Mazza and Chapman BMC Public Health 2010, 10:786 http://www.biomedcentral.com/1471-2458/10/786 R E S E A R C H A R T I C L E Open Access Improving the uptake of preconception care and periconceptional folate supplementation: what do women think? Danielle Mazza*, Anna Chapman Abstract Background: Despite strong evidence of the benefits of preconception interventions to improve pregnancy outcomes, the delivery and uptake of preconception care in general and periconceptional folate supplementation in particular remains low. The aim of this study was to determine women’s views of the barriers and enablers to the uptake of preconception care and periconceptional folate supplementation. Methods: Focus groups were undertaken in 2007 with 17 women of reproductive age (18-45 years). To identify key issues and themes within the data, focus groups were analysed using an inductive process of thematic analysis. Results: Most women were unaware of the need to attend for preconception care and were surprised at the breadth of issues involved. Women also felt general practitioners (GPs) should be more proactive in promoting preconception care availability but acknowledged that they themselves had to be thinking about pregnancy or becoming pregnant to be receptive to it. Barriers to periconceptional folate supplementation included confusion about reasons for use, dose, duration, timing and efficacy of folate use. Enablers included the desire to do anything they could to ensure optimum pregnancy outcomes, and promotional material and letters of invitation from their GP to advise them of the availability and the need for preconception care. Conclusion: A number of important barriers and enablers exist for women regarding the delivery and uptake of preconception care and periconceptional folate supplementation. It is essential that these patient perspectives are addressed in both the implementation of evidence based clinical practice guidelines and in the systematic design of an intervention to improve preconception care delivery. Background The repeated findings of low levels of knowledge and behaviour related to preconception care in women of reproductive age [1-4], particularly with regards to adherence to nutrition and lifestyle recommendations for planning a pregnancy [4] gives rise to questions about the efficacy of public health campaigns aimed at influencing these factors [5]. Women report that they prefer to obtain preconcep- tion advice from their primary care physician, yet only 39% of women recall doing so [6]. This figure suggests that doctors do not routinely address preconception * Correspondence: Danielle.Mazza@monash.edu Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia care in practice or implement existing preconception care guidelines, and also indicates that women do not actively seek such care. While research to date has provided insights into the factors associated with lower rates of folic acid supple- ment use, such as unintended pregnancy, age, socio- economic status and ethnic group [1,7,8], there has been little published regarding women’s views or any explora- tion of barriers and enablers to the delivery and uptake of preconception care and periconceptional folate sup- plementation. By ignoring these views we may neglect aspects of care provision which are important from the perspective of consumers of health care [9]. Preconception care guidelines and recommendations have been developed in many countries [10-12]. In order to capitalise on the preventive ‘window of opportunity’ of © 2010 Mazza and Chapman; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.