Abstract / Summary
Abstract Background Paternal health and behaviours prior to conception influence male fertility, pregnancy outcomes, and offspring health. Despite evidence of men's influence on reproductive outcomes and their willingness to engage, no dedicated policy framework exists in Scotland to support their preconception health. This study examined men's knowledge, behaviours, and perceived roles in preconception health in Scotland, with the aim of generating evidence to inform policy reform and the development of inclusive, male-centred services. Methods A mixed-methods study was conducted, integrating qualitative data from male focus groups (n = 26) with quantitative data from a national online survey of men (n = 67). Survey measures assessed preconception behaviours, knowledge, and attitudes, while focus groups explored men’s experiences, perceptions of fertility and pregnancy preparation, and engagement with health services. Quantitative data were analysed descriptively, and qualitative data were analysed using reflexive thematic analysis. Results Men were engaged in preconception health but in varied and often reactive ways. Prior to conception, 59.7% reported regular physical activity and 41.8% reported a healthy diet, while 28.4% reported at least one unplanned pregnancy. Knowledge of preconception health was imbalanced, with greater awareness of pregnancy prevention than preparation and limited understanding of male fertility, key nutrients, and modifiable risk factors affecting reproductive outcomes. Behavioural changes, including reductions in alcohol consumption, frequently occurred only after pregnancy confirmation. Qualitative findings revealed that preconception health was commonly framed as a woman’s responsibility, with men positioning their role primarily in providing emotional, practical, and financial support. Despite this, most participants expressed willingness to adopt healthier behaviours and reported being comfortable discussing pregnancy intentions with healthcare professionals. Conclusions Men appear willing to engage in preconception health, yet current policy and service structures provide limited support for their involvement. Addressing this requires revision of Scottish preconception frameworks to include explicit provisions for men, integration of paternal health into routine primary care, and investment in male-targeted public health messaging. Treating men's preconception health as a public health priority, rather than an afterthought, presents a significant and currently missed opportunity to improve reproductive outcomes across the population. Clinical trial number: not applicable