"Get the ball rolling": Results of a qualitative study to explore the current situation and develop elements essential for optimal preconception care in Indonesian primary care

Background: Despite its essential benefits to prevent pregnancy-related morbidity and mortality, comprehensive preconception counselling care in Indonesia is yet to exist. Before further developing the appropriate care for women, this study aimed to understand the current situation and propose essential elements necessary for further developing the optimal preconception care in Indonesian primary care. Study design: Focus group (FG) discussions guided by grounded theory approach were conducted with Indonesian general practitioners, nurses, midwives, and obstetricians from Bantul Regency, Yogyakarta Province, between July and September 2023. The data were thematically analysed. Results: Seven FGs involving 59 participants were conducted. Three themes emerged: "the Way", "the Dream Ball' and "the Bumps". The Way depicts the providers' conscious misconception regarding preconception care about being simple rather than comprehensive health examination and their intention to support women's readiness to conceive. The Way also covers the providers' perceived limited training in primary care to perform preconception care. The Dream Ball describes providers' ideas of an optimal preconception care and their future expectations for the service in practice. The Bumps are the potential challenges of preconception care in primary care practice. Framework elements are developed to visualise expected preconception service in Indonesian primary care from patient, clinical and policy levels. Discussion: Our findings add to the literature on Indonesia's healthcare providers' perceptions of preconception care and its potential implementation in practice. The proposed framework will guide providers, researchers, and policymakers in developing an appropriate preconception care model for Indonesian primary care. Conclusion: Health providers' perceptions of and proposed critical elements necessary for optimal preconception care in Indonesian primary care have been explored. Further study is desired to develop the model and strategic services of preconception care in Indonesian primary care practice.