Enablers and Barriers to Preconception Diet: A Mixed Method Study with Women of Reproductive Age

Abstract Background: A healthy diet before conception (preconception) diet is associated with enhanced maternal health, improved cardiometabolic outcomes, reduced risk of pregnancy complications, and effective weight management. Yet, women of reproductive age frequently exhibit suboptimal dietary behaviours before conception. We aimed to investigate the enablers and barriers related to preconception diet among women of reproductive age. Methods: Using sequential explanatory mixed methods, an online cross-sectional quantitative survey was followed by online qualitative interviews with women of reproductive age (18-45 years). Survey measures included the Healthy Eating Quiz (HEQ), and a pilot-tested new measure, the Preconception Diet Enablers and Barriers Scale (PDEBS) to evaluate barriers and enablers to diet. Linear logistic regression analysed the relationship between Australian Recommended Food Score (AFRS) and barriers/enablers. Qualitative interviews were conducted to understand the reasons behind women’s (non)engagement in healthy dietary habits. A weaving approach, use of joint-display, and the Capability Opportunity Motivation Behaviour (COM-B) model were used to integrate and present the data. Results: Seven hundred and eighty-eight non-pregnant women (mean M age 32.08 years, SD = 7.31) residing in Australia, India, and the US completed the survey. Qualitative interviews (M duration = 30 mins) were conducted with 13 women based in Australia. Women's capability to maintain a healthy preconception diet was influenced by their level of knowledge and awareness of its significance. Opportunities for a healthy preconception diet were shaped by social support, time availability, financial resources, and accessibility. Additionally, motivation to adhere to a healthful preconception diet was influenced by beliefs regarding its potential outcomes, alignment with personal goals, and emotional state. Conclusion: Our findings advance understanding of the determinants influencing preconception dietary behaviours and provide valuable insights for designing effective interventions to promote healthy preconception dietary habits. By addressing the identified enablers and barriers comprehensively, policymakers, healthcare professionals, and researchers can work together to support women in adopting and maintaining healthy preconception dietary behaviours, ultimately improving maternal and child health outcomes.