Mazza and Chapman BMC Public Health 2010, 10:786 http://www.biomedcentral.com/1471-2458/10/786 pregnancy, further information is needed to understand how to best implement preconception care guidelines [5]. As part of a larger study to develop and evaluate an inter- vention to improve the delivery of preconception care, our aim was to determine women’s views on the barriers and enablers to preconception care uptake and periconcep- tional folate supplementation. Methods Study participants Three focus groups were undertaken between October and November 2007 with 17 women of reproductive age (18-45 years). The total number of focus groups was limited, as their primary aim was to inform the next phase of the study and to complement focus groups undertaken with GPs. Focus groups took place in a low and high socioeconomic area of metropolitan Mel- bourne and in South Gippsland, a rural area of Victoria, Australia. We used the Index of Relative Socioeconomic Disadvantage [13] to determine postcodes in the lowest and highest quartiles of the index and recruited women residing at these postcodes through advertisements in local newspapers. Participants in our rural focus group were obtained through a convenience sample at a local playgroup and Division of General Practice due to a lack of response to the newspaper advertisement. Each focus group consisted of 5-7 participants. Data Collection The objectives and format of the focus groups were explained to participants before commencement, and their anonymity was assured. Participants gave written consent to participate. To maintain consistency, all focus groups were conducted by the same facilitator (DM) in a conversation-like manner and followed a schedule of guiding questions (Table 1). The study was approved by the Monash University Standing Commit- tee on Ethics in Research Involving Humans. Data analysis Data from the focus groups were audio-taped, tran- scribed verbatim and entered into NVIVO 7 software [14] to organise the data. Initially, transcripts were read and re-read by both authors in order to familiarise themselves with the data. To increase rigour, each tran- script was independently coded line by line by both authors. An inductive process of thematic analysis, as described by Braun and Clarke [15], was employed to identify key issues and themes within the data. For areas where coding differed, agreement of interpretation was reached through meetings between both authors. The thematic results were then presented to the project advi- sory group (which included content and methodological experts) for discussion and further interpretation. Page 2 of 6 Quotes representing typical views expressed by the women were extracted from the transcripts and are pre- sented in the results to illustrate the themes identified. Results Barriers Four major barriers to the uptake of preconception care were found and one barrier to the uptake of periconcep- tional folate supplementation was consistently identified. With the exception of service provider issues, all bar- riers identified were consistent across groups. Degree of receptivity There was a strong sense that women had to be recep- tive to the information in order to act upon it. This receptivity was dependent on their life stage and whether they were thinking about getting pregnant soon. “You have to be in the zone.” (Rural, 29 years) Women who had already had a child felt they already knew about preconception care issues and didn’t need to access preconception care. “Because you think you know it. I don’t have a child with spina bifida, so why should I take the folate? And I don’t need to go the doctor because I’ve done it all before.” (Low SES, 34 years) Conception is a normal event Because conception is perceived as an event that most women go through, women felt that it was normal and that there was no need for medical attention or inter- vention prior to it occurring. “Some women also think it’s a natural thing; that we should just go ahead and get pregnant and all have healthy babies because that is the norm and is what’s expected.” (Low SES, 34 years) Interestingly this contrasted with women’s sense that it was important to present to a general practitioner (GP) as soon as they knew they were pregnant as they felt medical attention then became necessary. “I thought the importance [of presenting to a GP] was more on when you were pregnant. When you think about going [to a GP], it’s once you have fallen pregnant.” (Rural, 29 years) Perceived risk and lack of awareness of the need for preconception care Most women were unaware of the need for preconcep- tion care in general and said that their GPs did not offer preconception care or inform them of its availability. They were surprised at the breadth of issues that could comprise a preconception care consultation. “It’s a bit daunting when you get all this [preconcep- tion care information]. It’s a lot to take in, but this is