Barriers to the delivery and uptake of preconception care: What is important and what is changeable?

Background Systematically designed interventions that address barriers to evidence based practice are necessary to improve quality of care. Formulating and implementing an intervention that addresses all the barriers is impossible. Researchers need to select the most appropriate barrier/s to focus on. One way of doing so is to determine the most important barrier/s and the one/s most open to change. Aims To identify and select barriers to the delivery and uptake of preconception care according to the criteria of “importance” and “changeability”. Methods Following focus groups with GPs and women, barriers were coded according to theoretical constructs related to professional behaviours. Focus group participants were sent a questionnaire asking them to rate the “importance” and “changeability” of each identified barrier on a 5-point Likert scale. Participants were also asked to identify the three most important and changeable barriers. Results GP barriers to the delivery of preconception care showed little compatibility between importance and changeability except for being unaware of the preconception guideline. Knowledge of reasons for folate supplementation and confusion about supplements were perceived as being both important and changeable by women as were don’t think to visit a GP for preconception care and don’t know preconception care is available. Differences existed between GPs and women in that women perceived that GPs don’t routinely provide preconception care while GPs felt that women don’t present for preconception care and women who need it don’t access it. Conclusion Systematic intervention design is necessary to produce effective outcomes. Barrier analyses tend to identify multiple barriers. “Importance” and “changeability” are important criteria to assist in the selection of barriers to target in intervention design. Consultation with professionals and patients is necessary to determine the relative significance of each barrier.