Facilitating Dissemination of Evidence-Based Practice for Preconception Health through an Ecological and Life Course Framework

Objective: To identify evidence-based interventions that focus on preconception health, organized by life course stage (target group) and the ecological phase (point of distribution).

Methods: We conducted a secondary analysis of evidence-based interventions listed by Healthy People 2020 (HP2020). Preconception-related interventions were selected if they identified and modified biomedical, behavioral or social risks to a woman's health or pregnancy outcome through prevention and management. Evidence-based interventions were plotted based upon life stage (i.e., infant/child; adolescent; adult) and ecological phase (i.e., public policy; environment; community; organization; individual).

Results: Fifty-eight interventions were identified as preconception-related. Interventions targeting infant/child focused on early childhood development, vision, and safety seats. Interventions targeting adolescents focused on violence, HIV prevention in pregnancy, and alcohol. Interventions targeting adults focused on depression, nutrition, tobacco cessation, general health, and obesity. Environmental interventions were most likely to target the entire life span, and focused on safety, cancer, violence, physical activity, tobacco cessation/prevention, dental, WIC, Healthy Start, and folic acid supplemental use. Only one intervention focused explicitly on preconception health influencing pregnancy outcome, and that was folic acid intake. There was 100% agreement between the authors on the placement of interventions within the framework.

Conclusions: As a disseminating framework, this organization of interventions will assist practitioners, communities and policy makers in identifying what they can do to advance the preconception health of their communities as well as how framing future evidence-based interventions they may discover.