title: General practitioners' knowledge, attitudes and views of providing preconception care: a qualitative investigation.
abstract: BACKGROUND
  Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Little is known about the preconception interventions that general practitioners (GPs) provide. The aim of this study was to examine GPs' knowledge, attitudes, and views towards preconception health and care in the general practice setting.
  
  
  METHODS
  As part of a large mixed-methods study to explore preconception care in England, we surveyed 1,173 women attending maternity units and GP services in London and interviewed women and health professionals. Seven GPs were interviewed, and the framework analysis method was used to analyse the data.
  
  
  RESULTS
  Seven themes emerged from the data: Knowledge of preconception guidelines; Content of preconception advice; Who should deliver preconception care?; Targeting provision of preconception care; Preconception health for men; Barriers to providing preconception care; and Ways of improving preconception care. A lack of knowledge and demand for preconception care was found, and although reaching women before they are pregnant was seen as important it was not a responsibility that could be adequately met by GPs. Specialist preconception services were not provided within GP surgeries, and care was mainly targeted at women with medical conditions. GPs described diverse patient groups with very different health needs.
  
  
  CONCLUSIONS
  Implementation of preconception policy and guidelines is required to engage women and men and to develop proactive delivery of care with the potential to improve pregnancy and neonatal outcomes. The role of education and of nurses in improving preconception health was acknowledged but remains under-developed.
authors.affiliation: a Institute for Women's Health, University College London , London , United Kingdom.
authors.forename: Obiamaka
authors.initials: O
authors.lastname: Ojukwu
authors.affiliation: a Institute for Women's Health, University College London , London , United Kingdom.
authors.forename: Dilisha
authors.initials: D
authors.lastname: Patel
authors.affiliation: a Institute for Women's Health, University College London , London , United Kingdom.
authors.forename: Judith
authors.initials: J
authors.lastname: Stephenson
authors.affiliation: b University of Bristol , Bristol , United Kingdom.
authors.forename: Beth
authors.initials: B
authors.lastname: Howden
authors.affiliation: c Faculty of Health and Medical Sciences , University of Surrey , Guildford , United Kingdom.
authors.forename: Jill
authors.initials: J
authors.lastname: Shawe
keywords: General practice; pre-pregnancy; preconception care; pregnancy; qualitative