Measurement of Preconception Health Knowledge: A Systematic Review.

Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges. MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018. Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men. Two independent reviewers completed data extraction and quality appraisal using standardized instruments. Due to measurement heterogeneity, a narrative synthesis was performed. The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men's health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools. This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.