Process and outcome evaluation of preconception health promotion through sexual and reproductive health services (Research Capability Funding - Bristol, North Somerset and South Gloucestershire Integrated Care Board)

What is the problem?
There is good evidence that poor health before pregnancy can lead to diabetes in pregnancy, baby loss, birth defects and other issues. It is important for women to take folic acid, have a healthy weight and be active before getting pregnant. Most women in the UK would benefit from support to improve their health before getting pregnant. Women from low-income homes and ethnic minority groups tend to need extra support and are more likely to have poor pregnancy outcomes. DH&SC have called for research on how to provide ‘targeted’ support to these groups before pregnancy. Unlike other health services, women from these groups are more likely to use sexual health services than those who have fewer support needs. Yet it is not standard practice to provide this support through these services and this has never been assessed. So, we don’t know the best way to do this or if it will improve women’s health before pregnancy.

The proposed work aligns with BNSSG ICB’s aims to improve the health of children in the first 1001 days of life and provide support for healthy weight, smoking, drugs and alcohol. It also aims to improve women’s access to health services and narrow health gaps between certain groups of women.

What is the aim of the research?
We aim to improve women’s health before pregnancy. We will answer the following questions:
1. Is it acceptable to ask women about their pregnancy plans in certain sexual health appointments?
2. Is it acceptable to give advice about pre-pregnancy health and local support services to women who are thinking of getting pregnant? These services include support for healthy weight, smoking, alcohol, drugs and folic acid
3. Does this support improve women’s health before and during pregnancy? Does it narrow health gaps between certain groups of women?
4. Does access to health services improve for groups of women who find it harder to get health care?
5. How can we improve this new care pathway and deliver it elsewhere?

How will BNSSG ICB RCF be used?
We will use the funding to:
• Co-design a plan for the new care pathway and how to evaluate it. This will involve working with sexual health service users and providers, the public, researchers and other groups. This will ensure the evaluation plan answers questions that are important to all, and highlight possible evaluation barriers and how to deal with these.
• Interview sexual health doctors and nurses to find out what support for pre-pregnancy health they provide at the moment. This will allow us to study the impacts of the new care pathway.
• Test collecting data and linking sexual health patient records with the health services that pre-pregnant women will be directed to. This will show if it is possible to assess if women’s use of these services before pregnancy improves in BNSSG.
• Write and submit an NIHR application to evaluate the new care pathway, based on the co-designed evaluation plan.