Development and validation of a comprehensive evaluation index system for preconception health behaviors in reproduc-tive-aged populations

ObjectiveTo develop a comprehensive evaluation index system for preconception health behaviors among reproductive-aged populations, providing a screening and intervention tool for the primary prevention of adverse pregnancy outcomes.MethodsAn initial indicator pool was established based on domestic and international preconception care guidelines and literature. After discussions within an indicator development group, a preliminary framework comprising 5 first-level and 22 second-level indicators was formed. Two rounds of Delphi expert consultations were conducted from October 2022 to March 2023. The coefficient of variation, Kendall's W, and statistical significance tests were used to evaluate expert consensus, based on which indicators were refined and rating categories determined. Analytic hierarchy process was applied to assign weights to indicators at each level, and a weighted composite scoring model with a total score ranging from 0 to 100 was established. The indicator system was operationalized into the "Beiyun" (pregnancy planning) questionnaire. Using multistage stratified sampling, reproductive-aged individuals with childbearing intentions—including those with natural pregnancy, infertility, or early miscarriage—were recruited from maternal and child health hospitals and primary healthcare facilities in Xihu and Gongshu Districts of Hangzhou Municipality, and Jiangshan City and Kaihua County of Quzhou Municipality, Zhejiang Province, between July and September 2023. Data were collected via the "Wenjuanxing" online platform. Composite scores were calculated using the scoring model, and influencing factors were analyzed using analysis of variance and multivariable linear regression.ResultsAfter two Delphi rounds (25 experts in the first round, 22 in the second; authority coefficients = 0.95 and 0.96, respectively), a final evaluation system was developed, consisting of 5 first-level indicators (pregnancy timing, healthcare-seeking behavior, health-promoting behavior, risk-avoidance behavior, and disease prevention/treatment behavior) and 26 second-level indicators, with a total score of 100. A total of 2,072 valid questionnaires were collected (1,120 from women, 952 from men). Among women, the median scores for the first-level indicators were 77.13, 29.43, 62.41, 74.51, and 85.88, respectively, with a composite score of 70.83 ± 9.17. Among men, the corresponding median scores were 100.00, 39.24, 63.63, 70.32, and 83.63, with a composite score of 70.32 ± 10.48. Educational level, self-rated health status, and pregnancy planning ("Beiyun") were independent predictors of higher behavioral scores (all P