By Nishadi Withanage, Sharon James, Jessica Botfield, Kirsten Black, Jeana Wong & Danielle Mazza 

Pre-pregnancy, the phase before conception, is an opportunity for health professionals to work with women and their partners to enhance health and pregnancy outcomes by managing risk factors such as obesity, alcohol consumption, smoking, and physical and mental health conditions. General practice electronic medical records (EMRs) store information relating to a patient’s medical and lifestyle risk factors such as smoking, alcohol consumption and current medical conditions. The information recorded in these EMRs could potentially assist clinicians in general practice, including general practitioners (GPs) and practice nurses (PNs), to identify and invite women who could most benefit from​ pre-pregnancy​​ care​. ​​Our current study “General practice ​pre-pregnancy care​ invitations: A qualitative study of women’s acceptability and preferences” published in ​​BMJ Sexual and Reproductive Health, investigated women’s acceptability and preferences for receiving pre-pregnancy care invitations from general practice settings.  

​​​Our study reports 4 main findings: ​​ 

​​​(1) ​​Receiving a ​​pre-pregnancy​​ care invitation is acceptable to women. ​​​​ 

​​Women indicated support for receiving invitations for pre-pregnancy care from general practices and felt it would be a valuable and important reminder. However, using respectful and appropriate language to avoid offending or stigmatising women was raised as being very important. ​​​It is also necessary to be mindful that some of the invitees will ​​​have completed their families, have infertility conditions, or may not wish to have ​​​​children​​. ​The respondents also proposed modifying new patient forms and patient EMRs to gather more information on reproductive intentions.  

(2) Text or email invitations outlining consultation details were preferred.

Women preferred receiving text or email invitations compared to telephone calls or letters. Texts were perceived to be more user-friendly and emails could provide more detailed information and appointment-booking links. 

(3) ​​Receiving an invitation may increase the likelihood that women who have risk factors, comorbidities or are actively planning conception will access pre-pregnancy care.

Women who were actively thinking about having a baby and/or who had known health conditions (e.g. diabetes) were more likely to be interested in making a pre-pregnancy care appointment after being invited by their general practice. 

(4) Health promotion strategies that increase awareness of pre-pregnancy care could increase the uptake of pre-pregnancy care in general practice. 

Women suggested various health promotion strategies could increase awareness and uptake of pre-pregnancy care in general practice. In addition to being invited, as described above, women ​also ​suggested promoting ​the availability of ​pre-pregnancy through general practice newsletters, waiting room or bathroom posters, and phone recordings when on-hold for appointment bookings. Women also supported integrating pre-pregnancy care with other GP consultations, such as for contraception or cervical screening. 

Our study demonstrated that using EMRs to identify and invite women with preconception health risk factors for pre-pregnancy care is acceptable to women. A text/email message outlining the details of what the pre-pregnancy care consultation would involve was preferred. Participants actively considering pregnancy or with known risk factors or health conditions felt they were more likely to respond to the pre-pregnancy care invite and make an appointment.  

Read the research paper here.   

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About the Authors  

 

Nishadi Withanage  

Ms Nishadi Withanage is a PhD Candidate with the NHMRC-funded SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University. She has a passion for improving women’s preconception health and her PhD is focussed on ‘Optimising the provision of preconception care in Australian General Practice: leveraging systems and providers’. She currently works as a Research Fellow at the Department of General Practice, Monash University.  

Sharon James 

Dr Sharon James is an experienced primary health care nurse and an Australian Primary Health Care Nurses Association Board Director. She currently works as a Research Fellow and Project Manager with the NHMRC-funded SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University at the Department of General Practice on the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network. Her other interests include women’s health, communication, preventive care, interconception health and nursing roles in primary health care. 

Jessica Botfield 

Dr Jessica Botfield is a Senior Research Fellow with the NHMRC-funded SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University, and a Senior Research Officer at Family Planning NSW. Her research interests focus on promoting equitable access to contraception, particularly through nurse- and midwifery-led models of contraceptive care.  

Kirsten Black 

Professor Kirsten Black is an academic gynaecologist at the University of Sydney. She is a Fellow of the Royal Australian and New Zealand College of Obstetricians (RANZCOG) and chairs the college’s special interest group in Sexual and Reproductive Health. Kirsten has a PhD from the London School of Hygiene and Tropical Medicine, University of London and a Fellowship of the United Kingdom’s Faculty of Sexual and Reproductive Healthcare. Kirsten has been awarded over $10 million in research funding and has 150 peer reviewed publications. She practices clinically in the areas of contraception, abortion and preconception care and combines clinical work, research and teaching. 

Jeana Wong  

Ms Jeana Wong is a registered nurse and a PhD candidate with the NHMRC-funded SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University. She is currently evaluating the effectiveness of a nurse-led model of care for contraception and abortion, as part of the national MRFF-funded ORIENT trial. 

Danielle Mazza 

Professor Danielle Mazza AM is the Head of Department of General Practice at Monash University and the Director of the NHMRC-funded SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University.