Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
Rotterdam University of Applied Sciences, School for Healthcare Studies, Department of Master Physician Assistant Midwifery, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands.
Reprod Health. 2018 Nov 23;15(1):192. doi: 10.1186/s12978-018-0617-1.
Women from lower socioeconomic groups tend to be at greater risk of adverse perinatal outcomes, but are less likely to participate in preconception counselling compared to higher socioeconomic groups. This could be partly because of their limited skills to assess, understand and use health related information in ways that promote and maintain good health (health literacy skills). In this study we explored determinants of participation in preconception counselling among women with low health literacy in The Netherlands.
Potential determinants of participation in preconception counselling were derived from the literature, and mapped onto a theoretical framework, which was tested for perceived relevance and completeness in an expert review (n = 20). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n = 139). In the interviews we explored preconception counselling awareness, knowledge, considerations, subjective norms, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with intention to participate in preconception counselling.
Most women (75%) were unaware of the concept of preconception counselling and the provision of counselling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counselling for themselves, and 41% reported that they would participate in preconception counselling.
Women with low health literacy were generally unaware of the concept and provision of preconception counselling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counselling. This knowledge is essential for evidence-based development of interventions to increase the accessibility and understanding of preconception counselling.
与社会经济地位较高的群体相比，来自较低社会经济群体的女性往往面临更大的不良围产期结局风险，但参与孕前咨询的可能性较小。这可能部分是因为她们在评估、理解和使用促进和维持健康的健康相关信息方面的技能有限（健康素养技能）。在这项研究中，我们探讨了荷兰低健康素养女性参与孕前咨询的决定因素。
潜在的参与决定因素来源于文献，并映射到一个理论框架中，该框架在专家审查中进行了相关性和完整性测试（n=20）。该框架用于为有低健康素养和怀孕意愿的女性（n=139）进行面对面访谈。在访谈中，我们探讨了对孕前咨询的认识、知识、考虑因素、主观规范、自我效能、态度和意向。线性回归分析用于检验与参与孕前咨询意向的关联。
大多数女性（75%）不知道孕前咨询和咨询服务的概念，即使她们居住在已发布书面邀请的地区。常见的参与考虑因素包括：为怀孕做准备；认为缺乏信息；以及前一次怀孕出现问题。不参与的考虑因素主要与认为自己有足够的知识和认为围产期问题的风险低有关。受访者普遍对自己参与孕前咨询持积极态度，41%的人表示会参与孕前咨询。
低健康素养的女性通常不知道孕前咨询的概念和提供情况，但似乎对参与感兴趣。进一步的研究应调查如何有效地接触和告知这一群体有关孕前咨询的信息。这方面的知识对于基于证据制定干预措施以提高获得和理解孕前咨询的机会至关重要。
