Preconception Care Recommendations, Training, and Competency of Primary Healthcare Nurses in South Africa: A Quantitative Descriptive Study.

Introduction: There has been a growing interest in preconception care (PCC) as a primary means of tackling the high maternal and child mortality rates, as evidence has shown that the state of maternal health before conception can have a direct impact on the health of the mother and baby. Primary care nurses have been recognized as the highest providers of sexual and reproductive healthcare to the vulnerable population in resource-constrained settings. Objective: This study aimed to examine and describe the PCC recommendations, training, and competency of primary healthcare (PHC) nurses in South Africa. Methods: A cross-sectional descriptive study was conducted among 196 PHC nurses to examine the PCC recommendations, training, and competency. A self-administered survey tool was used for data collection. Results: The self-reported PCC recommendations, training, and competency of PHC nurses were 63.3%, 88.3%, and 94.9%, respectively, in each aspect. The PCC training among the respondents was mainly in-service training. The only training that was indicated to have been done primarily at a pre-service level was training about reproductive life plan screening and brief counseling. Over 20% of the respondents indicated that they did not receive any training on how to provide alcohol, drug, or tobacco cessation services and how to conduct preconception risk assessments. Conclusion: Although PHC nurses reported a high level of recommendation, training, and competency, their level of reported PCC practice is not equivalent to their provision, as they rendered PCC services to fewer women, and they also reported fewer women seeking PCC. A future longitudinal study is required to examine the reason for low PCC-seeking habits among those at high risk of adverse pregnancy outcomes and contextual factors influencing the provision of PCC services among healthcare workers.

Integration of preconception care into the bachelor of nursing curriculum: An exploratory qualitative study.

Background: The significance of ensuring high quality of care has become apparent in nursing and midwifery education worldwide, especially in low- and middle-income countries. This has led to upgrades of the nursing curriculum to include several aspects of care that have been overlooked with recent evidence-based care. Objectives: To explore the integration of preconception care (PCC) into the Bachelor of nursing curriculum in South Africa. Design: An exploratory qualitative study. Setting and participants: This study was conducted in a higher education institution in South Africa that has recently revised its Bachelor of nursing curriculum. Data sources were Bachelor educators and program documents. Methods: Individual in-depth interviews were conducted among ten nurse educators. Interviews were complemented with an analysis of the curriculum documents for the Bachelor of nursing program using the BEKA (benchmarking, evidencing, knowing, and applying) model of curriculum analysis and evaluation. Findings: Benchmarking and evidencing of the Bachelor of nursing curriculum reveals a high level of compliance with the externally set standards. Both data sources pointed to some degree of incorporating the preconception care concept into the curriculum. The educators perceived that for full integration to occur, preconception care should be taught as a standalone topic. Lack of focus and poor perception was further reported as barriers to introducing the concept. Most preconception care components and services were taught to students throughout the four hundred levels of the nursing program, especially in the sexual and reproductive health module. Gaps were noted in female genital mutilation, mental health, environmental health, preconception vaccination, and other aspects where preconception care needs emphasis. Conclusions: There has been a high level of integration of preconception care competency in the Bachelor of nursing curriculum. Especially in the sexual and reproductive health module, most preconception care components are taught to students. However, there is a need to emphasise the preconception nursing management of women with certain conditions. To ensure nurses' role in providing health for all, safeguarding reproductive health, and maintaining the health continuum is enhanced.

Preconception care practices among primary health care nurses working in public health facilities in KwaZulu-Natal.

BACKGROUND: Preconception care (PCC) is necessary to identify and deal with all the risk factors before conception. Some aspects of PCC, like folic acid supplementation, would be relevant to people desiring a pregnancy. Alternatively, PCC could provide contraceptive support to those with no pregnancy intention. In South Africa, primary healthcare nurses provide a comprehensive package of essential services in public health facilities to about 90% of the population at no cost. Therefore, they are the key providers of promotive, preventive, and curative services, including PCC. OBJECTIVE: This study aimed to determine the level of PCC practice among primary healthcare nurses and identify determinants of effective practice. METHODS: This cross-sectional descriptive survey was conducted among 196 nurses undertaking a specialisation Primary HealthCare program in a selected higher education institution. A pretested questionnaire was used to collect data that were analysed with SPSS version 27 software. RESULTS: The overall practice of PCC was 87.8%. Older participants were significantly less likely to exhibit good PCC practice than their younger counterparts. Female participants were also less likely to have good PCC practices than their male counterparts. Married participants were significantly more likely to practice PCC than their unmarried counterparts. Participants practicing in rural areas were also less likely to have good PCC practices than their urban counterparts. CONCLUSION: The PCC practice of most primary healthcare nurses in the study is relatively high. The study also identified the determinants of good PCC practice that can enhance its practice. There is a need to revisit the PCC training of healthcare workers, as most indicated the need for further training.

"We Are Having a Huge Problem with Compliance": Exploring Preconception Care Utilization in South Africa.

BACKGROUND: Preconception care (PCC), a policy directive from the World Health Organisation (WHO), comprises all the health interventions offered to women and couples before conception and is intended to improve their overall health status and the pregnancy outcomes. Although PCC should be an essential part of maternal and child health services in most African countries, its provision and utilization are not widely documented. Hence, this study aimed to explore the factors influencing preconception care utilization among high-risk women in South Africa. METHODS: A descriptive qualitative study of 29 purposively selected women and healthcare workers was conducted through individual in-depth interviews using a semi-structured interview guide. The interviews were transcribed verbatim, and the analyses were performed using Nvivo version 12. The Social-Ecological Model (SEM) guided the data analysis. Four levels of factors (the individual, the interpersonal, the community and social, and the policy and institutional) were used to assess what can influence PCC utilization. FINDINGS: The availability of PCC services, the intrahospital referral of women, the referral practices of other healthcare workers, the underutilization of the PCC facility, and resources emerged at the institutional levels, while compliance with PCC appointments, socioeconomic factors, pregnancy planning, assumptions, and knowledge was at the individual levels. CONCLUSION: The utilization of the preconception care services was inadequate. The primary influencer of preconception care utilization was at the individual, policy, and institutional levels. The availability of preconception care services and the intrahospital referral of women at high risk of adverse pregnancy outcomes positively influenced the women's PCC utilization, while poor pregnancy planning, and unavailability of PCC policies and guidelines negatively influenced preconception care utilization. Therefore, interventions to improve PCC utilization should focus on the four SEM levels for effectiveness. There is a need to raise PCC awareness and develop policy and guidelines to ensure consistent, standardized practice among healthcare workers.

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study.

Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants' views, patients' access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the 'One key' reproductive life plan question as an entry point for the provision of preconception care.