Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Australian primary health care nurses’ knowledge, practice and attitudes relating to preconception care: learnings for service implementation

E. Dorney https://orcid.org/0000-0002-2891-4782 A E , J. Millard B , K. Hammarberg C , K. Griffin B , A. Gordon A , K. McGeechan D and K. I. Black A
+ Author Affiliations
- Author Affiliations

A Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.

B Australian Primary Care Nurses Association, Melbourne, Vic. 3000, Australia.

C Global and Women’s Health and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia.

D Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.

E Corresponding author. Email: edwina.dorney@sydney.edu.au

Australian Journal of Primary Health 28(1) 63-68 https://doi.org/10.1071/PY21104
Submitted: 19 May 2021  Accepted: 12 August 2021   Published: 1 December 2021

Abstract

Preconception care (PCC) entails counselling and interventions to optimise health before pregnancy. Barriers to this service delivery include access and time. Primary healthcare nurses (PHCNs) are uniquely placed to deliver PCC. The aim of this study was to understand PHCNs’ knowledge, practice and attitudes to PCC. A cross-sectional study was performed of a convenience sample of PHCNs in Australia who were seeing people of reproductive age. Recruitment was via the Australian Primary Health Care Nurses Association (APNA) electronic communication platforms. The 18-item, online, anonymous survey captured demographics, as well as PCC knowledge, practices and attitudes. Descriptive statistics were used to describe our findings. In all, 152 completed surveys were received. Of all respondents, 74% stated they discuss PCC in their practice, although only 13% do so routinely. Of these, more preconception discussions are held with women than with men. In total, 95% of respondents identified at least one barrier to delivery of PCC, with lack of time and knowledge being the most common. The findings of this study can inform targeted strategies, including education programs and resources, and consideration of incentives to support PHCNs deliver PCC. This study identifies areas for improvement at the individual, organisational and health system levels to enhance the role of PHCNs in PCC

Keywords: maternal health, preconception care, primary care, primary health care nurse, service implementation.


References

American Academy of Family Physicians (2016) Preconception care (position paper). Available at https://www.aafp.org/about/policies/all/preconception-care.html [Verified 24 April 2021]

Australian Government Department of Health (2013) National primary health care strategic framework. Available at https://www1.health.gov.au/internet/publications/publishing.nsf/Content/NPHC-Strategic-Framework

Australian Government Department of Health (2018) National women’s health strategy, 2020–2030. Available at https://www.health.gov.au/sites/default/files/documents/2021/05/national-women-s-health-strategy-2020-2030.pdf

Australian Government Department of Health (2021) Primary health care. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/Fact-Sheet-Primary-Health-Care

Australian Institute of Health and Welfare (2020) A profile of primary health care nurses. Available at https://www.aihw.gov.au/reports/primary-health-care/a-profile-of-primary-care-nurses/contents/primary-health-care-nurses [Verified 14 April 2020]

Australian Primary Health Care Nurses Association (2020) Annual workforce survey 2020. Available at https://www.apna.asn.au/files/DAM/6%20About/Annual%20Reports/APNA%20Annual%20Report%202020.pdf

Chivers BR, Boyle JA, Lang AY, Teede HJ, Moran LJ, Harrison CL (2020) Preconception health and lifestyle behaviours of women planning a pregnancy: a cross-sectional study. Journal of Clinical Medicine 9, 1701
Preconception health and lifestyle behaviours of women planning a pregnancy: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

Currie J, Chiarella M, Buckley T (2019) Privately practising nurse practitioners’ provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey. Australian Health Review 43, 55–61.
Privately practising nurse practitioners’ provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey.Crossref | GoogleScholarGoogle Scholar | 29031290PubMed |

De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC, Rayco-Solon P (2015) Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews CD007950
Effects and safety of periconceptional oral folate supplementation for preventing birth defects.Crossref | GoogleScholarGoogle Scholar |

Dorney E, Black KI (2018) Preconception care. Australian Journal of General Practice 47, 424–429.
Preconception care.Crossref | GoogleScholarGoogle Scholar | 30114868PubMed |

Goddard LHM, Claydon A (2017) The role of the practice nurse in the preconception care of women with type 2 diabetes. Journal of Diabetes Nursing 21, 155–160.

Guerin A, Nisenbaum R, Ray JG (2007) Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care 30, 1920–1925.
Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes.Crossref | GoogleScholarGoogle Scholar | 17446531PubMed |

Hammarberg K, Taylor L (2019) Survey of maternal, child and family health nurses’ attitudes and practice relating to preconception health promotion. Australian Journal of Primary Health 25, 43–48.
Survey of maternal, child and family health nurses’ attitudes and practice relating to preconception health promotion.Crossref | GoogleScholarGoogle Scholar | 30711021PubMed |

Helms C, Crookes J, Bailey D (2015) Financial viability, benefits and challenges of employing a nurse practitioner in general practice. Australian Health Review 39, 205–210.
Financial viability, benefits and challenges of employing a nurse practitioner in general practice.Crossref | GoogleScholarGoogle Scholar | 25528465PubMed |

Hogg K, Rizio T, Manocha R, McLachlan RI, Hammarberg K (2019) Men’s preconception health care in Australian general practice: GPs’ knowledge, attitudes and behaviours. Australian Journal of Primary Health 25, 353–358.
Men’s preconception health care in Australian general practice: GPs’ knowledge, attitudes and behaviours.Crossref | GoogleScholarGoogle Scholar | 31554536PubMed |

Hurst HM, Linton DM (2015) Preconception care: planning for the future. The Journal for Nurse Practitioners 11, 335–340.
Preconception care: planning for the future.Crossref | GoogleScholarGoogle Scholar |

Israel BA, Schulz AJ, Parker EA, Becker AB (1998) Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health 19, 173–202.
Review of community-based research: assessing partnership approaches to improve public health.Crossref | GoogleScholarGoogle Scholar | 9611617PubMed |

Jacob CM, Killeen SL, McAuliffe FM, Stephenson J, Hod M, Diaz Yamal I, Malhotra J, Mocanu E, McIntyre HD, Kihara AB, Ma RC, Divakar H, Kapur A, Ferriani R, Ng E, Henry L, Van Der Spuy Z, Rosenwaks Z, Hanson MA (2020) Prevention of noncommunicable diseases by interventions in the preconception period: a FIGO position paper for action by healthcare practitioners. International Journal of Gynaecology and Obstetrics 151, 6–15.
Prevention of noncommunicable diseases by interventions in the preconception period: a FIGO position paper for action by healthcare practitioners.Crossref | GoogleScholarGoogle Scholar | 32894587PubMed |

Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS (2006) 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. Recommendations and Reports 55, 1

Kizirian NV, Black KI, Musgrave L, Hespe C, Gordon A (2019) Understanding and provision of preconception care by general practitioners. Australian and New Zealand Journal of Obstetrics and Gynaecology 59, 799–804.
Understanding and provision of preconception care by general practitioners.Crossref | GoogleScholarGoogle Scholar | 30773610PubMed |

M’hamdi HI, van Voorst SF, Pinxten W, Hilhorst MT, Steegers EAP (2017) Barriers in the uptake and delivery of preconception care: exploring the views of care providers. Maternal and Child Health Journal 21, 21–28.
Barriers in the uptake and delivery of preconception care: exploring the views of care providers.Crossref | GoogleScholarGoogle Scholar | 27423236PubMed |

Matthys E, Remmen R, Van Bogaert P (2017) An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care? BMC Family Practice 18, 110
An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?Crossref | GoogleScholarGoogle Scholar | 29273023PubMed |

Mazza D, Chapman A, Michie S (2013) Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study. BMC Health Services Research 13, 36
Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 23368720PubMed |

Poels M, Koster MPH, Franx A, van Stel HF (2017) Healthcare providers’ views on the delivery of preconception care in a local community setting in the Netherlands. BMC Health Services Research 17, 92
Healthcare providers’ views on the delivery of preconception care in a local community setting in the Netherlands.Crossref | GoogleScholarGoogle Scholar | 28137263PubMed |

Royal Australian College of General Practitioners (RACGP) (2016) Guidelines for preventative activities in general practice; preventative activities prior to pregnancy. RACGP, Melbourne Vic., Australia.

Stephenson J, Heslehurst N, Hall J, Schoenaker D, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 391, 1830–1841.
Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.Crossref | GoogleScholarGoogle Scholar | 29673873PubMed |

Swanson M, Wong ST, Martin-Misener R, Browne AJ (2020) The role of registered nurses in primary care and public health collaboration: a scoping review. Nursing Open 7, 1197–1207.
The role of registered nurses in primary care and public health collaboration: a scoping review.Crossref | GoogleScholarGoogle Scholar | 32587740PubMed |

Walker R, Kandel P, Hill B, Hills S, Dunbar J, Skouteris H (2021) Practice nurses and providing preconception care to women in Australia: a qualitative study. Australian Journal of Primary Health 27, 13–21.
Practice nurses and providing preconception care to women in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 32895115PubMed |

World Health Organization (2016) Report of the Commission on ending childhood obesity. Report of the Director General. World Health Organization, Geneva, Switzerland.