issues

• high SE women sought preconception care from
  alternative health practitioners such as
  naturopaths
• difficulty accessing GPs, cost , no ongoing
  relationship with any particular GP
• Perceived role of the GP to be acute care
• other patients who were unwell should have
  priority in a stretched system.
•  You only go to a GP when you are sick
•   if I went in there to have a chat about
  planning pregnancy would I be wasting their
  time?

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Service Provider Issues

• Womens main source of information was from
  friends and family and increasingly from the
  internet for high SE women 
• if I wanted info like that (preconception care)
  I would probably just go to an internet sourceI
  wouldnt think of necessarily going to the GP if
  I can read it elsewhere
• Internet sites being accessed for preconception
  were sites run by commercial for profit companies
  (media companies, companies producing nappies and
  those producing preconception supplements).

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Enablers - High motivation to optimise pregnancy
outcome

• women had a strong desire to achieve the best
  outcome possible for their baby and as such were
  very motivated to access information and engage
  in preventive care.
•  
• Youll do anything you can
•  

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Proactive promotion by GPs

• if they said to me if you think you might ever
  want to start planning a family these are some of
  the things we can discuss with you..I would file
  that way and when Id made my decision I would
  come to talk to them about it
•  suggesting women return for a specific
  preconception care appointment
• letter from the GP inviting attendance for
  preconception care
• running preconception classes similar to
  antenatal classes
• having preconception appointments available with
  a nurse
• Waiting room posters patient information

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Conclusions

• Lack of patient push and practitioner pull
  for these services
• Further research needed
• Which of these barriers are the most important
  and most changeable?
• Development of interventions to address these
  barriers
• Randomised controlled trials to evaluate the
  efficacy of these interventions