Background: Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services. Aim: This study aims to review the current literature on the knowledge, utilisation and provision of PCC. Setting: This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries. Methods: Arksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study. Results: Out of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least. Conclusion: The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.
The approach of conducting a scoping review is critical for identifying the current knowledge gap in the field of interest.22 This review followed the Arksey and O’Malley and Joanna Briggs Institute scoping review frameworks.22,23 This study used five of the six scoping review steps from Arksey and O’Malley’s methodological framework. These steps include identifying the research question, identifying relevant studies, selecting a study, charting the data, collating, summarising and reporting the results. The sixth step was omitted because it is optional. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline (Online Appendix 1).24 This review of studies is part of a larger PhD project. A scoping review protocol was developed; however, it was not registered or published in any journal prior to the start of this review, as per the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. On request, the protocol will be made available. We identify the central research question that relates to the study’s purpose. What has been documented in the existing literature about women’s and HCWs’ knowledge, utilisation and provision of PCC in SSA countries? This was performed to assist us in identifying the gap in our knowledge of this phenomenon. The Joanna Briggs Institute Reviewer’s Manual, 201523 for the Population, Concept and Context, as shown in Table 1, was used to determine the study’s eligibility criteria. Framework for the determination of eligibility of the review question. Source: Adapted form Peters M, Godfrey C, McInerney P, Soares CB, Khalil H, Parker D. Methodology for JBI scoping reviews. The Joanna Briggs Institute reviewers manual 2015. Adelaide: The Joanna Briggs Institute, 2015; p. 3–24. PCC, preconception care. This study included empirical studies as well as grey literature such as academic dissertation documents, including government and non-governmental organisation documents. This stage consists of screening study titles relevant to the topic, abstracts and full articles. The following electronic databases were used to look for peer-reviewed articles that answered the review question; Google Scholar, Science Direct, PubMed Central, CINAHL Complete and Scopus. Articles published in English between January 2011 and May 2020 were included in the study to provide more recent secondary data. The title screening was carried out solely by the principal investigator (W.C.U.), who exported the results into a newly created Endnote library. After that, duplicates were removed before involving a co-screener (P.A.) in the study. During title screening for the study, the search strategy Medical Subject Headings (MeSH) terms such as PCC/pre-pregnancy care/inter-conception care; knowledge/awareness/; utilisation/provision/practice, and uptake was used during the search. Flowchart of preferred reporting items for systematic reviews and meta-analysis as shown in Figure 1,25 was used to report the number of records retrieved and those included and excluded. Adapted preferred reporting items for systematic reviews and metaanalyses flow chart, demonstrating search and selection of studies. A pilot study was conducted using keywords from the study population, concept and context to determine the appropriateness of the database chosen. In addition, the university librarian’s assistance was sought for difficult-to-access articles, and the authors were contacted for articles that were not available through electronic search. An End Note library, data management software, was created for this review. All study designs were included in this review. The inclusion of all elements of the research questions ensured that the study’s eligibility criteria were met. Two reviewers independently screened the abstracts and full text, and a third reviewer resolved the discrepancies. Articles were included in this review if they met the following criteria: (1) studies on PCC and its synonyms in the SSA context; (2) if the paper was published in English and was available in full-text; (3) studies on PCC, regardless of design, including quantitative, qualitative and mixed studies, and (4) the grey literature on PCC from governmental and non-governmental organisations, as well as academic dissertations. The goal of the data extraction process in a scoping review is to create a descriptive summary of the findings. Online Appendix 1 shows the extracted data and the process used to extract it. Relevant data from the included studies were charted, and all interventions were compared. The research team created a data charting form and determined what was charted in this study. The extraction of data and charting of data from the eligible studies was carried out independently by the principal investigator. Following that, the research team met to determine whether the data extraction approach and research purpose were consistent, as recommended by23 Braun and Clarke 2006 guiding steps.26 As a result, the descriptive-analytical method was used in this review, which entails applying an analytical framework to all research reports and collecting standard information on each study.22 Data were sought about knowledge, utilisation, and provision of PCC and factors associated with knowledge, utilisation and provision of PCC. As previously demonstrated, the lack of methodological quality assessment makes interpreting scoping review results difficult.27 As a result, the Mixed Methods Appraisal Tool (MMAT) version 2018 was used for quality assessment to assess the methodological qualities of the included studies.28 Depending on the study design, different sections of the MMAT were used. The methodology, design, aim, data collection, data analysis, results and conclusions of all included articles were used to assess their quality and appropriateness. Two independent reviewers critically appraised all papers included in this study. The appraisal checklist scores were used to rate the quality of the included papers on a three-point scale as high, medium or low. As a result, no paper was rejected based on this rating system. The scores were used as a variable in the analysis stage. The number of ‘yes’ responses for each paper’s methodological criteria was counted and computed to generate a percentage score. Scores of less than 50% were considered low; scores from 51% to 75% were considered average, while 76% or higher scores were considered high. The methodological quality appraisal of the majority of included studies was high, ranging from 80% to 100%, with only two studies scoring average, at 70% and 65%, as shown in Online Appendix 1. As a result, 37 of the included studies can influence PCC policy and service delivery. The location, methodologies, categories measured and findings of the studies were all described. Evidence was synthesised using the following categories: (1) knowledge and awareness of PCC services, (2) factors associated with the knowledge and awareness of PCC services, (3) utilisation and provision of PCC services, and (4) factors influencing utilisation and provision of PCC services. The scope of recent research on PCC knowledge, utilisation and provision in SSA was mapped and summarised. Ethical clearance for the study was obtained from the University of KwaZulu-Natal Human and Social Sciences Research Ethics Committee – HSSREC/00001069/2020.
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