title: Why Do Women Not Use Preconception Care? A Systematic Review On Barriers And Facilitators.
abstract: OBJECTIVE
  Preconception care (PCC) has the potential to optimize pregnancy outcomes. However, awareness of PCC among the target population is generally limited, and the use of PCC remains low.
  
  
  OBJECTIVE
  The objective of this study was to review the literature on women's perceptions regarding barriers and facilitators for the use of PCC.
  
  
  METHODS
  A systematic search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO for published studies until February 2015. Original qualitative and quantitative peer-reviewed studies from Western countries in English, holding women's perceptions regarding barriers and facilitators for the use of PCC. Data extraction and analysis were performed using NVivo version 10 software. A coding frame was derived from the findings and applied by 2 authors. Thematic analysis was used to identify key topics and themes.
  
  
  RESULTS
  Twenty-one good-quality articles were included, of which 10 qualitative and 11 quantitative studies. Seven main themes were identified: preconditions, emotions and beliefs, perceived need, knowledge and experience, social structure, accessibility, and provider characteristics. "Not (fully) planning pregnancy", "perceived absence of risks", "lack of awareness", and "pregnancy experiences" were the most frequently identified barriers and "believing in the benefits" and "availability of PCC" the most frequently identified facilitators for PCC use.
  
  
  CONCLUSIONS
  Women perceive more barriers than facilitators related to PCC uptake, which explains why the use of PCC remains low. Our results provide a starting point to refocus interventions and strategies, aiming on enlarging the awareness, perceived importance, and accessibility of PCC to improve its uptake.
authors: PhD Student.
authors: Marjolein
authors: M
authors: Poels
authors: Assistant Professor, Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Maria P H
authors: MP
authors: Koster
authors: Program Manager, NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
authors: Hennie R
authors: HR
authors: Boeije
authors: Professor and Chair, Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Arie
authors: A
authors: Franx
authors: Assistant Professor, Department of Health Technology Assessment, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Henk F
authors: HF
authors: van Stel
mesh_terms: D003144:Communication Barriers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D012938:Social Perception