Index
Introduction to Making Every Contact Count (MECC) conversations
Making Every Contact Count (MECC) is an approach that helps staff and volunteers use everyday conversations to support people's health and wellbeing.
A MECC conversation involves noticing opportunities, asking open questions, offering brief advice, and supporting people to take small steps toward change.
How to have an MECC conversation
Look for natural opportunities to start a friendly, supportive conversation.
Help the person tell their story to understand what matters to them.
Ask open questions, listen actively, and check understanding.
Ask permission before exploring sensitive topics or offering advice.
Use the As k– Assist – Act model to guide the conversation.
The Ask – Assist – Act model
Ask
Notice opportunities, use open questions, listen, and understand.
Assist
Explore what matters to the person and offer brief, tailored advice. Use Check - Chunk - Check to share information clearly:
- check what they already know
- chunk relevant information in small pieces
- check they've understood and ask what they'll do next
Act
Support people to take next steps, signpost to services, and help build confidence.
Preconception basics
Ask
Recognise an opportunity to discuss health and wellbeing and asking questions to explore the issue:
"Would you like to talk about your health before pregnancy?"
"Tell me about what matters to you when it comes to staying healthy."
"Describe how things are going for you at the moment."
"Are you thinking about having a baby in the next year?"
"Is now a good time for a quick chat about staying healthy?"
"Could you describe any worries that you might have about pregnancy or your health?"
"What are your thoughts on planning a pregnancy?"
"Would it be helpful to talk about ways to protect yourself from an unplanned pregnancy?"
"You mentioned that you’re thinking about making some healthy changes this year, that sounds really interesting, can you tell me more?"
"What's important to you at the moment around health and wellbeing?"
Only in a sexual health or other appropriate setting:
"If you don’t mind me asking, where does family planning come into all this for you?"
Assist
Offer general health messages:
- making healthy changes before pregnancy is good for both parents and future babies
- this matters even if someone is not planning a baby yet
- encourage simple steps
- encourage the individual to set a goal and make a plan for the next steps - advise them to contact their GP or midwifery service
- eating a healthy diet
- stopping smoking
- avoiding alcohol
- taking daily folic acid
- checking vaccinations are up-to-date
- starting pregnancy at a healthy weight
- looking after their mental health
- managing long-term conditions
- speak to health professional if taking regular medication
- check cervical screening is up-to-date
- taking regular exercise (government guidelines recommend 150 minutes of moderate exercise a week)
Act
Provide clear contact details to local services.
Help them take the first step if possible, for example booking an appointment or giving a leaflet.
Suggest resources like:
Closely spaced pregnancies
Ask
Examples questions to ask:
"How are you feeling about having another baby?"
"Can I ask if you'd ever think of adding to your family, and if so when that would be?"
"What are your thoughts on the timing between your pregnancies?"
"Can you describe how things have been for you since your last pregnancy."
"Tell me about what matters most to you when thinking about having another baby."
"Do you know why waiting between pregnancies can be helpful?"
"Can I ask, what are your thoughts about the spacing of your pregnancies? Can I add what the NHS recommend around this?"
"Can I ask if you'd ever think of adding to your family, and if so when that would be?"
Assist
Explain:
- waiting at least 18 months can lower risks and helps the body recover
- advise them to contact their GP or midwifery service
- encourage healthy lifestyle steps (see preconception basics)
Act
Encourage the individual to set a goal and make a plan for the next steps.
Your Sexual Health Matters provides sexual health information, clinical services, and practical advice and support to people living in Derby and Derbyshire to take control of their sexual and reproductive health.
Those living in Derbyshire, are over 12 weeks pregnant, or have given birth in the past 2 years, and are registered with a Derbyshire GP, can self-refer to the perinatal service.
NHS planning your pregnancy offers advise around steps you can take to support a health pregnancy.
Live Life Better Derbyshire is a healthy lifestyles service for individuals living in the Derbyshire which offers free support.
Derbyshire Community Health Service have a team of healthcare professionals that are there to support you and your family as part of the 0 to 19-year-olds free public health and wellbeing services.
Best Start in Life is a government website offering advice and support from pregnancy to your child starting school.
Tommy's healthy pregnancy tool for those who are planning a pregnancy and advice on how to improve the health of future pregnancies and children.
Preconception considerations for women and people aged over 35 years
Ask
"What have you heard about how age can affect pregnancy?"
"It sounds like you're thinking through some tough choices about what life stuff to prioritise first. What are your thoughts at the moment?"
"Would it be helpful if we talked about how age might affect pregnancy?"
"Describe how your life circumstances are shaping your thoughts about having a baby."
"What are your thoughts on planning a pregnancy at this stage in your life?"
"Where do you see your next steps in thinking about pregnancy?"
"Do you know why age can make a difference when planning a baby?"
"Can I share some things that I've learned from a health point of view?"
Assist
Most people over 35 have healthy pregnancies, there can be some extra things to think about.
Encourage healthy lifestyle steps (see preconception basics).
Early consultations - recommend contacting a GP, practice nurse, or midwifery service to discuss planning for pregnancy and any health checks that may help.
Act
Encourage the individual to set a small, achievable next steps.
Providing a referral to specialist services, such as a smoking cessation program or genetic counselling.
NHS planning your pregnancy offers advise around steps you can take to support a health pregnancy.
Live Life Better Derbyshire is a healthy lifestyles service for individuals living in the Derbyshire which offers free support.
Derbyshire Community Health Service have a team of healthcare professionals that are there to support you and your family as part of the 0 to 19-year-olds free public health and wellbeing services.
Information about Derbyshire Community Health Services NHS Foundation Trust including contact details, directions, opening hours.
Best Start in Life is a government website offering advice and support from pregnancy to your child starting school.
Tommy's healthy pregnancy tool for those who are planning a pregnancy and advice on how to improve the health of future pregnancies and children.
Teenage pregnancy
Ask
"If you don't mind sharing, I'd love to know how it's going with the new partner you're seeing."
"How are you feeling about your relationship just now?"
"Wow it sounds like there's a lot of life things in your mind. What are your hopes for the next few years?"
"How easy is it to practice safe sex at the moment?"
"What kind of people are giving inspiration for you at the moment, in real life or online? What kind of messages do you think you're getting from them?"
"That sounds important, how would you feel about contacting your GP or midwifery service?"
"Have you thought about how your health can help you in the future?"
Assist
Pregnancy at a young age can affect health and future plans, so it’s important to have the right support.
Being pregnant as a teenager can feel overwhelming at times, and there may be extra things to think about.
Teenage pregnancy is associated with poor outcomes for young women and their children.
Support discussion of relevant topics such as young people's hopes and aspirations, what makes for healthy relationships, importance of contraception, what makes a helpful peer influence and helpful and less helpful influencers to follow on social media.
Advise them to contact their GP or midwifery service.
Advise to them how using contraception can prevent a pregnancy, if they don't want a baby now.
Consider how your organisation could provide or endorse messages from relationship and sexual health education (RSHE).
Encourage healthy lifestyle steps (see preconception basics).
Act
Advise women and pregnant young people to contact their GP or midwifery service soon as possible after they find out that they're pregnant.
Your Sexual Health Matters provides sexual health information, clinical services, and practical advice and support to people living in Derby and Derbyshire to take control of their sexual and reproductive health.
Brook is a UK-wide charity providing free and confidential sexual health and wellbeing services, primarily aimed at young people.
Information about Derbyshire Community Health Services NHS Foundation Trust including contact details, directions, opening hours.
ChatHealth is a confidential NHS text‑messaging service that allows children, young people, parents, and carers to get health advice from qualified nurses, text: 07507 330025.
Starting Point contact and referral service for young people who needs are more complex and may need support from Children Services contact.
NHS planning your pregnancy offers advise around steps you can take to support a health pregnancy.
Live Life Better Derbyshire is a healthy lifestyles service for individuals living in the Derbyshire which offers free support.
Derbyshire Community Health Service have a team of healthcare professionals that are there to support you and your family as part of the 0 to 19-year-olds free public health and wellbeing services.
Best Start in Life is a government website offering advice and support from pregnancy to your child starting school.
Tommy's healthy pregnancy tool for those who are planning a pregnancy and advice on how to improve the health of future. pregnancies and children.
Contraception
Ask
"How are you feeling about practicing safe sex at the moment?"
"What do you know about how to avoid getting pregnant until you're ready? Do you mind if I add a couple of things?"
"What have you heard about different contraception options?"
"Would you like to talk about the different ways to prevent pregnancy until you're ready?"
"Tell me about what matters to you when choosing a method of contraception."
Assist
Contraception helps people choose when the right time is for them to have a baby.
There are many safe ways to prevent pregnancy until they are ready.
Everyone can choose the method that fits their life and needs.
Give easy steps - advise people to talk to their GP, nurse, or a sexual health clinic about the different contraception options available.
Using contraception reduces the risk of unplanned pregnancies.
Consider how your organisation could provide or endorse messages from relationship and sexual health education (RSHE).
Act
Provide clear contact details to local specialist sexual health services for free, confidential sexual health advice
Support with the first step, for example helping to book an appointment or providing a leaflet.
Your Sexual Health Matters provides sexual health information, clinical services, and practical advice and support to people living in Derby and Derbyshire to take control of their sexual and reproductive health.
NHS sexual health clinics are free and available to everyone, no matter your age, gender, ethnicity or sexuality.
Derbyshire Community Health Service have a team of healthcare professionals that are there to support you and your family as part of the 0 to 19-year-olds free public health and wellbeing services.
Brook is a UK-wide charity providing free and confidential sexual health and wellbeing services, primarily aimed at young people.
Information about Derbyshire Community Health Services NHS Foundation Trust including contact details, directions, opening hours.
ChatHealth is a confidential NHS text‑messaging service that allows children, young people, parents, and carers to get health advice from qualified nurses, text: 07507 330025.
Folic acid
Ask
"You're trying for a baby, that is lovely news. What do you know already about things you can do now that can have a healthy pregnancy? Great, I wonder what you've heard about folic acid if anything?"
"Have you heard much about folic acid and why it's helpful before pregnancy?"
"Tell me about any vitamins or supplements you use."
Assist
It's recommended to take folic acid as soon as anyone starts trying for a baby, ideally 3 months before and during the first 12 weeks of pregnancy.
This will help the baby's brain and spine develop normally.
Act
The local community pharmacy will be able to offer advice on folic acid and other vitamins.
NHS has information on folic acid.
NHS offers advice around pregnancy, breastfeeding and fertility while taking folic acid.
If someone is more than 10 weeks pregnant or has a child under 4, they may be entitled to free Healthy Start vitamins.
Smoking
Ask
"How are you feeling about your smoking levels at the moment?"
"How does that fit in with your thoughts about trying to start a family soon?"
"Would you like any help or support to cut down or stop?"
"Tell me about any past attempts you've made to stop smoking and what helped."
"Who supports you when you're trying to cut down or quit?"
“Would you like help to stop smoking?”
Assist
Stopping smoking is one of the best things someone can do for their health and their baby's health.
Cutting down or quitting before pregnancy reduces risks and improves fertility.
Explain that second‑hand smoke also affects babies and families, and simple changes can help.
Reassure them that many people find quitting hard, support is available, and every step helps.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
Derbyshire residents can get free 12-week stop smoking support from Live Life Better Derbyshire, telephone: 0800 085 2299 or telephone: 01629 538 200.
National Smokefree Helpline, telephone: 0300 123 1044.
It can be difficult to stop smoking, but it's never too late to quit. NHS offer advice to stop smoking in pregnancy.
Alcohol
Ask
"Could you tell me how you are feeling about your alcohol levels at the moment?"
"How does that fit in with your thoughts about trying to start a family soon?"
"Would you be happy to share how you think alcohol influences health or wellbeing?"
"Tell me about any changes you’ve already thought about when it comes to alcohol."
Assist
Drinking alcohol before pregnancy can affect fertility, pregnancy outcomes, and a child’s long‑term health.
There is no safe level of alcohol in pregnancy.
The safest choice is not to drink alcohol if someone is planning to have a baby.
Reassure people that reducing or stopping alcohol is a positive step at any time, particularly when preparing for pregnancy.
Encourage people who feel worried or unsure to talk to their GP or a support service for personalised advice.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
Derbyshire Addictions Advice Service (DAAS) DAAS is part of the Derbyshire Recovery Partnership, providing support for anyone over the age of 18 who lives in Derbyshire and is affected by substance misuse, their own or someone else's.
Derbyshire Healthcare NHS Foundation Trust offers advice, support and treatment to adults in Derbyshire who need help with their drug or alcohol use.
Change Grow Live offers free and confidential service for young people aged 18 and under living in Derbyshire who are using drugs or alcohol and want some.
Drymester help is parents-to-be go alcohol free, to keep risks to babies to a minimum, the safest approach is to go alcohol free throughout pregnancy.
Substance use
Ask
"Could you tell me how you are feeling about your substance levels at the moment?"
"How does that fit in with your thoughts about trying to start a family soon?"
"Would you be happy to share how you think substance use influences health or mood?"
"Tell me about any changes you've already thought about when it comes to substance use."
"Would you like to share any changes you've been thinking about around your substance use?"
Assist
Non-prescription and recreational substance use can have serious, long-lasting effects on someone's health.
Using substances can have a big impact on preconception health, making it harder to get pregnant and increasing risks during pregnancy for both parents and their baby.
Getting support before becoming pregnant can improve fertility, reduce complications, and support better long‑term health.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
Derbyshire Recovery partnership (DRP) provides advice, support and treatment for adults in Derbyshire who wish to address issues and problems arising from the use of drugs.
Change Grow Live offers free and confidential service for young people aged 18 and under living in Derbyshire (excluding Derby City Council) who are using drugs or alcohol and want some support.
Derbyshire Healthcare NHS Foundation Trust - advice, support, and treatment to adults in Derbyshire who need help with their drug or alcohol use.
Emotional and mental health
Ask
"How are you feeling in yourself?"
"Trying for a baby can be an emotional rollercoaster – how are you feeling about it all?"
"Having a pregnancy scare /termination / worrying about pregnancy can be really tough, you've been through a lot lately, haven't you. How are you in yourself just now?"
"Would you like to talk about how you're feeling?"
Assist
Emotional and mental health plays an important role in preparing for pregnancy.
If someone is struggling, getting support early can make a big difference.
Mental wellbeing can affect how people cope with trying to conceive, pregnancy stress, and the transition to parenthood.
Encourage them to talk to someone they trust, take small breaks, rest, go for a walk, or do activities that help them feel calm.
Remind them that:
- they are not alone - many people struggle emotionally at times
- help is available, and reaching out is a positive step
- they should not stop prescribed mental health medication without medical
If someone feels overwhelmed, anxious, or depressed, encourage them to speak to their GP before becoming pregnant.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
Mental health and emotional wellbeing support is available from Derbyshire Family Health Service.
Those living in Derbyshire, are over 12 weeks pregnant, or have given birth in the past 2 years, and are registered with a Derbyshire GP, can self-refer to the perinatal service. They provide treatment for women experiencing mental health problems either during pregnancy or after pregnancy.
The DadPad app is a downloadable resource for new dads and dads-to-be. It’s full of relevant information, as well as details on local support groups and service providers. Find out more about the DadPad from Derbyshire Family Health Service.
DadSpace have spaces where dads can meet other dads in a relaxed environment, as well as access perinatal peer support from the warm and welcoming volunteers. Sessions are free and there is no need to book, simply turn up.
Andy's Man Club is a men's suicide prevention charity, offering free-to-attend peer-to-peer support groups across the United Kingdom and online, if they are 18+.
DigiDAD is a unique online peer support community created by young dads, for young dads.
Maternal Mental Health Alliance (MMHA) is a UK charity and network of organisations, dedicated to ensuring women and birthing people affected by perinatal mental health problems have access to high-quality, compassionate care.
Mums Aid specialist perinatal mental health charity.
Mind offers information and support for postnatal depression and perinatal mental health.
Healthy weight
Ask
"You mentioned you're thinking about starting a family, this can be a great motivator to make healthy changes for you and your baby. What are your thoughts on this?"
"It's great to hear that you're wanting some help with your weight. Tell me more about why that's important to you just now?"
"Are you OK to tell me about any changes you've already thought about when it comes to your diet, or activity levels."
Assist
Being a healthy weight before pregnancy can help individuals and their baby to stay well.
If someone's weight is too high or too low, it can increase risks and complications during pregnancy and birth.
Encourage early conversations about weight, diet, physical activity, and lifestyle when planning a pregnancy.
Small, sustainable changes often work better than big or sudden changes.
Advise individuals planning a pregnancy to speak with their GP.
Act
Provide clear contact details to local services, where possible, help with the first step, for example helping to book an appointment or providing a leaflet.
Signpost to local weight management services if a person is pregnant and needs support around weight management.
Promote the NHS Healthy Start Scheme. Healthy Start supports better nutrition for pregnant women and young children in low-income families. Eligible families receive a prepaid card to buy fruit, vegetables, milk, infant formula, and vitamins. Ask about eligibility and signpost families to apply.
The Gestational Diabetes Pathway is a free, accessible programme designed to help people make small, sustainable lifestyle changes to reduce their risk of type 2 diabetes. Encourage anyone who's had gestational diabetes to join the diabetes prevention programme.
Screening and vaccinations
Ask
"If it feels alright for you, can we chat about health checks and vaccinations before pregnancy?"
"How do you feel about checking your vaccination history with your GP or getting health checks done?"
"Would it be helpful if I shared some information about screening and vaccines?"
Assist
Health checks and vaccines help keep people and their babies safe. Some infections can harm a baby during pregnancy, so it's important to check these things before getting pregnant.
Encourage people planning a pregnancy to contact their GP to review their screening and vaccination history.
Cervical screening is also important, women and people with a cervix should check that their screening is up-to-date before trying for a baby.
Act
Read more about NHS vaccination information in pregnancy.
Oral health
Act
"One area people often don't think about until we really need it is visiting the dentist. What's your dentist like, have you seen them lately?"
"Now you're pregnant you can get free dental care, win! How would you feel about going to see them?"
"What do you know already about how to keep your teeth and gums healthy when you're pregnant?"
Assist
Healthy teeth and gums are important before having a baby.
Gum problems can make it harder to stay healthy and can affect pregnancy.
Advise to maintain oral hygiene, brush twice daily for 2 minutes using fluoride toothpaste (1,000–1,500 ppm), floss daily, and reduce sugary foods and drink.
Encourage regular dental check-ups before and during pregnancy.
Advise pregnant people to avoid brushing teeth immediately after vomiting (due to morning sickness). Wait at least 1 hour to prevent damage from stomach acid.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
Find an NHS dentist.
Some women get swollen and sore gums, which may bleed, during pregnancy. Bleeding gums are caused by a build-up of plaque on the teeth. Find out more about bleeding gums in pregnancy.
Long-term conditions and medicines
Ask
"Now you're thinking of getting pregnant and I know you'll want to make sure your health conditions are in the best place possible. How are you managing with your [health condition] at the moment?"
"It sounds like you're a bit worried about how this medicine could work when you're pregnant. Tell me more about your concerns?"
"What if anything is bothering you about your health at the moment?"
Assist
Encourage the person to book an appointment with their GP, practice nurse, or specialist team to review their condition and medicines before pregnancy.
People should not stop any medications without medical advice.
Genetics and preconception health.
Some health conditions can be inherited, so knowing about family history can help people understand any possible risks.
Encourage individuals with a family history of inherited conditions to seek guidance from their GP or consultant, genetic screening and counselling may be recommended for those at risk.
Act
Provide clear contact details to local services, where possible, assist with the first step, for example helping to book an appointment or providing a leaflet.
For more guidance on pre-existing medical conditions before conception.