Background:
The Improving Pregnancy Outcomes Program (IPOP) targets low-income, African-Americans in high-risk zip codes within the cities of Oakland, Emeryville and San Leandro, California. IPOP's focus is to reduce infant mortality and improve pregnancy outcomes by providing case management/care coordination, health education and fatherhood services to medically and socially at-risk pregnant and interconceptional African-American women, their infants (up to age two) and their male partners.

Objectives:
• To identify barriers to promoting preconception health among IPOP clients.
• To identify ways IPOP case management staff addressed barriers to seeking and obtaining preconception care.
• To identify ways preconception health and health care were promoted among IPOP clients.

Methods:
• Staff addressed obesity reduction, diabetes control and proper nutrition, etc., by assisting clients with meal planning, grocery shopping, meal preparation and growing produce in containers. • Staff promoted the importance of preconception care by encouraging women to put their health first.
• Staff provided information in private, public, and community settings where clients felt comfortable: clients' homes, grocery stores, staff offices, fast food restaurants, WIC offices, educational settings, and provider offices.
• Staff encouraged use of non-standard appointments (e.g. Saturdays or evenings) for employed and for student clients.
• Staff had clients make preconception care appointments while they were present, had them write appointments on refrigerator magnets so they were constantly visible, and sent them appointment reminder notices.
• To reduce trips to urgent care centers and emergency rooms, staff explained the roles of the family practice/internal medicine providers and their importance in comprehensive, unfragmented, and preventive care.

Results:
• 85.1% of interconception clients had an ongoing source of primary and preventive care in 2006.

Conclusion and implications for practice:
• There is no one-way of promoting preconception health. • Case managers need to be creative in ways to support clients.
• Clients need education on the role of the family practice provider and internist in comprehensive preconceptional care.
• Women may need to be coached to make their own health a priority.