The co-development of a behaviour change intervention to improve preconception health

Abstract

Background: The intrauterine environment can influence the future health of the child and their likelihood of developing obesity. Behaviour change interventions conducted during pregnancy have limited effectiveness to improve health outcomes during and after pregnancy. The aim of this thesis was to co-develop a behaviour change intervention to improve health behaviours before conception.

Methods: Four studies were conducted. Study one reviewed preconception health behaviour recommendations, examining consistency across Scotland, the UK, Europe and western international countries. Study two was a secondary analysis of survey data examining engagement in multiple health behaviours among preconception women in Scotland. The third study was a qualitative systematic review exploring preconception knowledge, beliefs and behaviours among people of reproductive age. Findings from these studies, alongside input from Patient and Public Involvement (PPI), informed the development of a theory-based intervention. The intervention, based on the information-motivation-behavioural skills model, was piloted in study four.

Findings and conclusions: Preconception guidelines within Scotland were similar to comparable countries, with key behaviours such as folic acid, weight management, alcohol and smoking cessation addressed in all. In Scotland, there was a lack of engagement in health promoting behaviours, particularly among those not planning a pregnancy and those living in areas of socio-economic disadvantage. Findings from the systematic review indicated a lack of understanding of preconception health across the preconception population. These findings led to the prioritisation of raising awareness as the first step to behaviour change and, with PPI input, a theory-based awareness raising intervention video was developed. The pilot study evidenced the video’s acceptability and effectiveness at increasing knowledge. Future research could further develop the video by considering feasibility and implementation in primary care settings such as community pharmacy.