title: Why women do not ask for information on preconception health? A qualitative study.
abstract: Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health.
  
  
  
  We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups.
  
  
  
  Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist.
  
  
  
  The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines.
authors.affiliation: Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy. renata.bortolus@ospedaleuniverona.it.
authors.forename: Renata
authors.initials: R
authors.lastname: Bortolus
authors.affiliation: Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
authors.forename: Nadia C
authors.initials: NC
authors.lastname: Oprandi
authors.affiliation: Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rech Morassutti
authors.affiliation: Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Marchetto
authors.affiliation: Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Filippini
authors.affiliation: Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Agricola
authors.affiliation: Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Tozzi
authors.affiliation: Cystic Fibrosis Centre, Verona University Hospital, Verona, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Castellani
authors.affiliation: Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Faustina
authors.initials: F
authors.lastname: Lalatta
authors.affiliation: National Agency for Regional Health Services, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rusticali
authors.affiliation: Alessandra Lisi International Centre on Birth Defects and Prematurity - ICBD, Rome, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Mastroiacovo
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007558:Italy; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D016742:Preconception Care; D011247:Pregnancy; D036301:Qualitative Research; D055815:Young Adult
keywords: Adverse reproductive outcomes; Focus group; Healthcare professionals; Preconception health and care; Risk factors; Women of childbearing age