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Table 2 Summary of the twelve themes, with an illustrative quote from the IDIs

From: Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study

Main themes Sub themes Quote Ref (source)
1. Awareness about PCC -Lack of/ awareness about PCC
-Unawareness about timing and content of PCC
-Misconceptions on PCC
-Awareness about risk factors to pregnancy and mitigations
“I did not know there was even such a thing! I have never heard of it. No, people are not aware about it. Like myself I have heard it for the very first time with you.” PCC 009, AKUH, N
2. Availability of PCC Un/availability of PCC “I think it’s important it’s just that I am not sure it’s usually available. If I knew how to access it I would probably do it.” PCC 009, AKUH, N.
3. Accessibility of PCC -Financial constraints
-Time and occupational constraints
-Area of residence
-Distance to health facility
“If I can’t afford it, I would ignore it. Sometimes you even convince yourself that you don’t actually need this care cos you don’t have money for it” PCC 004, AKUH, N
4. Responsibility for PCC -Lack of consensus on whose it was to initiate PCC
-Role of health providers
“I think the responsibility for preconception care goes both ways. The greater responsibility lying on the individual, the patient but I think the initial part at least starts with the health care professional’s side.” PCC 065, MLFH
5. Attitudes towards pregnancy in general -Lack of pregnancy planning
-Downplaying pregnancy and taking it as a natural phenomenon
-Feeling one is well versed on pregnancy and childbirth
-Prior good pregnancy outcomes
-Blaming witchcraft
-Prior bad pregnancy outcomes and fear
“We had counseling and doctor reviews after the stillbirth of my second born, just to be ready for the next pregnancy. Before that I had never bothered to seek care before getting pregnant. I always assumed I will have a smooth pregnancy and bouncing babies. After all people get pregnant all the time, even without planning and everything goes just fine.” PCC 071, AKUH, N
6. Attitude towards PCC -Dismissing importance of PCC
-Personal preferences
-Personal beliefs, culture and traditions.
-Skepticism about PCC
-Understanding importance of PCC
-Desire for more information on pregnancy and preparation
-Absolution from blame
“If you want a healthy baby you must take care of yourself first and rectify the things in your power to change. Sometimes things can go wrong like when you get a miscarriage or something goes wrong with your baby it is better if you know you did everything that you could have done to make things okay. Also, some people just want to be healthy during pregnancy and carry pregnancy to term without any health issues.” PCC 020, MLFH
Minor themes
7. Previous interactions with health professionals -Communication skills and nature of relationships with health providers
-Fear, confidentiality and stigmatization concerns
-Unmet expectations and frustrations in the past
“We have been telling ourselves that doctors are harsh and bad. When you go to the hospital they can harass and embarrass you.” PCC 036, MLFH
8. Social influences -Role of partner, traditional birth attendants, friends and family
-Social media and internet
“I personally advocate for PCC. So I have been talking to a few people who I know are getting married, I have been advising them, make sure if you want to get pregnant start at an early age, quit alcohol, be fit, you know prepare your body.” PCC 071, AKUH, N
9. Health seeking behaviour -Health checkups and ascertaining health status
-Seeking information on what pregnancy entails
“I need to know what to expect, be aware of potential pregnancy challenges and complications and how to overcome them. Maybe most of them can actually be reduced with good planning and preparation.” PCC 020, MLFH
10. Health concerns -Coexisting medical and genetic conditions
-Fertility concerns
-Family planning concerns
“Well some women have conditions that may affect the baby or their health may be worsened by the pregnancy like heart condition so they might want to talk to a doctor before they conceive.” PCC 051, AKUH, N
11. Level of education -Level of education “Those who are learned go to the hospital to prepare for pregnancy. Those who are uneducated don’t understand PCC” PCC 019, MLFH
12. Strategies for increasing PCC awareness and utilization -Public education using print and broadcast media
PCC in institutions like churches and learning institutions
-Initiating PCC services through clinics
-Government initiatives like free PCC services.
“A good point to catch people is at the family planning clinic. Getting the PCC information out there would help even by raising awareness through the social media, just get the conversation happening.” PCC 009, AKUH, N