Preconception health knowledge, attitudes and behavioural intentions among adults: A multi-country study

Background Preconception health – the health status of individuals prior to conception – is vital for positive pregnancy outcomes and long-term health. Despite its importance for maternal and infant well-being, it remains under-researched and often overlooked in global maternal and child healthcare. Methods We conducted a cross-sectional online survey with adults (18–55 years old) from Kenya, South Africa, Malaysia, the United States, and the United Kingdom (n = 5000), gathering data on preconception health knowledge, attitudes, behavioural intent, and respondents' preferences regarding factors important before pregnancy and preferred sources of health information. A generalised structural equation model (gSEM) was constructed a priori to assess the relationship between socioeconomic position and preconception health knowledge, and whether this relationship was mediated by preconception attitudes and behavioural intent. Results Preconception health knowledge, attitudes, and behavioural intent showed significant variation across the countries. Over half of the respondents reported having adequate preconception knowledge (50.3%), with the USA having the highest proportion of respondents with good knowledge (13.8%) and Malaysia having the highest proportion with poor knowledge (42.5%). In the pooled sample, physical health was considered the most important factor before pregnancy, followed by relationships and family. Clinic doctors were the most preferred source of information, followed by nurses and obstetricians/gynaecologists. The relationship between socioeconomic position and behavioural intent was partially mediated by preconception knowledge (4.3%), while the relationship between preconception knowledge and behavioural intent was fully mediated by a combination of preconception attitudes (73.1%). Conclusion Preconception health knowledge, attitudes, and behavioural intent differed across the five economically diverse countries. Pregnancy factors were prioritised differently across settings, likely reflecting disparities in culture, socioeconomic status, and healthcare access, with varying preferences for sources of preconception health information. These findings underscore the importance of designing tailored interventions that consider socioeconomic and cultural differences to enhance overall health outcomes.