Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

Abstract

Background Current efforts to integrate reproductive health care into primary care in the United States involve assessing pregnancy intentions and reproductive goals, which are often not meaningful or attainable for some. Alternatively, we designed a reproductive health services-based screening question: “Can I help you with any reproductive health services today, such as preventing pregnancy or planning a healthy pregnancy?” In this study, we describe women's interpretations of this question as part of a larger study, exploring perspectives on reproductive health care quality in primary care. Materials and Methods We utilized a third-party research firm to recruit New York women of reproductive age (18–45), who visited a primary care provider in the past year. We conducted five focus groups and eight interviews ( N = 30). Semistructured guides queried participants on interpretations of the screening question and preferences for raising reproductive health concerns during a primary care visit. We employed inductive thematic analysis. Results Participants interpreted the question as offering contraception or pregnancy counseling and care, although younger participants also understood it as offering sexual and reproductive health services broadly. Participants also connected the question with discussions about their ability to conceive. Some participants described experiences with provider assumptions and implicit bias. Tensions emerged around accepting primary care as a setting for reproductive health due to a perceived lack of specialized training. Conclusions Participants interpreted the screening question as intended, indicating face validity. Primary care settings should increase patients' awareness of reproductive health service availability, such as by routinely introducing a services-based screening question.

A scoping review of the format, content, effectiveness and acceptability of reproductive life planning tools

“…Some had answer options, for example the OKQ has ‘Yes’, ‘No’, ‘I’m not sure’, ‘OK, either way’, but most were open-ended in line with the verbal format. Some PIS were focused on the reproductive health services an individual wanted and were therefore only applicable to clinical encounters (31, 32, 38, 48, 49, 54).…”

“…The majority of PIS/RLPs were employed verbally during clinical encounters (15 RLPs in 27 papers) (6, 16, 17, 22, 24, 25, 28–36, 38–42, 44, 45, 48, 49, 52–54), five were self-completed (written) RLPs studied in seven papers (14, 15, 21, 37, 46, 47, 50) and six were digital RLPs (13, 19, 20, 26, 43, 51), although one was designed to be used/completed with a midwife (26) and one was linked to primary care (51). Several PIS/RLP were implemented in different formats, for example, the OKQ, FPQ/RepLI and Moos were all asked both verbally during clinical encounters and self-completed (written).…”

“…However, it was vital that providers did this, and gave the subsequent advice, in a non-judgemental, unbiased way that respected autonomy (17, 23, 32). This was particularly important for those with lower agency due to perceived shame, for example where their desires may not conform with society’s expectations of who should become a mother and when, whether that related to teenage pregnancy (23) or being childless by choice (38).…”

Patient perspectives of using reproductive autonomy to measure quality of care: a qualitative study

“…The semi-structured FG guide domains centered on experiences and perceptions of what makes for a good primary care visit generally and for reproductive health care, an ideal visit when seeking information or services on preventing pregnancy and for having a healthy pregnancy, and their receptivity to using a proposed definition of reproductive autonomy to measure quality of reproductive health service delivery. Results are reported elsewhere on their perspectives on telehealth visits and providers asking an open-ended reproductive health service needs question (versus pregnancy intentions question) [ 15 , 16 ]. We queried specifically for feedback on using reproductive autonomy as a measure of quality of care.…”