Dr Danielle Schoenaker, Research Fellow in the School of Primary Care, Population Sciences and Medical Education at the University of Southampton
Working with the public to inform meaningful language to communicate about health and well-being before pregnancy and parenthood – aka preconception health
Preconception health refers to the health and health behaviours of all people during the years they can have a child. It influences their own health and can affect the health and development of a child they may have in the future. Despite global recognition by researchers that optimising preconception health represents an opportunity to improve health and reduce inequalities across generations, this is not common knowledge among the public nor policy makers. The New Things Fund allowed me to explore how we can address a key barrier towards creating public and policy awareness: the lack of meaningful language to communicate about “preconception health”.
The project
During the past few months, I organised and facilitated small group discussions with over 50 members of the public aged 18-50. The groups were diverse and included people with different gender identities and cultural and ethnic backgrounds, and people who already had children, had experienced recurrent pregnancy loss, and lived with a long-term condition. We talked about why being healthy before trying to have a baby is important, and how we may best communicate about this.
Findings
The discussions revealed that most people did not know that optimising health before pregnancy was something to consider. Some people knew that taking a daily folic acid supplement when trying to become pregnant reduces risks for the baby, and that things like older age and obesity may affect the chance of successfully becoming pregnant. People were not aware that a large range of health-related conditions and behaviours can influence health during and beyond pregnancy for both the pregnant person and their child. It was also new to nearly everyone I spoke with that the health of men or partners may influence the chance of pregnancy and the health of the child. While people were largely unaware of the notion of ‘being healthy in preparation for pregnancy and parenthood’, they were intrigued and interested in learning more.
To educate people on health before pregnancy and parenthood, and to advocate for resources to develop and implement interventions to improve preconception health, we need to effectively communicate about it. While the term “preconception health” is well-defined and widely used in the academic literature, I discovered that very few members of the public had ever heard of the term, and very few could relate to it. People felt that without further education or explanation the term was not clear, not inclusive, and incorrectly assumed that pregnancy will occur at a specific point in the future. An alternative term was not identified, and people agreed this may not be needed if appropriate and clear language is used in educational messages.
Based on the discussions, I developed a set of recommendations about appropriate language and messages, and about ways to disseminate these messages and increase awareness. For example, people would like to see messages that are positively framed, specific, realistic and that use simple and non-clinical language. The use of inclusive and gender-neutral language was also identified as important, and this was further explored in conversations with non-binary and transgender people on which I have written a separate blog.
To increase awareness, people felt it would be important to make sure that everyone is exposed to messages on the what, who, when and why of preconception health. Suggestions included for example education in schools, social media campaigns, and posters in public places and at healthcare services. People also believed that healthcare professionals have a role in creating awareness on preconception health, and in supporting people who may become pregnant to improve their health. While people thought it would be acceptable for healthcare professionals to ask about pregnancy intentions, healthcare professionals would need to clearly indicate the reason for the conversation upfront and not make any assumptions.
Impact
The recommendations I developed are already informing the language used in the Ready for Pregnancy campaign – a collaboration between local maternity systems from across the South East region working together to raise awareness on what people can do to optimise their health before trying to have a baby and how this may affect them and their child.
The next steps for this project include roundtable discussions with relevant policy stakeholders including campaign developers, and healthcare organisations, professionals and their governing bodies. These discussions will help build coalitions, and consensus on the most appropriate and meaningful language to use and on ways to increase awareness and support optimal preconception health. The roundtable discussions will also explore what language is used by policy stakeholders, and how this aligns with language that is meaningful to the public. Together, this will inform the preparation of policy briefs that use accessible language to support effective advocacy for appropriate preconception health interventions.
As part of this project I have been supported by Public Policy Southampton, and by colleagues and stakeholders across multiple organisations and disciplines. The project has been the start of a journey for me to critically think about policy needs, to identify and build relationships with members of the public and relevant stakeholders, and to work together to inform and implement recommendations. I look forward to ongoing collaboration and further engagement activities that contribute to shaping the preconception health agenda and ultimately improve the health and well-being of families.