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Review date: January 2020

Citation: Hogg K, Rizio T, Manocha R, McLachlan RI, Hammarberg K. 2019 Men’s preconception health care in Australian general practice: GPs’ knowledge, attitudes and behaviours. Australian Journal of Primary Health 25(4) 353-358

 

A man’s health and lifestyle prior to conception can influence pregnancy outcomes and the health of his children. A man’s age and modifiable lifestyle factors can influence pregnancy outcomes and offspring health, including obesity, alcohol, smoking and diet. However, men do not have adequate knowledge of how age and lifestyle factors can influence pregnancy outcomes, and there is little knowledge of whether and how primary health care practitioners promote preconception advice to men. A study by researchers at Healthy Male has revealed the barriers and enablers to fertility and preconception health promotion to men, and the need for better education and training of general practitioners and for the provision of patient guides and online resources.

Accumulating evidence suggests that fertility, pregnancy outcomes and health of offspring can be influenced by a man’s health, age and lifestyle prior to conception. It is well-recognised that effective strategies are required to modify health behaviours of both men and women to optimise pregnancy outcomes. Both men and women believe that health practitioners, including GPs, should provide advice and resources on fertility and pregnancy. Yet preconception health care is primarily focussed on women, and is not widely practised for men in Australian primary health care. Studies show that men do not have adequate knowledge about the effect of age and lifestyle factors on their fertility, nor about the potential consequences for the health of their children. Health practitioners, including GPs, have an important role to play in providing advice on preconception health and fertility to men. In order to find ways to improve the delivery of preconception advice to men, researchers at Healthy Male investigated GPs’ knowledge, attitudes and behaviours towards men’s preconception health and fertility health promotion.

The study aimed to identify the gaps in GPs knowledge about male fertility and to assess their views on the barriers and enablers for delivering advice to men on their fertility and preconception health. An online survey was open to all GPs, and a total of 304 GPs completed the survey.

The main findings and recommendations were:

  • Most GPs feel it is part of their role to deliver fertility health information to men, yet very few routinely raise the subject with men and only about half raise the subject opportunistically when consulted about a reproductive issue or advice.
  • Almost two-thirds of GPs agreed it was their role to discuss modifiable risk factors affecting fertility yet most stated they did so only “occasionally” or “never”.
  • Almost all GPs (90%) did not feel confident in their knowledge of risk factors affecting a man’s fertility. Knowledge gaps identified included factors that affect reproductive outcomes, such as obesity and older paternal age.
  • A range of barriers to discussing fertility and preconception health were identified, including lack of knowledge, difficulty in bringing up the subject unless specifically asked, men’s discomfort or disinterest in discussing the subject, and the fact that younger men rarely visit the GP.
  • Most GPs responded that a potentially useful approach to initiating fertility and preconception health conversations with men could be based on the “One Key Question” approach, where patients are asked whether they would like to become pregnant in the next year.
  • The vast majority of GPs stated that better information and education would make them more confident to talk to patients about fertility. The types of information that GPs believed would help included patient factsheets and trustworthy websites to refer patients to.
  • The authors recommended that a national framework for preconception health care and promotion should include male-specific reproductive health resources and further GP education and training, and would help GPs to promote awareness of fertility and preconception health to men.