Preconception care adopts a life-course approach, aiming to improve reproductive health even before conception [1]. For women to achieve a healthy pregnancy at their preferred timing, support is needed from their families, communities, and national health systems, encompassing intellectual, physical, and psychological preparation for pregnancy [2,3]. Women encounter various challenges prior to becoming pregnant, including delays and difficulties in conceiving, as well as associated physical and mental health issues [2]. Health problems related to pregnancy can have enduring effects on a woman’s overall well-being [4]. Therefore, the foundation for healthy pregnancy outcomes is laid through preconception care, since the period before pregnancy is a critical time for ensuring health [5].

Numerous studies have examined the factors associated with preconception health behaviors among women in the general population [6,7]. However, there is a paucity of studies focusing on the preconception health behaviors of nurses, a profession dominated by women. In Korea, approximately 72% of currently practicing nurses are in their 20s and 30s [8]. Considering that the average age of first marriage and childbirth in Korean women is 30.6 and 33.1 years, respectively [9], reproductive choices are likely to be relevant for the majority of nurses. Due to shift work and excessive workload, clinical nurses have lower levels of health behaviors than other professions and the general population [10], and they are at a higher risk of miscarriage and preterm labor [11]. Despite their role as professionals caring for the health of others, nurses frequently adopt a passive approach to their own health [10]. Therefore, identifying the factors that influence clinical nurses’ preconception health behaviors is crucial for promoting their well-being and ensuring the sustainability of their careers.

Factors related to health behavior can be categorized as personal and social [12]. Controllable personal factors include perceived health status [13] and pregnancy anxiety [14], while social factors encompass the nursing practice environment [6,15] and social support [6,7]. Perceived health status refers to individuals’ self-assessment of their overall health, which can contribute to health behaviors [16]. As women prepare for pregnancy, they become increasingly aware of their health issues and recognize the importance of preconception health behaviors [7]. Therefore, it is vital to ensure that clinical nurses accurately evaluate their own health status.

Furthermore, women of childbearing age often experience moderate to severe pregnancy anxiety, which is more prevalent among those who have never given birth [14]. Women frequently express anxiety about challenges in conceiving, pregnancy-related changes, miscarriage, and unknown fears [5]. Childbearing women also experience concerns about childbirth, appearance, body shape, and weight gain [17]. Health behaviors are also linked to anxiety experienced during pregnancy [18]. While some research has focused on pregnancy anxiety in childbearing women, there are limited studies exploring the relationship between this anxiety and health behaviors—particularly among reproductive-age clinical nurses.

Preconception health behaviors are influenced by social factors, such as the environment and available resources [6]. Specifically, the ability of clinical nurses to practice health behaviors is hindered by factors including shift work [19], constraints on time, the pressures of overwork, and the scarcity of resources and facilities [20]. Women working in healthcare are more likely to have miscarriages, preterm labor, and low-birth-weight deliveries than women in other professions [21]. Thus, it is necessary to investigate the relationship between preconception health behaviors and clinical nurses’ practice environment.

Social support from spouses, family, colleagues, and the community is instrumental in helping women achieve successful pregnancies and maintain psychological stability, which in turn encourages healthy behaviors before conception [6]. Pregnant nurses, in particular, draw strength from the understanding and support provided by head nurses and their peers, enabling them to continue working during their pregnancy [22]. Furthermore, higher levels of social support have been linked to improved health behaviors [20,23]. Collectively, previous research has shown that social support is an important factor for women preparing for pregnancy.

Previous studies on pregnant women have investigated the degree to which health behaviors are influenced by health status [24] and social support [25]. In addition, research on health behaviors among women of childbearing age has focused on factors including marriage and pregnancy awareness [26], fatigue, and depression [27]. However, there has been little research on preconception health behaviors among clinical nurses, a significant proportion of whom are reproductive-age women.

The purpose of this study was to investigate preconception health behavior, perceived health status, pregnancy anxiety, nursing practice environment, and social support among clinical nurses working in hospitals. Specifically, it aimed to clarify the relationships between these variables and identify the factors associated with preconception health behaviors.

This study found that the key factors influencing preconception health behaviors among clinical nurses included social support, perceived health status, satisfaction with their work department, and marital status. First and foremost, social support emerged as the most influential factor, consistent with previous research on its role in health behaviors [6]. This highlights the importance of social support in improving emotional and physical health behaviors among nurses. Preparing for pregnancy requires not only efforts made by the prospective mother and her partner, but also support from family, the workplace, and society [6]. Previous research has shown that social support can predict health behavior changes and maintenance [35]. Therefore, organizational strategies are needed to increase social support among nurses, who primarily consist of women of childbearing age [35]. Given that male partners may not actively engage in preconception health behaviors [5], it is crucial to raise their awareness about the importance of those behaviors and to expand educational opportunities for them.

Perceived health status was found to be the next major influencing factor. Higher levels of perceived health status were found to be associated with more positive preconception health behaviors. This finding is consistent with previous research indicating that higher perceived health status among nurses correlates with more favorable health behaviors [16]. Since preconception health issues can have a negative impact on birth outcomes, women planning to become pregnant should prioritize and maintain their health status [3]. In particular, clinical nurses, due to their work characteristics, are disproportionately likely to experience symptoms related to the digestive, nervous, and reproductive systems [36]. Therefore, educational programs should be developed with the goal of improving the perceived health status of clinical nurses preparing for pregnancy.

Third, participants who were more satisfied with their work department demonstrated better preconception health behaviors than those who were dissatisfied. This aligns with previous research finding that higher work department satisfaction was associated with increased general health promotion behaviors in operating room nurses [37]. However, direct comparisons to preconception health behaviors are difficult, highlighting the need for additional research. The nursing practice environment was not identified as an influencing factor in this study, despite previous research indicating a link between the nursing practice environment and health behaviors [37]. The discrepancy between the present study and previous research warrants further investigation.

Lastly, this study identified marital status as an influencing factor. Married nurses exhibited better preconception health behaviors than their unmarried counterparts, even those in a relationship with a sexual partner. This supports previous research, according to which married nurses engaged in more general health promotion behaviors [35]. A possible explanation for this finding is that marriage fosters mutual reliance and interest in each other’s health, resulting in improved health behaviors. Furthermore, because married nurses tend to be older and have more work experience, this study analyzed the relationships among marital status, age, and work experience. Nurses aged 35 years or older scored higher on preconception health behaviors than those aged 29 years or younger, and nurses with more than 5 years of work experience scored higher than those with 4 years or less of experience. The tendency in Korea for later marriages (e.g., after age 30 years) and a rise in pregnancies at an advanced maternal age suggest that the increased concern for health behaviors before conception may stem from the fear of infertility [38], along with the risks associated with miscarriage, preterm birth, and low-birth-weight deliveries [39]. Furthermore, more experienced nurses, often in leadership positions, might have inspired their colleagues by serving as role models for a healthy lifestyle [20]. Similar to the findings in this study, previous research [40] has shown that older nurses with more work experience exhibit better health behaviors. As a result, it is essential to emphasize the importance of preconception health behaviors and develop actionable strategies for nurses aged 29 years and younger and those with less than 5 years of work experience to effectively practice these behaviors.

Previous research suggests that individuals who frequently experience anxiety symptoms are more likely to engage in less physical activity, suffer from inadequate sleep, and adopt unhealthy behaviors such as excessive drinking and smoking [41]. However, pregnancy anxiety was not found to be a significant predictor of preconception health behaviors in this study. A reason for this discrepancy may be that the participants in this study did not explicitly report anxiety symptoms, and it is also possible that pregnancy anxiety did not directly impact preconception health behaviors because the participants were not yet pregnant. Consequently, women of childbearing age may find it difficult to adopt preconception health behaviors due to uncertainties regarding when they will conceive. Nonetheless, the motivation to change these behaviors generally increases after pregnancy is confirmed.

In this study, clinical nurses had a mean score of 100.68 points (item mean, 3.73) on preconception health behaviors, which is lower than the 114.17 points (item mean, 4.23) reported in a previous study on women of childbearing age [42]. Other research has also shown that nurses exhibit lower levels of health behaviors than those in other professions [43]. Nurses are aware of the need for their own health behaviors; however, it is difficult for them to maintain regular health behaviors due to factors including a lack of time, excessive workload, limited facilities for physical activities, insufficient cooking appliances for accessing healthy food options, fatigue, and lack of sleep [20]. Furthermore, approximately 70% of the participants in this study worked as shift nurses, which may have influenced their preconception health behaviors. Existing research suggests a link between shift work and poorer health behaviors. For instance, shift-working nurses were found to consume more fats and saturated fats than day-shift nurses [44], and among smoking nurses, those working shifts were more likely to continue smoking during pregnancy than their day-shift counterparts [45]. This highlights the need for further research on the factors contributing to the lower levels of preconception health behaviors among shift-working nurses.

This study is significant because, to the best of our knowledge, it is the first to investigate the factors influencing preconception health behaviors among clinical nurses, who are predominantly women. Furthermore, it distinguishes between personal and social factors, such as perceived health status and social support, respectively. Based on these findings, we propose developing educational programs and interventions aimed at strengthening nurses’ perceived health status and social support to improve preconception health behaviors among clinical nurses, considering marital status and satisfaction with the work unit. Although the factors identified in this study explained only a moderate portion (40.9%) of the variance in preconception health behaviors, previous research has also found other influencing factors, such as motivation and the financial costs of health behaviors [7], which warrant further investigation in future studies. Furthermore, because the data were collected among clinical nurses through convenience sampling from selected online platforms, there is a potential bias favoring users of these platforms. This limitation may restrict the generalizability of these findings. Therefore, future research should broaden the study population to include more diverse groups of women of childbearing age, shift-working women, and their partners.