Mazza and Chapman BMC Public Health 2010, 10:786 http://www.biomedcentral.com/1471-2458/10/786 Table 1 Schedule of guiding questions used in the focus groups 1. 2. 3a. 3b. 3c. 3d. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. What triggered your interest in this subject? To date, what has been your experience with preconception care? What do you know about folate and pregnancy? What are neural tube defects e.g. spina bifida? Is dietary folate adequate in meeting women’s needs for pregnancy? How much folate (mg) should women take and when should they take it to prevent neural tube defects? What other health issues need to be addressed prior to pregnancy? Where do you go to find out information about folate and preconception health care issues? What issues prevent women from using folate supplements? What would assist women to use folate prior to conception? What is the role of a General Practitioner (GP) in preconception care? Are GPs conducting preconception care at the moment? How should GPs discuss preconception care issues with women? What issues may exist for women from culturally and linguistically diverse groups? What about women who are between pregnancies or who have previously had one or two children? Should anything different be offered to them? Is there anything important that hasn’t already been raised? Page 3 of 6 what I would like to have gotten from my GP. The thing is - I never had the concept of preconception care in my mind.” (Rural, 26 years) “Unless you actually go and pursue it [preconception care consultation] nothing will happen. (Low SES, 21 years) Service Provider Issues Service provider issues were a major theme elicited in the focus groups and the theme most related to socioeco- nomic status and rurality. Women living in high socioe- conomic areas described attending alternative health practitioners such as naturopaths and Chinese medical practitioners for preconception advice. This was particu- larly the case for women who had experienced trouble conceiving or who were currently accessing assisted reproductive technologies such as in-vitro fertilisation. Many women had been given specially prepared supple- ments by their naturopath but were unaware of the con- tents of these supplements. They nevertheless had implicit trust that they contained ’all that was needed’ to optimise conception and pregnancy outcomes. “I don’t have a GP; I have a naturopath, and have a really close relationship. She’s been my guiding force behind all the information.” (High SES, 33 years) “If I was looking at information from a dietary perspec- tive I would go to a naturopath. I would ask a GP but that’s not their area of specialty and they’re not so keen on supplements and vitamins.” (High SES, 24 years) “I am trying lots of things. I’m seeing a Chinese medi- cine specialist and he knows all the medications - more than my GP. I’m impressed about what he knows."(High SES, 40 years) For a number of women the GP was not initially thought of as a major provider of preconception care. The reasons given for this were many. In rural areas there was difficulty accessing GPs, cost was a barrier for some women and women across all groups felt that as they were young and healthy, and in some cases yet to have children, they had not established an ongoing rela- tionship with any particular GP and did not identify anyone as ‘their GP’. Women also perceived the role of the GP to be one of ‘acute care’ and did not consider that GPs could or should deliver preventive care. Many felt that other patients who were unwell should have priority in a stretched system. “You go to a GP because you’re sick, not to discuss family planning.” (High SES, 40 years) “If I went in there to have a chat about planning preg- nancy, would I be wasting their time?"(Rural, 26 years) Women also felt that because there wasn’t a proce- dure to carry out (in contrast to having a pap smear), they didn’t feel they had to attend their GP to obtain preconception care advice. “Because it’s not active, with your pap smear and breast check you get something done, but for preconcep- tion care it’s an appointment to go and talk, it’s not actually a procedure.” (Rural, 35 years) Women’s main source of information regarding pre- conception care was from friends and family and increasingly from the internet. Broadcast and printed media were not raised by participants. “If I wanted information like that [preconception care] I would probably just go to an internet source...I wouldn’t think of necessarily going to the GP if I can read it elsewhere.” (Rural 26 years) The most widely named internet sites being accessed for preconception related information were sites run by commercial for profit companies (media companies,