OBJECTIVES: The objective of this systematic review was to assess the effects of preconception health interventions, delivered to individuals of reproductive age in public health and community settings, on reproductive, maternal, and child health outcomes. METHODS:A search of Ovid MEDLINE, CINAHL, EMBASE, PsychINFO, Scopus, Gender Studies Database, and SocINDEX from July 1999 through July 2016 was performed. We included studies that reported original data, used an interventional study design, included reproductive-aged women or men, were written in English, and were published in peer-reviewed journals. Two reviewers independently used standardized instruments for data extraction and quality assessment. A narrative synthesis was performed.SYNTHESIS: Twelve studies met the inclusion criteria. These studies included randomized controlled trials and quasi-experimental, pre-post, and timeseries designs. Most studies were conducted in the United States; all but one study included only women. Interventions were mainly educational initiatives focused on nutrition, immunization, and lifestyle behaviours and were delivered in a single contact. The studies reported positive effects on health knowledge (n = 9), behaviour change (n = 4), and health outcomes (n = 1). Study quality was weak (n = 11) or moderate (n = 1), with limitations related to selection bias, blinding, data collection methods, and participant attrition. CONCLUSION:To develop a comprehensive, standardized approach to preconception health promotion and care in Canada, there is a clear need for highquality research evaluating the effectiveness of preconception health interventions. Studies should use a health equity lens that includes all individuals of reproductive age and addresses the broad determinants of preconception health.KEY WORDS: Health promotion; preconception care; public health La traduction du résumé se trouve à la fin de l'article.Can 18 However, given the wide scope of preconception health and the high rate of unplanned pregnancies, it is important that preconception health promotion and care also be delivered to individuals in public health and community settings, in addition to primary care, to maximize population impact. There is a need to identify and assess preconception health interventions that adopt a broader health promotion and prevention approach and that are suitable for delivery in public health and community settings (e.g., education programs, public awareness campaigns, peer support, interactive electronic risk assessments, healthy public policy, and supportive environments). The objective of this systematic review was to assess the effects of preconception health interventions, delivered to individuals of reproductive age in public health and community settings, on reproductive, maternal, and child health outcomes. METHODS Search strategyWe followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 21 An expert librarian searched seven databases in July 2016. These databases ...

Objective: Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges. Data Source: MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018. Study Inclusion and Exclusion Criteria: Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men. Data Extraction: Two independent reviewers completed data extraction and quality appraisal using standardized instruments. Data Synthesis: Due to measurement heterogeneity, a narrative synthesis was performed. Results: The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men’s health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools. Conclusions: This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.

Purpose: To develop and psychometrically test a comprehensive measure of preconception health knowledge. Design: Cross-sectional survey, in May and June, 2019. Setting: Alberta, Ontario, and Québec, Canada. Sample: One thousand seven hundred seventy-seven women and men with ≥1 children born in the last 5 years or planning a pregnancy in the next 5 years. Measures: Using prior literature and input from public health nurses and physicians, the Preconception Health Knowledge Questionnaire (PHKQ) was developed and comprised 25 multiple choice questions on reproductive history, sexual health, infectious diseases, chronic medical conditions, mental health, medications, immunizations, lifestyle behaviors, psychosocial stressors, and environmental exposures. Analysis: Psychometric testing was undertaken to evaluate item difficulty, discrimination, quality of response alternatives, internal consistency, and construct validity. Results: Participants had a mean total score of 15.8/25 (SD = 3.9); women and men had mean total scores of 16.2 (SD = 3.6) and 13.8 (SD = 4.7), respectively. Most items were neither too difficult nor too easy, discriminated well between participants with high and low knowledge, and had appropriate response alternatives. High internal consistency (KR-20 = 0.87) and construct validity, shown via significant correlations with education level and previous preconception care receipt, were demonstrated. Conclusion: The PHKQ is a reliable and valid tool for measuring preconception health knowledge and may be useful in identification of high-risk groups in need of preconception health education and evaluation of preconception health interventions.

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