Associations between behavior cognition-social influence and pregnancy planning behavior in China: An integrated individual-couple analysis.

Objective: Pregnancy planning is a critical opportunity to enhance preconception health. "Beiyun," a culturally rooted concept in China, encompasses traditional and modern practices for preparing for pregnancy. This study used the comprehensive idea of "Beiyun" to examine the mechanisms of pregnancy planning behavior among women and men through an integrated individual-couple analysis based on the Behavior Cognition - Social Influence Theory.

Methods: Using multistage stratified sampling, we recruited reproductive-aged individuals in Zhejiang, China between July and September 2023. A cross-sectional survey collected data on pregnancy planning behavior. Analyses were conducted at both individual (Study 1, all participants) and couple levels (Study 2, coupled participants) using path analysis, specifically employing the actor-partner interdependence model in Study 2.

Results: Study 1 included 1086 women and 905 men, with 57.6 % and 67.7 % reporting pregnancy planning, respectively. Study 2 comprised 458 heterosexual couples. At the individual level, perceived susceptibility (women: β = 0.09, p = 0.01; men: β = 0.09, p = 0.04) and behavioral norms (women: β = 0.37, p < 0.01; men: β = 0.45, p < 0.01) were significantly associated with planning behavior. Couple-level analysis revealed that women's pregnancy planning was associated with their perceived susceptibility (β = 0.13, p = 0.02), behavioral norms (β = 0.29, p < 0.01), and their partner's behavioral norms (β = 0.30, p < 0.01), while men's behavior was associated with their norms (β = 0.35, p < 0.01) and partner's perceived susceptibility (β = 0.13, p = 0.03).

Conclusions: This study yielded new insights into pregnancy planning behavior, highlighting the role of individual factors and partner dynamics. Future interventions should enhance risk awareness among women and shape behavioral norms in men, considering partner dynamics in public health campaigns.