Participants’ perceptions of the preconception phase of the <i>Bukhali</i> trial for young women in Soweto, South Africa: A qualitative study

Background The preconception phase of the Healthy Life Trajectories Initiative Bukhali randomised controlled trial has been completed with young women in Soweto, South Africa. Given the gap in preconception care and interventions in low- and middle-income countries, and low levels of awareness about preconception health as a concept, it is important to understand participants’ perceptions of this phase of the trial. Objectives The aim of this study was to report on trial participants’ perceptions of the preconception phase of the trial, with a focus on its acceptability. Design This qualitative, descriptive study formed part of the Bukhali process evaluation. Methods Participants were purposively selected from the intervention (n=22) and control (n=17) arms of the Bukhali trial. Eight semi-structured focus groups were conducted with participants (two rounds of focus groups with same participants, including some replacements). A codebook thematic approach was taken to the descriptive process of data analysis. Results The main themes identified were perceptions of preconception and pregnancy planning, perceived impact of the trial, motivation for staying involved in the trial, agency, and suggestions for preconception services. The trial was viewed as acceptable by women participating in both the intervention and control arms of the trial, but preconception remains an unfamiliar term. Terms such as pregnancy planning, family planning, and ‘preventing’ added to the confusion around the framing of health promotion for young women who are not pregnant. Participants preferred a longer intervention or service, and wanted this service to be delivered in a similar way to the Bukhali trial, not in clinics by nurses. Conclusion Addressing preconception health with young women in Soweto should be done in a way that is contextually relevant, and that over time, contributes to their learning and development, benefitting their physical and mental health, irrespective of their pregnancy plans or intentions.