In April 2022, QNIS’ Healthier Pregnancies, Better Lives programme supported by The National Lottery Community Fund and Cattanach, conducted its second online survey. This survey focused on preconception health, education and care.
This is the first blog in a series of four, you can read the other blogs here:
It sought to understand what Scottish community nurses and midwives know and do about this often-overlooked area of primary healthcare. This incredible community of healthcare professionals once again took time from their busy schedules to share their knowledge and help us learn from their experience. The questionnaire was designed by QNIS Senior Fellow (Dr Jonathan Sher), HPBL Consultant (Michele Stranger Hunter) and Project Coordinator (Lisa Lyte).
The Survey Facts:
- An ‘illustrative’ voluntary, online survey, open to all registered community nurses and midwives working anywhere in Scotland
- Ascertain preconception health, care and education knowledge, attitudes, experiences and opinions of respondents
- Open from 8-30 April 2022
- 21 questions (binary, multiple-choice and open); promoted by email, social media & QNIS website
- 212 respondents
- Every Scottish NHS region (except Lanarkshire) is represented
- 98% of respondents are employed by the NHS
- Midwives (30%) and Health Visitors (24%) are the specialities most represented
- 35% of respondents had 25+ years of experience (the largest proportion)
- 21 respondents were randomly selected to receive one £50 voucher each
The Healthier Pregnancies, Better Lives programme has one primary aim: Helping more birth parents throughout Scotland have a safe pregnancy, a healthy baby and a thriving family. To construct our pathway, we needed a snapshot of what the preconception health, education and care landscape looks like today. With that information, we will be able to formulate plans to bridge any gaps.
What we discovered was a passionate and dedicated workforce, keen to keep their skills and knowledge up to date. However, what also came through loud and clear were some systemic gaps that make preconception care challenging. Some respondents indicated they ‘rarely see or deal with people who have not yet conceived or are preparing for pregnancy’.
If this is the reality, then when (how and by whom) are crucial pre-pregnancy messages conveyed – for instance, the message that neural tubes are fully formed or malformed by the fourth week of pregnancy (before most women even realise they’re pregnant)? When, and how, does the message that only by consistently taking enough folic acid (Vitamin B9) BEFORE pregnancy can most NTDs (neural tube defects) be prevented? No one wants an NTD-driven miscarriage, stillbirth, neonatal death, therapeutic termination or lifelong birth defect. Yet, they continue because the prevention message too often remains unspoken and so, not acted upon soon enough to matter.
The folic acid issue highlighted another gap, with only 38% of respondents knowing this key NTD-prevention fact regarding timing. The knowledge gap comes not through incompetence or a lack of caring, but rather from pre-service education, continuing professional development and public health messaging that has never prioritised preconception health or preparing for pregnancy.
Respondents were overwhelmingly comfortable (over 84% very comfortable or comfortable) responding to questions or concerns raised by people of reproductive age about avoiding, delaying or preparing for pregnancy. Yet, initiating such a conversation was only usual for 44% of respondents. This raises the question ‘If not now, then when?’
This is the first in a series of blogs exploring what we have learnt from the Preconception Health, Education and Care survey. We shall go on to consider how best the Healthier Pregnancies, Better Lives programme can begin to facilitate plugging some gaps and working towards a healthier Scotland.
The next blog will delve into the details behind the answers. This will be followed by a blog on Your Views and Experience. It is important to better understand what preconception care information community nurses and midwives already know; what their experiences are; and what areas need concentrated educational efforts.
In general, the responses leave us very encouraged. Those who don’t know, want to know and want to receive more assistance with learning whatever will improve their practice. As a QNIS programme, Healthier Pregnancies, Better Lives, is involved with practitioners who are open to change, IF that change can improve health outcomes beneficial to their clients and patients. We will be shining a light on what is not commonly known and understood about how to improve pregnancy and birth outcomes, especially by becoming better prepared for a first or next pregnancy.