Preconception care knowledge, attitudes, and practices among women attending a private women's hospital in Riyadh, Saudi Arabia: a cross-sectional study

Abstract

Preconception care (PCC) is an important preventive strategy for improving maternal and fetal outcomes by addressing modifiable health risks before conception, yet its uptake remains limited in Saudi Arabia and evidence from private healthcare settings is scarce. This study assessed PCC knowledge, attitudes, and practices among women attending a private women's hospital in Riyadh, identified perceived barriers to PCC utilization, and examined factors associated with these outcomes. A cross-sectional questionnaire study incorporating one open-ended question on barriers was conducted among 203 women aged 18–45 years attending outpatient clinics at a private women's hospital in Riyadh during March 2025. Participants were recruited by convenience sampling and completed a structured Arabic questionnaire adapted from a previously published instrument, expert-reviewed and pilot-tested, with acceptable internal consistency for the attitude and practice scales (Cronbach's alpha 0.727 and 0.862). Scores were dichotomized using a modified Bloom's cut-off, with sensitivity analyses at alternative thresholds. Associations were assessed using chi-square or Fisher's exact tests and Firth penalized logistic regression. Knowledge was high, with participants answering 92.3% of items correctly, and attitudes were predominantly favorable, with 89.2% scoring at or above the neutral midpoint. Practice was low, and 56.2% reported no preconception preparation. Knowledge and practice were not associated ( r = −0.001), and no sociodemographic characteristic was associated with either preconception preparation or attitude. The most frequently reported barriers were lack of awareness of available services (46%), financial constraints (25%), difficulty of access (25%), and unplanned pregnancy (14%). Favorable knowledge and attitudes were not accompanied by preventive action, and the barriers women described were predominantly structural rather than cognitive. These findings identify potentially important targets in this setting, particularly the visibility, affordability, and routine offering of preconception services. As the study was conducted in a single private facility using convenience sampling, multicenter and population-based studies are needed to establish wider applicability.