Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students
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Abstract
Objective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students’ perspectives.
Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis.
Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students.
Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services.
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2. Ontario Public Health Association. Shift–enhancing the health of Ontarians: a call to action for preconception health promotion and care. Toronto, ON. 2014.
3. Alio A. Preconception and inter-conception care: The role of the home visitor. University of Rochester Medical Centre: NYS Maternal & Infant Health Centre of Excellence. 2017.
4. Mason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA. Preconception care: advancing from ‘important to do and can be done to ‘is being done and is making a difference. Reprod Health 2014; 11: 1-9.
5. Dean SV, Mason E, Howson CP, Lassi ZS, Imam AM, Bhutta ZA. Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action. Reprod Health 2013;10 Suppl 1: S3.
6. Van der Zee B, de Beaufort ID, Steegers EA, Denktas S. Perceptions of preconception counselling among women planning a pregnancy: a qualitative study. Fam Pract 2013; 30: 341-6.
7. Dean SV, Imam AM, Lassi ZS, Bhutta ZA. Importance of intervening in the preconception period to impact pregnancy outcomes. Nestle Nutr Inst Workshop Ser 2013; 74: 63-73.
8. Hussein N, Kai J, Qureshi N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur J Gen Pract 2016; 22: 42-52.
9. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep 2006; 55: 1-23.
10. Berglund A, Lindmark G. Preconception health and care (PHC)—a strategy for improved maternal and child health. Ups J Med Sci 2016; 121: 216-21.
11. Delissaint D, McKyer EL. A systematic review of factors utilized in preconception health behavior research. Health Educ Behav 2011; 38: 603-16.
12. Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21: 411-26.
13. Stern J. Preconception Health and Care: A Window of Opportunity: Doctoral dissertation, Acta Universitatis Upsaliensis, Sweden; 2015.
14. Poels M, Koster MPH, Franx A, van Stel HF. Parental perspectives on the awareness and delivery of preconception care. BMC Pregnancy Childbirth 2017; 17: 324.
15. World Health Organization. Preconception care to reduce maternal and childhood mortality and morbidity: policy brief. WHO; 2013.
16. Weerd S, Steegers EA. The past and present practices
and continuing controversies of preconception care. Community Genet 2002; 5: 50-60.
17. Goodfellow A, Frank J, McAteer J, Rankin J. Improving preconception health and care: a situation analysis. BMC Health Serv Res 2017; 17: 595.
18. Ojukwu O, Patel D, Stephenson J, Howden B, Shawe J. General practitioners' knowledge, attitudes and views of providing preconception care: a qualitative investigation. Ups J Med Sci 2016; 121: 256-63.
19. Steel A, Lucke J, Reid R, Adams J. A systematic review of women’s and health professional’s attitudes and experience of preconception care service delivery. Fam Pract 2016; 33: 588-95.
20. Mitchell EW, Verbiest S. Effective strategies for promoting preconception health--from research to practice. Am J Health Promot 2013; 27: S1-3.
21. Charafeddine L, El Rafei R, Azizi S, Sinno D, Alamiddine K, Howson CP, et al. Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon. BMC public Health 2014; 14: 1-9.
22. Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reprod Health 2014; 11 Suppl 3: S7.
23. Young CT, Urquia ML, Ray JG. Preconception care in low-and middle-income countries: new opportunities and a new metric. PLoS Med 2013; 10: e1001507.
24. Weinstein ND, Sandman PM. A model of the precaution adoption process: evidence from home radon testing. Health Psychol 1992; 11: 170-80.
25. Kassa A, Yohannes Z. Women’s knowledge and associated factors on preconception care at Public Health Institution in Hawassa City, South Ethiopia. BMC Res Notes 2018; 11: 841.
26. Whitworth M, Dowswell T. Routine pre‐pregnancy health promotion for improving pregnancy outcomes. Cochrane Database Syst Rev 2009: CD007536.
27. Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J 2006; 10: S29-35.
28. UNDP Ghana.2015 Ghana Millennium Development Goals Report. Available:https://www.undp.org/ghana/publications/2015-ghana-millennium-development-goals-report
29. Der EM, Moyer C, Gyasi RK, Akosa AB, Tettey Y, Akakpo PK, et al. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Med J 2013; 47: 158-63.
30. Ghana Demographic and Health Survey 2014; 2015.
31. Ghana Health Service. National safe motherhood
service protocol. Accra: Yamens Press Ltd 2007.
32. Harelick L, Viola D, Tahara D. Preconception health of low socioeconomic status women: assessing knowledge and behaviors. Womens Health Issues 2011; 21: 272-6.
33. Sabarre KA, Khan Z, Whitten AN, Remes O, Phillips KP. A qualitative study of Ottawa university students' awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART). Reprod Health 2013; 10: 41.
34. Santos MJ, Ferreira E, Duarte J, Ferreira M. Risk factors that influence sexual and reproductive health in Portuguese university students. Int Nurs Rev 2018; 65: 225-33.
35. Lampic C, Svanberg AS, Karlström P, Tydén T. Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics. Hum Reprod 2006; 21: 558-64.
36. Wade GH, Herrman J, McBeth-Snyder L. A preconception care program for women in a college setting. MCN Am J Matern Child Nurs 2012; 37: 164-70.
37. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. Afr J Emerg Med 2017; 7: 93-9.
38. Nelson MC, Story M, Larson NI, Neumark-Sztainer D, Lytle LA. Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Obesity (Silver Spring) 2008; 16: 2205-11.
39. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology 2006; 3: 77-101.
40. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract 2018; 24: 120-4.
41. Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitative content analysis and thematic analysis. Journal of Nursing Education and Practice 2016; 6:100-10.
42. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open 2016; 2: 8-14.
43. Lincoln YS, Guba EG.Naturalistic inquiry, 1st edn. Newbury Park: Sage Publications Inc; 1985.
44. Hemsing N, Greaves L, Poole N. Preconception health care interventions: a scoping review. Sex Reprod Healthc 2017; 14: 24-32.
45. Squiers L, Mitchell EW, Levis DM, Lynch M, Dolina
S, Margolis M, et al. Consumers' perceptions of preconception health. Am J Health Promot 2013; 27:S10-9.
46. Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reprod Health 2014; 11 Suppl 3: S7.
47. Weinstein ND, Sandman PM. A model of the precaution adoption process: evidence from home radon testing.Health Psychol 1992; 11: 170-80.
48. Fisher WA, Fisher JD, Harman J. The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior. Social psychological foundations of health and illness, Blackwell Publishing 2003: 82-106.
49. Charafeddine L, El Rafei R, Azizi S, Sinno D, Alamiddine K, Howson CP, et al. Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon. BMC Public Health 2014; 14:774.
50. Young CT, Urquia ML, Ray JG. Preconception Care in low-and Middle-Income Countries: new opportunities and a new metric. PLoS Med 2013; 10: e1001507.
51. Atrash HK, Johnson K, Adams M, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 2006; 10: S3-11.
52. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988; 15: 351-77.
53. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th edition. Jossey-Bass 2008.
54. Tuomainen H, Cross-Bardell L, Bhoday M, Qureshi N, Kai J. Opportunities and challenges for enhancing preconception health in primary care: a qualitative study with women from ethnically diverse communities. BMJ Open 2013; 3: e002977.
2. Ontario Public Health Association. Shift–enhancing the health of Ontarians: a call to action for preconception health promotion and care. Toronto, ON. 2014.
3. Alio A. Preconception and inter-conception care: The role of the home visitor. University of Rochester Medical Centre: NYS Maternal & Infant Health Centre of Excellence. 2017.
4. Mason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA. Preconception care: advancing from ‘important to do and can be done to ‘is being done and is making a difference. Reprod Health 2014; 11: 1-9.
5. Dean SV, Mason E, Howson CP, Lassi ZS, Imam AM, Bhutta ZA. Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action. Reprod Health 2013;10 Suppl 1: S3.
6. Van der Zee B, de Beaufort ID, Steegers EA, Denktas S. Perceptions of preconception counselling among women planning a pregnancy: a qualitative study. Fam Pract 2013; 30: 341-6.
7. Dean SV, Imam AM, Lassi ZS, Bhutta ZA. Importance of intervening in the preconception period to impact pregnancy outcomes. Nestle Nutr Inst Workshop Ser 2013; 74: 63-73.
8. Hussein N, Kai J, Qureshi N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur J Gen Pract 2016; 22: 42-52.
9. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep 2006; 55: 1-23.
10. Berglund A, Lindmark G. Preconception health and care (PHC)—a strategy for improved maternal and child health. Ups J Med Sci 2016; 121: 216-21.
11. Delissaint D, McKyer EL. A systematic review of factors utilized in preconception health behavior research. Health Educ Behav 2011; 38: 603-16.
12. Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21: 411-26.
13. Stern J. Preconception Health and Care: A Window of Opportunity: Doctoral dissertation, Acta Universitatis Upsaliensis, Sweden; 2015.
14. Poels M, Koster MPH, Franx A, van Stel HF. Parental perspectives on the awareness and delivery of preconception care. BMC Pregnancy Childbirth 2017; 17: 324.
15. World Health Organization. Preconception care to reduce maternal and childhood mortality and morbidity: policy brief. WHO; 2013.
16. Weerd S, Steegers EA. The past and present practices
and continuing controversies of preconception care. Community Genet 2002; 5: 50-60.
17. Goodfellow A, Frank J, McAteer J, Rankin J. Improving preconception health and care: a situation analysis. BMC Health Serv Res 2017; 17: 595.
18. Ojukwu O, Patel D, Stephenson J, Howden B, Shawe J. General practitioners' knowledge, attitudes and views of providing preconception care: a qualitative investigation. Ups J Med Sci 2016; 121: 256-63.
19. Steel A, Lucke J, Reid R, Adams J. A systematic review of women’s and health professional’s attitudes and experience of preconception care service delivery. Fam Pract 2016; 33: 588-95.
20. Mitchell EW, Verbiest S. Effective strategies for promoting preconception health--from research to practice. Am J Health Promot 2013; 27: S1-3.
21. Charafeddine L, El Rafei R, Azizi S, Sinno D, Alamiddine K, Howson CP, et al. Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon. BMC public Health 2014; 14: 1-9.
22. Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reprod Health 2014; 11 Suppl 3: S7.
23. Young CT, Urquia ML, Ray JG. Preconception care in low-and middle-income countries: new opportunities and a new metric. PLoS Med 2013; 10: e1001507.
24. Weinstein ND, Sandman PM. A model of the precaution adoption process: evidence from home radon testing. Health Psychol 1992; 11: 170-80.
25. Kassa A, Yohannes Z. Women’s knowledge and associated factors on preconception care at Public Health Institution in Hawassa City, South Ethiopia. BMC Res Notes 2018; 11: 841.
26. Whitworth M, Dowswell T. Routine pre‐pregnancy health promotion for improving pregnancy outcomes. Cochrane Database Syst Rev 2009: CD007536.
27. Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J 2006; 10: S29-35.
28. UNDP Ghana.2015 Ghana Millennium Development Goals Report. Available:https://www.undp.org/ghana/publications/2015-ghana-millennium-development-goals-report
29. Der EM, Moyer C, Gyasi RK, Akosa AB, Tettey Y, Akakpo PK, et al. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Med J 2013; 47: 158-63.
30. Ghana Demographic and Health Survey 2014; 2015.
31. Ghana Health Service. National safe motherhood
service protocol. Accra: Yamens Press Ltd 2007.
32. Harelick L, Viola D, Tahara D. Preconception health of low socioeconomic status women: assessing knowledge and behaviors. Womens Health Issues 2011; 21: 272-6.
33. Sabarre KA, Khan Z, Whitten AN, Remes O, Phillips KP. A qualitative study of Ottawa university students' awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART). Reprod Health 2013; 10: 41.
34. Santos MJ, Ferreira E, Duarte J, Ferreira M. Risk factors that influence sexual and reproductive health in Portuguese university students. Int Nurs Rev 2018; 65: 225-33.
35. Lampic C, Svanberg AS, Karlström P, Tydén T. Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics. Hum Reprod 2006; 21: 558-64.
36. Wade GH, Herrman J, McBeth-Snyder L. A preconception care program for women in a college setting. MCN Am J Matern Child Nurs 2012; 37: 164-70.
37. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. Afr J Emerg Med 2017; 7: 93-9.
38. Nelson MC, Story M, Larson NI, Neumark-Sztainer D, Lytle LA. Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Obesity (Silver Spring) 2008; 16: 2205-11.
39. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology 2006; 3: 77-101.
40. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract 2018; 24: 120-4.
41. Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitative content analysis and thematic analysis. Journal of Nursing Education and Practice 2016; 6:100-10.
42. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open 2016; 2: 8-14.
43. Lincoln YS, Guba EG.Naturalistic inquiry, 1st edn. Newbury Park: Sage Publications Inc; 1985.
44. Hemsing N, Greaves L, Poole N. Preconception health care interventions: a scoping review. Sex Reprod Healthc 2017; 14: 24-32.
45. Squiers L, Mitchell EW, Levis DM, Lynch M, Dolina
S, Margolis M, et al. Consumers' perceptions of preconception health. Am J Health Promot 2013; 27:S10-9.
46. Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reprod Health 2014; 11 Suppl 3: S7.
47. Weinstein ND, Sandman PM. A model of the precaution adoption process: evidence from home radon testing.Health Psychol 1992; 11: 170-80.
48. Fisher WA, Fisher JD, Harman J. The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior. Social psychological foundations of health and illness, Blackwell Publishing 2003: 82-106.
49. Charafeddine L, El Rafei R, Azizi S, Sinno D, Alamiddine K, Howson CP, et al. Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon. BMC Public Health 2014; 14:774.
50. Young CT, Urquia ML, Ray JG. Preconception Care in low-and Middle-Income Countries: new opportunities and a new metric. PLoS Med 2013; 10: e1001507.
51. Atrash HK, Johnson K, Adams M, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 2006; 10: S3-11.
52. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988; 15: 351-77.
53. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th edition. Jossey-Bass 2008.
54. Tuomainen H, Cross-Bardell L, Bhoday M, Qureshi N, Kai J. Opportunities and challenges for enhancing preconception health in primary care: a qualitative study with women from ethnically diverse communities. BMJ Open 2013; 3: e002977.
| Files | ||
| Issue | Vol 16, No 1 (March 2022) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v16i1.8593 | |
| Keywords | ||
| Reproductive Health Reproductive Health Services Ghana Qualitative Research | ||
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How to Cite
1.
Doe P, Hormenu T, Enyan NI. Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students. J Family Reprod Health. 2022;16(1):43-51.
