Preconception Health Improvement: Intervention development to target multiple modifiable risk factors for multiple adverse perinatal outcomes

This PhD is an exciting opportunity to develop quantitative and qualitative research skills and apply them to develop a new intervention for women and men to improve health before pregnancy. There is a little evidence about effective preconception interventions for improving maternal and child outcomes. Therefore this PhD will provide novel insights and developments in this emerging area of public health research. Women’s health and lifestyles before pregnancy can have a negative impact on their pregnancy and baby’s health. In the UK there is no service aimed at improving health for women and men before pregnancy, unlike in the USA. Women with unplanned pregnancies are at greater risk of adverse health outcomes before and after birth often related to modifiable behaviours. However, a large proportion of women with planned pregnancies are also not engaging in healthy behaviours. Changes before pregnancy could lead to improved health, for example, starting pregnancy with a healthy weight, not smoking, folic acid supplementation and vaccination against infections such as rubella. If women’s partners are involved in the lifestyle changes, it could make the changes more effective and help to develop healthy family environments.

The research will be supervised across the Universities for Bristol and Cardiff. The student will be based at the University of Bristol’s Department of Population Health http://www.bristol.ac.uk/population-health-sciences/) which has an international reputation in public health and epidemiology and provides an excellent training in research with over 35 research methods short courses.

Aims and objectives
The aims of the PhD are to determine:
a) which interventions evaluated as RCTs improve preconception health
b) what knowledge women of child-bearing age and men of a similar age have about preconception health
c) whether a universal or targeted intervention to improve preconception health is appropriate
d) what intervention design to improve preconception health would be feasible and acceptable to women, men, partners and key stakeholders in preconception health
e) how to recruit women and their partners in an intervention to improve preconception health
and f) to co-produce an intervention to improve preconception health across multiple risk factors.

Methods
The research methods will include:
1) A systematic review of interventions to improve preconception health.
2) A survey in primary care will be undertaken by the student to assess knowledge of preconception health and views of methods to improve preconception health with four groups: men/women aged 16-24/25-48. 7200 participants will be invited, to give a sample of 1292 (323/group). The survey will include questions about SEP, education, ethnicity, relationship status, number of children, miscarriages, frequency of visits to pharmacy, dentist, GP, hairdresser/ barber and use of social media/media. Practices will be purposively selected to ensure maximum variation in recruitment and a stratified sample of eligible patients. Exploratory analysis will generate hypotheses to be explored in method 3.
3) A purposive sample of survey participants (20) based upon gender and knowledge of preconception health professionals and policy/practice partners (15) will be invited for in-depth interviews to inform the design of the intervention. Interviews will be analysed thematically to identify acceptable methods.
4) Analysis of methods 1, 2 and 3 will inform creation of a logic model and intervention design through co-production.
5) A Delphi consultation on the findings and intervention design to refine the logic model and intervention.
The output from this PhD will inform the next step, potentially via a post-doctoral fellowship including a pilot RCT and future large-scale RCT to test the effectiveness of the intervention to improve maternal and child health.