Integrating interconception care in preventive child health care services: The Healthy Pregnancy 4 All program

Abstract

BackgroundMost parents with young children pay routine visits to Well-Baby Clinics, or so-called Preventive Child Health Care (PCHC) services. This offers a unique opportunity to promote and deliver interconception care. This study aimed to integrate such care and perform an implementation evaluation.MethodsIn seven Dutch municipalities, PCHC professionals were instructed to discuss the possibility of an interconception care consultation during each routine six-months well-baby visit. The primary outcome of this study was coverage of the intervention, quantified as the proportion of visits during which women were informed about interconception care. Secondary outcomes included adoption, fidelity, feasibility, appropriateness, acceptability and effectiveness of the intervention, studied by surveying PCHC professionals and women considering becoming pregnant.ResultsThe possibility of interconception care was discussed during 29% (n = 1,849) of all visits, and 60% of the PCHC physicians adopted the promotion of interconception care by regularly informing women. About half of the PCHC professionals and most women judged integration of interconception care in PCHC appropriate and acceptable. Estimated feasibility was poor, since 13% of the professionals judged future integration in daily practice as probable. The uptake of interconception care consultations was low (n = 4 consultations).ConclusionsPromotion of interconception care was achieved in approximately one-third of the routine PCHC consultations and appeared promising with regards to adoption, appropriateness and acceptability. However, concerns on feasibility and uptake of interconception care consultations in daily practice remain. Suggestions for improvement may include further integration of interconception care health promotion in routine PCHC consultations, while allocating sufficient resources.

A scoping review of nutritional interventions and policy guidelines in the interconception period for prevention of noncommunicable diseases

“…Six studies were identified, scoring high (1) to moderate (5) quality. Pilot studies focused on outcomes, including nutritional supplementation, mental health outcomes, interconception care provision, and contraception and process evaluation of the studies 25–31 . Interconception care interventions can include risk assessments leading to tailored care, complex interventions and educational components, including counselling, multivitamin supplementation, peer support groups, walking programmes, contraception, mental health and substance support, and dental care 25,26 .…”

“…Pilot studies focused on outcomes, including nutritional supplementation, mental health outcomes, interconception care provision, and contraception and process evaluation of the studies. [25][26][27][28][29][30][31] Interconception care interventions can include risk assessments leading to tailored care, complex interventions and educational components, including counselling, multivitamin supplementation, peer support groups, walking programmes, contraception, mental health and substance support, and dental care. 25,26 Although none of these interventions were followed up to assess infant outcomes, they have improved women's uptake of multivitamins supplements, mental health support, use of contraception, physical exercise and dental care.…”

“…However, only 13% of health professionals felt they could implement interconception care into routine practice, as it did not fit into their current priorities and they expected little interest from women. 28…”

Interconception Health: Improving Equitable Access to Pregnancy Planning

“…83 84 Mothers regularly attend their child's health care visits even if they do not seek care for themselves between pregnancies. 85 Given children typically attend 8 to 10 WCVs in the first 2 years of life, the WCV offers a consistent and repeated point of maternal contact and chance for intervention. 86 Finally, prior studies demonstrate that most mothers accept inquiry about their own health behaviors and referral for services at visits with their pediatric care providers.…”

Health Agency and Perfectionism: The Case of Perinatal Health Inequalities

“…Initiatives aimed at increasing the awareness of pregnancy preparation and the availability of pregnancy-related care have been launched ( van der Zee et al , 2011 ; Lagendijk et al , 2019a ; Sijpkens et al , 2019 ). A striking example is the so-called ‘Healthy Pregnancy 4 All-2’ program which aims to identify vulnerable mothers living in underprivileged areas and young children at risk of adverse health outcomes to offer them pregnancy-related care ( Lagendijk et al , 2019a ).…”