Perspectives and preferences on delivery of preconception care in primary care among people of reproductive age and primary care professionals – A mixed methods systematic review

Abstract Background Primary care is central to delivering support for planning and preparing for pregnancy. To explore key considerations around how preconception care could be delivered in primary care, this systematic review aimed to synthesise the literature on perspectives and preferences of primary care professionals and people of reproductive age regarding preconception care content and delivery. Methods Five databases (MEDLINE, EMBASE, CINAHL, Web of Science, PsycInfo) and two preprint servers (MedRxiv, BioRxiv) were searched (February 2025). Studies were eligible if they included people of reproductive age and/or primary care professionals, reported perspectives and preferences on content and delivery of preconception care in a primary care setting using quantitative, qualitative or mixed-methods research. Two reviewers independently conducted data extraction and quality assessment. Quality was assessed using the Mixed Methods Appraisal Tool and Joanna Briggs Institute JBI tool. Data analysis used the JBI convergent integrated approach with thematic synthesis. Public contributors were involved in protocol development and interpretation of findings. The review is registered with PROSPERO (CRD420251000878). Results The review included 51 studies, conducted in Europe (n = 20), Australia (n = 14), New Zealand (n = 1), USA (n = 12), Africa (n = 3) and Asia (n = 1). The thematic synthesis identified descriptive themes, including: roles and responsibilities around delivering preconception care in primary care, approaches to targeting preconception care in primary care; timing and context of preconception care; support with delivery of preconception care; and systemic needs for successful integration of preconception care. The analytical theme suggested that engagement with preconception care in primary care settings depends on communication, awareness, and empowerment. The acceptability also depended on how conversations were initiated and facilitated, with discussions perceived as more appropriate when individuals had prior awareness of preconception health and its relevance. Conclusions The findings suggest that people of reproductive age and primary care professionals are receptive to introducing preconception care in primary care. Successful implementation requires trusted primary care professionals, sensitive and non-judgemental communication, increased awareness among people of reproductive age, and system-level training, resources and clear clinical pathways. Findings provide an evidence-informed foundation for co-developing and evaluating a context-sensitive approach to integrating preconception care into primary care. Funding: NIHR Advanced Fellowship (NIHR302955).