Abstract
Objective
Despite growing consensus about the clinical value of preconception care (PCC), gaps and disparities remain in its delivery. This study aimed to examine the factors influencing behavior of health care providers around PCC in outpatient clinical settings in the United States.
Methods
Twenty health care providers who serve people of reproductive age were interviewed using semi-structured interviews. Data was coded based on a modified Theoretical Domains Framework and analyzed using deductive content analysis.
Results
We interviewed eight family medicine physicians, four obstetricians/gynecologists, seven nurse practitioners, and one nurse midwife. Overall, we found a wide variety in practices and attitudes towards PCC. Barriers and challenges to delivering PCC were shared across sites. We identified six themes that influenced provider behavior around PCC: (1) lack of knowledge of PCC guidelines, (2) perception of lack of preconception patient contact, (3) pessimism around patient “compliance,” (4) opinion about scope of practice, (5) clinical site structure, and (6) reliance on the patient/provider relationship.
Conclusions for Practice
Overall, our findings call for improved provider understanding of PCC and creative incorporation into current health care culture and practice. Given that PCC-specific visits are perceived by some as outside the norm of clinical offerings, providers may need to incorporate PCC into other encounters, as many in this study reported doing. We amplify the call for providers to understand how structural inequities may influence patient behavior and the value of standardized screening, within and beyond PCC, as well as examination of implicit and explicit provider bias.
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Data Availability
Upon request and with appropriate IRB approval.
Code Availability
Not applicable.
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Acknowledgements
Funding for this work was provided by the Herman and Gwendolyn Shapiro Foundation and the Population Research Infrastructure grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (P2C HD047873). The Social Sciences Computing Cooperative at the University of Wisconsin-Madison provided technological support. The authors thank Ann Vitous of the Center for Healthcare Outcomes and Policy at the University of Michigan for providing guidance on the Theoretical Domains Framework used in this analysis.
Funding
This research was supported by the Herman and Gwendolyn Shapiro Foundation at the University of Wisconsin-Madison and the Population Research Infrastructure grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (P2C HD047873).
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Dr. ECN recruited participants, conducted interviews, coded transcripts, drafted the initial manuscript, and reviewed and revised the final manuscript. Dr. MZG advised on the design of the analysis, coded transcripts, reviewed and contributed to themes, critically reviewed the manuscript for important intellectual content, and reviewed and revised the manuscript. Dr. MPT recruited participants, conducted interviews, coded transcripts, reviewed and contributed to themes, and reviewed and revised the final manuscript. Dr. DBE conceptualized the study, critically reviewed the manuscript for important intellectual content, and reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The study was deemed exempt by the University of Wisconsin–Madison Institutional Review Board.
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Nacev, E.C., Greene, M.Z., Taboada, M.P. et al. Factors Influencing Provider Behavior Around Delivery of Preconception Care. Matern Child Health J 26, 1567–1575 (2022). https://doi.org/10.1007/s10995-022-03411-8
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DOI: https://doi.org/10.1007/s10995-022-03411-8