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Intention to make preconception lifestyle changes among married men in an urban primary care clinic and its association with self-efficacy
1Trong Health Clinic, Ministry of Health, 34800 Taiping, Perak, Malaysia
2Department of Family Medicine, University of Putra Malaysia, 43400 Serdang, Selangor, Malaysia
*Corresponding Author(s):irmiismail@upm.edu.my (Irmi Zarina Ismail)
| History | Submitted: 08 June 2024 | Accepted: 23 August 2024 | Published: 30 November 2024 |
| Copyright: | ©2024 The Author(s). Published by MRE Press. |
Men’s lifestyle is a relevant factor influencing pregnancy outcomes; however, their participation in preconception health is often overlooked. Therefore, the objective of this study is to determine the prevalence of men’s intention to implement preconception lifestyle changes and the factors that influence it. This single-centre, cross-sectional study used systematic random sampling to invite 352 married men with pregnancy plans who attended the clinic from February until April 2023. The respondent’s intention, self-efficacy, and social influences regarding preconception lifestyle changes were assessed through a validated self-administered questionnaire. A median score of 5 (minimum = 0, maximum = 10) was used as the cutoff to categorise intention as either low or high as the outcome variable. A total of 352 respondents were invited, and 284 (79.6%) men completed the questionnaire. Overall, 56.7% (n = 161) of married men indicated high intentions to make preconception lifestyle changes. The positive predictors of the intention to make preconception lifestyle changes among married men were having attended preconception counselling (adjusted odds ratio (aOR) = 13.33, 95% confidence interval (CI) = 2.82–63.02, p = 0.001), having higher self-efficacy (aOR = 1.76, 95% CI = 1.39–2.24, p < 0.001), influence of social norms (aOR = 1.39, 95% CI = 1.03–1.87, p = 0.030), and social influence from recognising the importance of other’s opinions (aOR = 1.23, 95% CI = 1.12–1.35, p < 0.001). More than half of the respondents have the intention to make preconception lifestyle changes. Preconception lifestyle interventions should focus on fostering self-efficacy among men with substance dependence to facilitate behavioural changes by leveraging their social influences.
Cite this article
Siti Solehah Ahmad Mazlan, Irmi Zarina Ismail, Navin Kumar Devaraj. Intention to make preconception lifestyle changes among married men in an urban primary care clinic and its association with self-efficacy.Journal of Men's Health,2024,20(11):112-119 DOI:10.22514/jomh.2024.191
1. Introduction
In Malaysia, preconception healthcare provides couples and single men and women within the reproductive age range with an opportunity to optimise their chances of achieving a safe and successful pregnancy [1]. The Centers for Disease Control and Prevention defines preconception health as the health of women and men during their reproductive years, within which they are able to conceive a child [2]. Preconception health among men is relevant to couples’ reproductive lives. Promoting the active involvement of men in preconception preparation is potentially beneficial, as men who actively plan for pregnancy are more inclined to stop unhealthy lifestyles and adopt healthier eating habits in preparation for pregnancy than other men [3, 4]. Promoting men’s preconception health presents an opportunity to improve their well-being by providing them access to primary health care [5]. Preconception health in men can enhance sperm quality and count, which can be adversely affected by many factors such as alcohol consumption, drugs, poor diet, caffeine intake, radiation, chemotherapy, and testicular hyperthermia [5, 6]. Men who typically consumed more than five units of alcohol per week exhibited a decline in various aspects of sperm quality [7]. Emphasising the reduction of alcohol consumption during preconception care counselling is essential to prevent poor sperm quality.
Men play significant roles in ensuring their spouse enters a healthy reproductive life and family relationship. Preconception care for men can improve women’s health by preventing sexually transmitted diseases through early screening, treatment and the use of dual protection during appropriate situations [4, 5]. Men who embrace good preconception health would acknowledge the role of family planning and that successful family planning practice is essential to healthy preconception health [3, 8]. Women, especially among Asian couples, still refer to their husbands for direct or indirect approval for family planning. In Malaysia, women still identify the lack of their husbands’ consent as a barrier to accepting contraception, highlighting their reluctance to do so independently [9]. In addition, preconception health in men can provide an opportunity to address their behaviours that might result in domestic violence and multiple sexual partners [4, 5]. Prioritising preconception health has encouraged men to enhance their parental ability by recognising their crucial roles as parents during pregnancy and after childbirth, ultimately contributing to establishing healthy families [5]. In summary, men’s involvement in preconception health and care offers an opportunity to support women’s positive health and healthcare-seeking practices [10, 11].
The importance of involving men in preconception health is indisputable. Nonetheless, men’s participation in preconception health is not easily assessed. Men have demonstrated poor health-seeking behaviour, especially in matters related to reproductive health [10, 12]. Shawe et al. [3] reported that only 19.1% of men had visited a general practitioner or healthcare professional to consult on pregnancy. Lim et al. [13] reported that men were less inclined than women to perceive the importance of seeking healthcare for preventive health concerns. However, most men (83%) did not change their preconception lifestyle to improve health and fertility [14]. Therefore, while men’s participation in embracing good preconception health is questionable, it should still be emphasised. Despite men exhibiting an awareness regarding a healthy lifestyle, they do not echo similar attitudes in preparing for pregnancy [15, 16]. Nonetheless, men want to be included in preconception health. Since the participation of men in preconception health care is not compulsory in Malaysia [1], information on how men in Malaysia perceive preconception health care and preconception health is limited. Therefore, this study aimed to investigate the intention of men towards making lifestyle changes in preparation for pregnancy and the factors influencing it.
2. Materials and methods
2.1 Study design and setting
This cross-sectional study involved 284 married men at a public health clinic in the centre of Kuala Lumpur, the largest city in Malaysia, covering an area of 243 km2. The patients visiting this public health clinic are of various ethnicities, including Malay, Chinese and Indian, closely resembling the Malaysian population. Married men aged 18–45 years old with wives of reproductive age (18–49 years), not on permanent contraception (bilateral tubal ligation and hysterectomy), and planning to have (more) children who attended this public health clinic between February and April 2023 were invited to participate in this study. Foreigners and those who could not understand Bahasa Melayu or English were excluded. A sample size was determined using a single sample proportion with Z = 1.96 at a 95% confidence interval and an acceptable margin of error of 0.05. Based on the 19% prevalence of men who attended preconception counselling before pregnancy [3] and a non-response rate of 35%, the minimum estimated sample size was 236.
2.2 Data collection
The participants were identified from the main list of daily registrations and selected using systematic random sampling with an interval number of two, which was chosen based on the number of men with spouses of reproductive age who attended the public health clinic per month and the expected number of days for data collection. The first respondent was selected from the second man who registered on the first day of the data collection. Then, every other man was invited to participate in the study. Eligible participants were approached, and the study’s purpose and nature were explained before they were asked to provide verbal and written informed consent to participate in this study. The self-administered questionnaire was distributed via a quick response (QR) code. The participants had to answer all questions before the questionnaire could be submitted. The principal investigator was available for clarification and guidance when necessary.
2.3 The questionnaire
A validated questionnaire on the intention to make preconception lifestyle changes by Goossens et al. [17] was adapted and adopted. The questionnaire underwent forward and backward translation from English into Bahasa Melayu by two family medicine specialists interested in men’s health and two language experts in Bahasa Melayu and English [18]. It comprised 70 items grouped into six sections (A–F). Section A collected information on sociodemographic and clinical characteristics. Sections B and C assessed the intention and self-efficacy in making preconception lifestyle changes, each including six general healthy behaviours and four specific preconception behaviours. Each section comprised ten items; each Yes answer was given 1 point, and each No or Not Relevant answer was given 0 points. The scores for both sections ranged from 0 to 10 points; higher scores represent greater intention and self-efficacy in making preconception lifestyle changes.
Section D assessed attitudes toward pregnancy preparation and comprised four items that examined beliefs about the positive and negative consequences of preconception preparation, assessing views on a healthy lifestyle during the preconception period by both partners on pregnancy outcome. Responses were scored on a five-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree. All responses were arranged positively except for question three, which was reverse scored.
Section E consisted of 12 questions on the social influence to perform the preconception lifestyle changes, which were placed into five subgroups: (ⅰ) social influence of close social environment (e.g., own expectation on performing a healthy lifestyle; supporting partner to improve their health before pregnancy; expectation from partner, family, friends, and colleagues to live a healthy lifestyle before pregnancy), (ⅱ) social norms (e.g., other men also live healthy/healthier before pregnancy), (ⅲ) social influence of healthcare provider (HCP; e.g., recommendations from HCPs to make preconception lifestyle changes), (ⅳ) social influence of media (e.g., pressured by media to make preconception lifestyle changes), and (ⅴ) recognising the importance of other’s opinion regarding preconception health behaviours (e.g., opinions of wives, family members, friends, colleagues and HCPs). Responses were scored on a five-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree.
Section F assessed knowledge on preconception health. It comprised 17 items assessing knowledge on (ⅰ) tobacco, alcohol and substance abuse; (ⅱ) nutrition; (ⅲ) family planning; (ⅳ) medications; and (ⅴ) infection disease and immunisation.
The questionnaire underwent validation by two family medicine specialists and one obstetrics and gynaecology specialist to ensure its content validity. The content experts suggested using the five-point Likert scale for the attitude and social influences section instead of the six-point Likert scale from the original questionnaire to improve clarity and minimise selection bias. Face validity was assessed among 33 married men from Klinik Kesihatan Setapak, Kuala Lumpur. A Cronbach’s alpha of at least 0.70 indicates adequate internal consistency [19]. In this study, Cronbach’s alpha was 0.74 for intention to make preconception lifestyle changes, 0.78 for self-efficacy in making preconception lifestyle changes, 0.76 for attitude towards pregnancy preparation, 0.75 for social influence to perform the preconception lifestyle changes, and 0.87 for knowledge on preconception health.
2.4 Data analysis
The data were analysed using the Statistical Package for the Social Sciences software (version 27.0, IBM Corp., Armonk, New York, NY, USA). Categorical variables are reported as frequencies and percentages, and continuous variables are reported as the median and interquartile range (IQR). Bivariate analyses were performed to assess the association between the dependent variable (intention to make preconception lifestyle changes) and categorical independent variables (race, educational level, employment status, monthly household income, medical illness status, body mass index (BMI), practising family planning method, and have attended preconception counselling at least once). The outcome variable, indicating the intention to make preconception lifestyle changes, was categorised into low- and high-intention groups based on the median score; those with scores above the median were classified as having high intention. The association was tested with a chi-square test. A p-value of < 0.05 was considered statistically significant.
Simple logistic regression analysis was conducted to test the dependent variable’s associations with continuous independent variables (age, number of children, the total score of self-efficacies in making preconception lifestyle changes, the total score of attitudes towards pregnancy preparation, the total score of social influence in making preconception lifestyle changes, and the total score of knowledge on preconception lifestyle changes) and categorical independent variables (smoking and alcohol status, recreational drug and supplements use and BMI). For self-efficacy, attitudes, and social influences, a higher score reflects a higher degree of that attribute. Then, we used multivariate logistic regression with backward selection to identify the factors (p-value of < 0.25) [17] associated with the intention to make preconception lifestyle changes. A p-value of < 0.05 was considered statistically significant.
3. Results
3.1 Demographic characteristics of the respondents
This study invited 357 men attending Klinik Kesihatan Kuala Lumpur to participate, of which 289 agreed and 68 refused. Five of the 289 who agreed to participate did not complete the questionnaire, leaving 284 complete responses. Therefore, the response rate was 79.6%. The respondents’ sociodemographic characteristics and the couple’s reproductive practices are presented in Tables 1 and 2, respectively.
| Variables | n (%) or median (IQR) | |
| Age (yr) | 32 (24) | |
| Number of children | ||
| None | 64 (22.5) | |
| At least one | 220 (77.5) | |
| Race | ||
| Malay | 246 (86.6) | |
| Non-Malay | 38 (13.4) | |
| Education | ||
| No formal primary or secondary education | 72 (25.4) | |
| College/diploma or higher | 212 (74.6) | |
| Income | ||
| <4850 RM | 219 (77.1) | |
| ≥4850 RM | 65 (22.9) | |
| Smoking | ||
| Yes | 97 (34.2) | |
| No | 187 (65.8) | |
| Alcohol consumption | ||
| Yes | 20 (7.0) | |
| Social drinker | 7 (35.0) | |
| Regular drinker (1–4 times/week) | 13 (65.0) | |
| No | 264 (93.0) | |
| Recreational drugs | ||
| Yes | 5 (1.8) | |
| No | 279 (98.2) | |
| Taking supplements | ||
| Yes | 104 (36.3) | |
| No | 180 (63.4) | |
| Medical illness | ||
| Yes | 49 (17.3) | |
| No | 235 (82.7) | |
| BMI [20] | ||
| Underweight (<18.5) | 4 (1.4) | |
| Normal weight (18.5–22.9) | 50 (15.6) | |
| Overweight (23.0–27.4) | 111 (39.1) | |
| Obese (≥27.5) | 119 (41.9) | |
| IQR: interquartile range; BMI: body mass index. |
| Variables | n (%) | |
| Family planning practice | ||
| Yes | 158 (55.6) | |
| Barrier method/condom | 69 (24.3) | |
| Oral contraceptive pills | 22 (7.7) | |
| Intramuscular hormone injection | 17 (6.0) | |
| Intra-uterine contraceptive device | 9 (3.2) | |
| Implanon | 11 (3.9) | |
| No | 126 (44.4) | |
| Have attended preconception care | ||
| Yes | 25 (8.8) | |
| No | 259 (91.2) |
3.2 Prevalence of the intention to make preconception lifestyle changes
The median score of intention to make preconception lifestyle changes among respondents was 5 (IQR = 2). The respondents’ answers to the questions related to the intention to make preconception lifestyle changes are summarised in Table 3. Overall, 56.7% (n = 161) of married men indicated high intentions to make preconception lifestyle changes. Most married men indicated the intention to adopt a healthy lifestyle before their partner becomes pregnant (90.1%, n = 256) and support their partner to perform preconception lifestyle changes before pregnancy (95.8%, n = 272). They indicated an intention to search for information or advice on how to become pregnant healthily (77.5%, n = 220). Of the 97 respondents who smoked, 43 (44.3%) indicated they intended to stop smoking before their partners became pregnant. Of the 20 respondents who consumed alcohol, 7 (35%) indicated an intention to reduce their drinking habits before their partners became pregnant. In addition, 64.4% (n = 67/104) of the respondents indicated an intention to consult HCPs about their medications or herb intake before their partners became pregnant.
| Intention | Yes (%) | No (%) |
| Adopt a healthy lifestyle before your partner becomes pregnant | 256 (90.1) | 28 (9.9) |
| Search for information or advice on how to become pregnant in a healthy way before your partner becomes pregnant | 220 (77.5) | 64 (22.5) |
| Eat healthily before your partner becomes pregnant | 213 (75.0) | 71 (25.0) |
| Avoid testicular hyperthermia (exposure to abnormally high temperatures to the testicles (e.g., prolonged sitting, hot baths, saunas, tight underwear and putting a laptop on your thighs)) before your partner becomes pregnant | 162 (57.0) | 122 (43.0) |
| Attend a preconception consult with a healthcare provider before your partner becomes pregnant | 100 (35.2) | 184 (64.8) |
| Support your partner to perform a preconception lifestyle before they become pregnant | 272 (95.8) | 12 (4.2) |
| Reduce drinking alcohol before your partner becomes pregnant (n = 20) | 7 (35) | 13 (65) |
| Stop smoking before your partner becomes pregnant (n = 97) | 43 (44.3) | 54 (55.7) |
| Reduce weight before your partner becomes pregnant (BMI <23 kg/m2, n = 230) | 140 (60.9) | 90 (39.1) |
| Discuss medications or herb use with a healthcare provider before your partner becomes pregnant (n = 104) | 67 (64.4) | 37 (35.6) |
| BMI: body mass index. |
3.3 Respondents’ self-efficacy in making preconception lifestyle changes
The median score for self-efficacy in making preconception lifestyle changes among respondents was 6 (IQR = 1). The respondents’ answers to questions related to self-efficacy in making preconception lifestyle changes are summarised in Table 4. Most had high self-efficacy in adopting healthy lifestyles (98.2%, n = 279), searching for information or advice on how to become pregnant healthily (91.2%, n = 259), eating healthily (89.1%, n = 253), avoiding testicular hyperthermia (83.5%, n = 237), and supporting their partner to perform preconception lifestyle changes (96.1%, n = 273). Of the 284 respondents, 70.4% (n = 200) indicated they could attend preconception consultations with a HCP.
| Self-efficacy | Yes (%) | No (%) |
| Able to adopt a healthy lifestyle | 279 (98.2) | 5 (1.8) |
| Able to search for information or advice on how to become pregnant in a healthy way | 259 (91.2) | 25 (8.8) |
| Able to eat healthily | 253 (89.1) | 31 (10.9) |
| Able to avoid testicular hyperthermia (exposure to abnormally high temperatures to the testicles (e.g., prolonged sitting, hot baths, saunas, tight underwear, and putting a laptop on your thighs)) | 237 (83.5) | 47 (16.5) |
| Able to attend a preconception consult with a healthcare provider | 200 (70.4) | 84 (29.6) |
| Able to support your partner to perform a preconception lifestyle | 273 (96.1) | 11 (3.9) |
| Able to reduce drinking alcohol (n = 20) | 6 (30) | 14 (70) |
| Able to stop smoking (n = 97) | 48 (49.5) | 49 (50.5) |
| Able to reduce weight (n = 230) | 140 (60.9) | 90 (39.1) |
| Able to discuss medications or herbs use with a healthcare provider (n = 104) | 78 (75.0) | 26 (25.0) |
3.4 Social influences on respondents’ intention to make preconception lifestyle changes
The median score (IQR) for each social influence were as follows: 17 (IQR = 4) for social influence of close social environment, 4 (IQR = 1) for social norms, 5 (IQR = 1) for social influence of HCPs, 2 (IQR = 1) for social influence of media, and 21 (IQR = 6) for recognising of importance of others’ opinions. Most respondents regarded the social influences of HCPs (96.4%, n = 274) and their close social environment (partners, family members, friends and colleagues; 89.8%, n = 255), and 94.7% (n = 269) agreed that their partner, friends, family and colleagues would recommend and support them to make preconception lifestyle changes. The opinion of their wives about preparing for pregnancy was assessed as the most important (95.8%, n = 272), followed by healthcare professionals (96.5%, n = 274).
3.5 Predictors of the intention to make preconception lifestyle changes
The positive predictors of the intention to make preconception lifestyle changes among married men were having attended preconception counselling (adjusted odds ratio (aOR) = 13.33, 95% confidence interval (CI) = 2.82–63.02, p = 0.001), having higher self-efficacy (aOR = 1.76, 95% CI = 1.39–2.24, p < 0.001), influence of social norms (aOR = 1.39, 95% CI = 1.03–1.87, p = 0.030), and social influence from recognising the importance of other’s opinions (aOR = 1.23, 95% CI = 1.12–1.35, p < 0.001). The factors associated with the intention to make preconception lifestyle changes in univariate simple and multivariate logistic regression analyses are listed in Tables 5 and 6, respectively.
| Variable | Intention, median (IQR) | Crude OR | 95% CI | p-value | |||
| Low | High | LL | UL | ||||
| Agea | 32.00 (8.00) | 32.00 (7.00) | 0.98 | 0.94 | 1.03 | 0.500 | |
| Number of childrenb | 1.00 (1.00) | 1.00 (1.00) | 1.00 | 0.82 | 1.21 | 0.990 | |
| Self-efficacy scorec | 6.00 (2.00) | 7.00 (2.00) | 1.84 | 1.49 | 2.27 | <0.001** | |
| Attitude scored | 17.00 (4.00) | 18.00 (3.00) | 1.09 | 1.00 | 1.19 | 0.050* | |
| Smokere | 0.64 | 0.38 | 1.05 | 0.080* | |||
| Alcohol drinkere | 1.16 | 0.46 | 2.93 | 0.760 | |||
| BMI ≥23e | 1.40 | 0.77 | 2.53 | 0.270 | |||
| Social influence | |||||||
| Close social environmentf | 16.00 (2.00) | 18.00 (4.00) | 1.20 | 1.09 | 1.33 | <0.001** | |
| Peer supportg | 4.00 (2.00) | 4.00 (1.00) | 1.82 | 1.42 | 2.34 | <0.001** | |
| HCPg | 4.00 (1.00) | 5.00 (1.00) | 1.32 | 0.94 | 1.85 | 0.110* | |
| Social influence of mediag | 2.00 (1.00) | 2.00 (2.00) | 1.19 | 0.96 | 1.47 | 0.110* | |
| Importance of other’s opinionsh | 18.00 (5.00) | 22.00 (3.00) | 1.32 | 1.22 | 1.44 | <0.001** | |
aage range: 25–45 years; brange of number of children: 0–6; crange of score: 0–10; drange of score: 4–25; ecategorical variable; frange of score: 4–20; grange of score; 1–5; hrange of score: 5–25; *p < 0.25; **statistically significant; OR: odds ratio; LL: lower limit; UL: upper limit; IQR: interquartile range; CI: confidence interval; BMI: body mass index; HCP: healthcare provider. |
| Variables | β | SE | Adjusted OR | 95% CI | p-value | ||
| LL | UL | ||||||
| Preconception counselling | |||||||
| Yes | 2.59 | 0.79 | 13.33 | 2.82 | 63.02 | 0.001* | |
| No | 1 | ||||||
| Self-efficacy scorea | 0.57 | 0.12 | 1.76 | 1.39 | 2.24 | <0.001* | |
| Social influence: peer supportb | 0.33 | 0.15 | 1.39 | 1.03 | 1.87 | 0.030* | |
| Social influence: importance of other’s opinionsc | 0.21 | 0.05 | 1.23 | 1.12 | 1.35 | <0.001* | |
arange of score: 0–10; brange of score: 0–5; crange of score: 5–25; *statistically significant; SE: standard error; OR: odds ratio; LL: lower limit; UL: upper limit: CI: confidence interval. The model has an adjusted R2 of 32.9 and a p-value of < 0.001. There was no multicollinearity as the variance inflation factor was <10. Variables were selected in the multiple linear regressions using the backward method to remove highly correlated variables. |
4. Discussion
Men in Kuala Lumpur (the respondents) demonstrated less intention to make preconception lifestyle changes than their counterparts in Western countries [17]. Currently, no published evidence describes similar issues among men in Malaysia or other Asian countries. Nonetheless, the men in our study scored better in some aspects of the intention. Over 90% of our respondents showed a greater intention to adopt a healthy lifestyle and support their spouses through preconception care, compared to 85% in Goossens et al. [17]. The greater intention to adopt a healthy lifestyle could be because our respondents planned to have (more) children, compared to only 37% of participants planning pregnancy in less than one year in Goossens et al. [17]. Therefore, following a healthy preconception lifestyle is more relevant for these men. Indeed, pregnancy planning is associated with increased awareness of the need for preconception behavioural changes [21], which is further emphasised by Maas et al. [15], who showed that prospective fathers in England had a strong inclination to receive preconception health information. Furthermore, Shawe et al. [3] found that married men in England who received or sought information regarding preconception health displayed positive preconception health behaviours such as smoking cessation, reduced alcohol consumption, and healthy eating. These men discontinued these behaviours before conception because they were informed that their preconception behaviour affected their partners’ health behaviour [3, 22, 23]. Dollar et al. [24] showed that both men and women were unlikely to stop smoking or reduce alcohol consumption if their partners still engaged in similar behaviours. Therefore, couples who planned their pregnancy were more likely to make behavioural changes to these substance dependences [3].
Pregnancy planning positively influences both partners’ intention to change their preconception lifestyle, but the intention to adopt good behaviour is not without challenges. Our study demonstrated that, while married men showed a positive inclination to adopt a healthy lifestyle, fewer than 50% admitted they would not stop smoking or quit alcohol during the preconception period. Similarly, Högberg et al. [22] (in Sweden) and Goossens et al. [17] (in Belgium) also reported that only 45% and 58% of all partners decreased their substance dependency (alcohol consumption and smoking) once their partner became pregnant, respectively. These findings are unsurprising because smoking and chronic alcohol use are addictive over time, and overcoming addiction requires self-efficacy and dedicated medical attention. In Malaysia, the success of programs targeting substance dependence is known to be suboptimal. Fewer than half of Malaysian smokers (48.9%) have attempted to quit smoking, and less than 10% of current smokers have visited an HCP in the past 12 months [25], with only 30% of smokers managing to quit smoking after attending a quit-smoking centre [26]. One study showed that more males consumed alcohol (15.8%) than females (6.2%) [25]. While the proportion of drinkers with alcohol dependence was very low (0.9%), up to 17% consume alcohol in amounts that could lead to adverse health effects [25].
Intentions to adopt good behaviour do not necessarily translate into action, especially when self-efficacy is involved. Self-efficacy plays a significant role in realising behavioural intentions. However, it is also apparent that under the influence of smoking and alcohol, some men do not have sufficient confidence or self-efficacy to overcome these unhealthy behaviours, even for the sake of pregnancy. Men with high self-efficacy expressed greater intent to reduce alcohol consumption and quit smoking [17, 27]. They also experienced longer periods of alcohol abstinence, longer time-to-relapse, and longer time-to-first drink after alcohol treatment [27]. However, even though respondents in other studies reported that showing solidarity to support their partner was their most common motive to reduce drinking, fewer than 50% of our respondents who were actively smoking and consuming alcohol believed that they were capable of stopping these addictive behaviours. In conclusion, our study is consistent with social psychology frameworks and emphasises similar findings from other studies; higher self-efficacy predicts actual behaviour [28].
One strategy to promote self-efficacy among these men is peer support. Good peer support can empower men to change their unhealthy habits, and our study found it to positively predict intention for lifestyle behaviour change. Lowenstein et al. [29] found that among 4182 men in Thailand, 34% of men who successfully abstained from smoking had at least one friend within their immediate social network, and their 12-month abstinence rate was higher (51.5%) than those without a friend who had quit smoking. A randomised controlled trial emphasised the effectiveness of peer support intervention programs; participants in the peer-based brief interventions program exhibited a significant decrease in the mean number of binge drinking episodes from an average of 5.2 per month to only 2.6 per month at the 12-month follow-up [30]. Men’s self-efficacy in making changes is significantly influenced by peer support, whereas women’s self-efficacy is not strongly affected by the presence of supportive peers [31, 32]. Therefore, incorporating peer support mechanisms into substance dependence intervention could enhance the effectiveness of such programs.
Unfortunately, health-seeking behaviours are lower among men than women in Malaysia [13] partly because they are not the target population of reproductive-based preconception care services [1]. Indeed, it is paramount for HCPs to adopt more assertive and persuasive approaches to engage women’s partners in preconception care by promoting a healthy lifestyle and encouraging medical health screenings, including offering them available substance-dependence services if needed [2, 5]. When HCPs promote quitting smoking and reducing alcohol use, it is crucial to acknowledge that overcoming substance dependence is not an easy journey. These men must focus on personal values and be empowered to adopt a healthier lifestyle.
5. Conclusions
More than half of married men intending to conceive at a public health clinic in Kuala Lumpur intend to implement preconception lifestyle changes. Despite their intentions for preconception lifestyle changes, they demonstrated low intention towards changing substance dependence behaviours preconception. Factors influencing the intention were having attended preconception counselling, having higher self-efficacy, and social influence. Therefore, preconception lifestyle interventions should focus on fostering self-efficacy among men with substance dependence to facilitate behavioural changes using support from their social environment.
Availability of data and materials
The data presented in this study are available on reasonable request from the corresponding author.
Author contributions
IZI, NKD and SSAM—designed the research study, wrote the manuscript. SSAM—performed the research. IZI and SSAM—analyzed the data. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
This study was approved by the ethics approval from the Medical Research Ethics Committee (MREC), Ministry of Health, Malaysia on 28 October 2022 (NMRR ID-22-01502-BXV (IIR)). All the respondents signed an informed consent form prior to answering the questionnaire.
Acknowledgment
The authors would like to express their gratitudes to all respondents of this study, the Ministry of Health for their support and University of Putra Malaysia Research Management Centre for the funding. The authors would also like to thank the Director General of Health Malaysia for the permission to publish this paper.
Funding
This research received funding from the University of Putra Malaysia (Geran Putra-IPS 9726500). The funder had no role in the study design, data collection and analysis, decision to publish and preparation of the manuscript.
Conflict of interest
The authors declare no conflict of interest.
