Authors
Ruyu Sun, Hanqian Wang, Xin Xu, Lu Li
Published in
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences. Pages 1-12. Jul 21, 2026. Epub Jul 21, 2026.
Abstract
To develop and validate a comprehensive evaluation index system for preconception health behaviors among reproductive-aged populations.
An initial indicator pool was established based on domestic and international preconception care guidelines and literature. After discussion by the indicator development group, a preliminary framework comprising 5 first-level and 22 second-level indicators was formed. Two rounds of Delphi expert consultation 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 the consultation results, the indicators were refined and rating categories were determined. The 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, as well as Jiangshan city and Kaihua county of Quzhou, 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.
After two rounds of Delphi consultation (25 experts in the first round, 22 in the second; authority coefficients=0.95 and 0.96, respectively), a final evaluation system was developed. The system consisted 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 2072 valid questionnaires were collected (1120 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 planned pregnancy status were independent predictors of higher behavioral scores (all P<0.05).
The comprehensive evaluation index system for preconception health behaviors developed in this study demonstrates good scientific rigor and practical utility. The preconception health behaviors of reproductive-aged populations require improvement, with healthcare-seeking behavior being the weakest dimension. The concept of pregnancy planning represents a key target for improving these behaviors, while attention must also be focused on behavioral interventions for key populations, such as those with lower educational levels.
PMID:
42515973
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.
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