How a Holistic Approach to People of Reproductive Age Can Support Access to Preconception Care for People Living with Health Conditions: Findings from a Realist Evaluation

This realist evaluation explored how access to preconception care works for people with pre-existing health conditions, for whom, and in what contexts. Thirty one participants (women of reproductive age, partners, and healthcare professionals) were interviewed using qualitative realist methods. Iterative analysis refined 35 initial programme theories into 13 middle range theories. The theory reported here identifies healthcare professionals’ knowledge of sexual and reproductive health, understanding of pregnancy planning, and enquiry regarding pregnancy intention as key mechanisms. In the context of diagnosis or review, these resources support holistic and individualized preconception care, enabling improved preconception health and reduced adverse maternal and offspring outcome.