{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:00Z","timestamp":1787017080242,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"unspecified","delay-in-days":47,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,1,21]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Preconception care (PCC) is an important health promotion intervention aimed at optimising the health of women of reproductive age before pregnancy to reduce maternal mortality. However, the quest for its implementation within the healthcare system remains a significant challenge in Ghana. Understanding the views of healthcare professionals and hospital administrative managers is vital for identifying feasible strategies to address challenges. The study sought to explore factors influencing the non-implementation of PCC interventions at Agogo Presbyterian Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative exploratory approach was used. 10 healthcare professionals and three hospital administrative managers with experience in providing maternal healthcare services and the ability to provide information on maternal health issues at Agogo Presbyterian Hospital were interviewed. Data analysis was conducted using Braun and Clarke\u2019s thematic content analysis approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>The study identified key barriers to PCC implementation within the healthcare system. The participants described knowledge gaps among care providers, excessive workload, role confusion, the unavailability of PCC guidelines and infrastructure, inadequate human and financial resources and a lack of support and motivation of staff as hurdles to PCC implementation in the healthcare system. They suggested the need for capacity building of human resources, specific PCC guidelines, job descriptions and sustainable funding mechanisms to strengthen the healthcare system for effective PCC implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The challenges revealed by this study provide policymakers and healthcare institutions with insights to address the implicit barriers in the healthcare system to promote the practice of PCC as part of maternal healthcare services to ensure optimal maternal health before conception and to decrease maternal mortality rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003468","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T13:40:25Z","timestamp":1771335625000},"page":"e003468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["\u2018The silent struggles\u2019: a qualitative exploration of factors influencing non-implementation of preconception care in Agogo Presbyterian Hospital"],"prefix":"10.1136","volume":"4","author":[{"given":"Vivian","family":"Appiah-Ankobeah","sequence":"first","affiliation":[{"name":"University of Ghana, Accra, Ghana"},{"name":"Agogo Presbyterian Hospital, Agogo, Ashanti, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-366X","authenticated-orcid":false,"given":"Josephine Mpomaa","family":"Kyei","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4360-4747","authenticated-orcid":false,"given":"Vivian Efua","family":"Senoo-Dogbey","sequence":"additional","affiliation":[{"name":"Public Health Nursing, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"2026021705401696000_4.1.e003468.1","unstructured":"WHO . Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity. In: Hqrs Geneva Meet Rep. Geneva: WHO, 2013."},{"key":"2026021705401696000_4.1.e003468.2","doi-asserted-by":"crossref","first-page":"355","DOI":"10.7322\/jhgd.v30.11064","article-title":"Preconception Care to Improve Pregnancy Outcomes: The Science","volume":"30","author":"Atrash","year":"2020","journal-title":"jhgd"},{"key":"2026021705401696000_4.1.e003468.3","unstructured":"WHO . Key facts. 2024."},{"key":"2026021705401696000_4.1.e003468.4","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03884-5"},{"key":"2026021705401696000_4.1.e003468.5","unstructured":"GSS . Ghana statistical service. Accra Maternal mortality in Ghana: Thematic brief; 2024. Available: https:\/\/statsghana.gov.gh\/gssmain\/fileUpload\/pressrelease\/Maternal_mortality_submita.pdf"},{"key":"2026021705401696000_4.1.e003468.6","doi-asserted-by":"crossref","DOI":"10.3389\/frph.2025.1509737","article-title":"Preconception care utilization and pregnancy outcomes among postpartum women at Komfo Anokye Teaching Hospital, Ghana","volume":"7","author":"Adjei","year":"2025","journal-title":"Front Reprod Health"},{"key":"2026021705401696000_4.1.e003468.7","first-page":"43","article-title":"Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students","volume":"16","author":"Fakornam Doe","year":"2022","journal-title":"JFRH"},{"key":"2026021705401696000_4.1.e003468.8","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.mjafi.2021.03.006","article-title":"Maternal health: Challenges and the way forward","volume":"77","author":"Menon","year":"2021","journal-title":"Med J Armed Forces India"},{"key":"2026021705401696000_4.1.e003468.9","unstructured":"WHO . Global health observatory data on maternal health. 2023. Available: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/sdg-target-3-1-maternal-mortality"},{"key":"2026021705401696000_4.1.e003468.10","unstructured":"United Nations . United Nations. transforming our world: the 2030 agenda for sustainable development. 2015. Available: https:\/\/sdgs.un.org\/2030agenda"},{"key":"2026021705401696000_4.1.e003468.11","unstructured":"Agogo Presbyterian Hospital . DHIMS maternal deaths extract: agogo presbyterian hospital records, 2019\u20132022. Agogo Presbyterian Hospital; 2022."},{"key":"2026021705401696000_4.1.e003468.12","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2665-0"},{"key":"2026021705401696000_4.1.e003468.13","unstructured":"Mtshali NG , Ukoha W . Current state of preconception care in Sub-Saharan Africa: A systematic scoping review. Afr J 2022;1\u201311."},{"key":"2026021705401696000_4.1.e003468.14","doi-asserted-by":"crossref","first-page":"10","DOI":"10.47672\/ajhmn.848","article-title":"Delivery of Preconception Counselling Services: The Snags of Health Care Service Providers","volume":"6","author":"Hikimatu","year":"2021","journal-title":"AJHMN"},{"key":"2026021705401696000_4.1.e003468.15","unstructured":"Ministry of Health, Ghana Health Service . Ghana Health Sector Medium-Term Development Plan 2022\u20132025. Accra, Ghana: Ministry of Health (Ghana), 2022."},{"key":"2026021705401696000_4.1.e003468.16","unstructured":"Agogo Presbyterian Hospital . About us. 2025. Available: https:\/\/agogopresbyhospital.org\/about-us\/"},{"key":"2026021705401696000_4.1.e003468.17","unstructured":"Presbyterian Church of Ghana . Agogo presbyterian hospital upgraded to regional hospital status. 2022. 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Midwifery 2022;107. doi:10.1016\/j.midw.2022.103274","DOI":"10.1016\/j.midw.2022.103274"},{"key":"2026021705401696000_4.1.e003468.21","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1002\/pd.5914","article-title":"Health practitioners\u2019 perceptions of the barriers and enablers to the implementation of reproductive genetic carrier screening: A systematic review","volume":"41","author":"Best","year":"2021","journal-title":"Prenat Diagn"},{"key":"2026021705401696000_4.1.e003468.22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/dme.15014","article-title":"Attendance at pre-pregnancy care clinics for women with type 1 diabetes: A scoping review","volume":"40","author":"Ferry","year":"2023","journal-title":"Diabet Med"},{"key":"2026021705401696000_4.1.e003468.23","unstructured":"Daly M . Addressing the key uncertainties of improving preconception health in the UK A dissertation submitted to the University of Bristol in accordance with the requirements. 2023."},{"key":"2026021705401696000_4.1.e003468.24","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp21X715733"},{"key":"2026021705401696000_4.1.e003468.25","doi-asserted-by":"crossref","first-page":"100351","DOI":"10.1016\/j.ijans.2021.100351","article-title":"The perspective of healthcare practitioners on preconception care at primary healthcare in Jakarta: A qualitative study","volume":"15","author":"Kurniawati","year":"2021","journal-title":"International Journal of Africa Nursing Sciences"},{"key":"2026021705401696000_4.1.e003468.26","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.3390\/healthcare10061056","article-title":"\u201cWe Are Having a Huge Problem with Compliance\u201d: Exploring Preconception Care Utilization in South Africa","volume":"10","author":"Ukoha","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"2026021705401696000_4.1.e003468.27","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.888708","article-title":"Perceptions of and challenges faced by primary healthcare workers about preconception services in rural India: A qualitative study using focus group discussion","volume":"10","author":"Chutke","year":"2022","journal-title":"Front Public Health"},{"key":"2026021705401696000_4.1.e003468.28","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare9111552","article-title":"Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study","volume":"9","author":"Ukoha","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"2026021705401696000_4.1.e003468.29","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/fampra\/cmab065","article-title":"Understanding primary health care physicians\u2019 perspective and approach to pre-conception care in Saudi Arabia","volume":"39","author":"Alamer","year":"2022","journal-title":"Fam Pract"},{"key":"2026021705401696000_4.1.e003468.30","doi-asserted-by":"crossref","first-page":"293","DOI":"10.32598\/jpr.9.4.905.2","article-title":"Perceived Barriers and Facilitators of Adolescent Friendly Reproductive Health Services in the World: A Qualitative Systematic Review Protocol","volume":"9","author":"Banaei","year":"2021","journal-title":"J Pediatr Rev"},{"key":"2026021705401696000_4.1.e003468.31","doi-asserted-by":"crossref","DOI":"10.1016\/j.dialog.2022.100040","article-title":"Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers","volume":"1","author":"Smith","year":"2022","journal-title":"Dialogues Health"},{"key":"2026021705401696000_4.1.e003468.32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/phcfm.v11i1.1916","article-title":"Primary health care nursing students\u2019 knowledge of and attitude towards the provision of preconception care in KwaZulu-Natal","volume":"11","author":"Ukoha","year":"2019","journal-title":"Afr j prim health care fam med"},{"key":"2026021705401696000_4.1.e003468.33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s12978-022-01454-2","article-title":"\u201cIs the health system ready?\u201d A qualitative exploration of stakeholders\u2019 opinions about the feasibility of preconception care services in the Nigerian health system","volume":"19","author":"Ojifinni","year":"2022","journal-title":"Reprod Health"},{"key":"2026021705401696000_4.1.e003468.34","unstructured":"Nyanchama B . Implementing Preconception Care in Zambia: Addressing Gaps and Leveraging Opportunities Brenda Nyanchama Onguti. 2023."},{"key":"2026021705401696000_4.1.e003468.35","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s10995-021-03305-1","article-title":"Health Care Providers Perceptions About Preconception Care in Ibadan, Southwest Nigeria: A Qualitative Study","volume":"26","author":"Ojifinni","year":"2022","journal-title":"Matern Child Health J"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T13:40:33Z","timestamp":1771335633000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,17]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjph-2025-003468"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003468","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}