Some key questions: Pregnancy intention screening by community health workers

Background: Unintended pregnancy contributes to a high burden of maternal and fetal morbidity in the United States, and pregnancy intention screening offers a key strategy to improve preconception health and reproductive health equity. The One Key Question^© is a pregnancy intention screening tool that asks a single question, "Would you like to become pregnant in the next year?" to all reproductive-age women. This study explored the perspectives of community health workers on using One Key Question in community-based settings.

Objectives: This study aimed to identify barriers and facilitators to the use of the One Key Question pregnancy intention screening tool by community health workers who serve reproductive-age women in Salt Lake City, Utah.

Design: Using reproductive justice as a guiding conceptual framework, this study employed a qualitative descriptive design. Participants were asked to identify barriers and facilitators to the One Key Question, with open-ended discussion to explore community health workers' knowledge and perceptions about pregnancy intention screening.

Methods: We conducted focus groups with 43 community health workers in Salt Lake City, Utah, from December 2017 through January 2018. Participants were trained on the One Key Question algorithm and asked to identify barriers and facilitators to implementation. All focus groups occurred face-to-face in community settings and used a semi-structured facilitation guide developed by the study Principal Investigator with input from community partners.

Results: Pregnancy intention screening is perceived positively by community health workers. Barriers identified include traditional cultural beliefs about modesty and sex, lack of trust in health care providers, and female bias in the One Key Question algorithm. Facilitators include the simplicity of the One Key Question algorithm and the flexibility of One Key Question responses.

Conclusion: One Key Question is an effective pregnancy intention screening tool in primary care settings but is limited in its capacity to reach those outside the health system. Community-based pregnancy intention screening offers an alternative avenue for implementation of One Key Question that could address many of these barriers and reduce disparities for underserved populations.