# Preconception Health Attitudes and Behaviours of Women: A Qualitative Investigation
## 4 Discussion
Our findings, along with previous research [12; 25], may provide insight into the findings of [PERSON], who reported that whilst women have a positive attitude towards preconception care, many do not view themselves as belonging to the target population in need of preconception care [12]. Women in preconception are a diverse population not necessarily regularly engaged with the healthcare system. This limited healthcare engagement may reduce risk perception and impact on health awareness. Consequently, women may not perceive healthcare engagement to be of top priority preconception unless a fertility problem exists or develops. Additionally, a few women in our study alluded to dissatisfaction with preconception health information provided by their primary care providers indicating that it may not be perceived as helpful. The Royal Australian College of General Practitioners (RACGP) recommends that preconception care be provided to all women of reproductive age and encompass medical as well as lifestyle related considerations, consistent with international recommendations [5; 6]. Medical considerations include reproductive life planning, assessment of reproductive, medical and genetic history, general physical wellbeing, substance use and vaccinations [4]. Our findings suggest that women have a low awareness and recognition of the importance of medical-related preconception considerations. This highlightsthe need for multi-strategic approaches in both health promotion to improve awareness, supported by appropriate healthcare provision according to guidelines by GPs when engagement does occur. Currently, there are no national preconception health care clinical practice guidelines in Australia [3], which may in part explain the variability in preconception healthcare services that women are reportedly receiving. Creation of an evidence-based national guideline, which is supplemented with consumer resources, may assist in increasing both healthcare provider's and women's awareness of the full-spectrum of preconception health-related issues. Previously, Australian GPs have suggested checklists for healthcare providers as an enabler for delivering appropriate preconception care [33]. Similarly, women in our study also felt that a checklist for themselves, which lists key preconception health actions and their suggested timing, may be a useful resource, particularly if accessible online or through their GP. Despite our sample of women being highly educated and motivated to optimise their preconception health, many experienced difficulties accessing reliable preconception health information and reported confusion over conflicting information. Therefore, whilst the internet may enhance accessibility of information, it may preclude behaviour change, information seeking behaviour and confidence in health knowledge. Importantly, these findings may be exacerbated in more vulnerable populations, including those of low sociodemographic status, of lower health literacy as well as culturally and linguistically diverse populations, emphasising the importance of provision of simple, consistent evidence-based information with broad applicability. Preconception health behaviours prioritised by women in this study, such as taking pre-pregnancy supplementation and reducing alcohol consumption, were also identified by a recent scoping review as areas that have consistently been the focus of research studies investigating preconception health [34]. Conversely, the scoping review found that the topic of stress has often been neglected in preconception health research [34], and this is an area that we identified as a challenge for women during preconception. Additionally, our findings also warrant the investigation of men's preconception health attitudes, behaviours and information preferences as women in our sample identified a need for more information regarding men's preconception health.