Barriers and Facilitators to Implementing One Key Question® in a Midwifery Practice within a University Health System

Prevention of unintended pregnancy and promotion of health prior to conception are widely accepted approaches to lowering maternal and infant mortality. Despite the likely substantial return on investment, routine screening for pregnancy intention is not typically incorporated into the care of reproductive- age women during all healthcare encounters. With nearly half of all births in the United States unintended, and the increased risks for the mother and infant associated with unintended pregnancies, the need to establish clinical practices aimed at accurately identifying and referring women to appropriate reproductive health services is essential. One Key Question®(OKQ), developed by the Oregon Foundation for Reproductive Health (OFRH), was introduced as simple approach to encourage primary care providers to routinely ask women about their reproductive health intentions. This promising strategy encourages providers to ask all women of reproductive-age, regardless of the primary reason for their visit, "Would you like to become pregnant in the next year?" By developing a simple question to initiate the conversation and an algorithm to guide recommendations, OFRH created a program for health care providers to facilitate preconception counseling for all women capable of reproduction and promote contraceptive utilization for women that do not desire pregnancy. If used routinely, universal pregnancy intention screening and appropriate referral could result in significant reductions in unintended pregnancy rates and increased uptake of preconception care for reproductive-age women. The aim of this project was to improve knowledge of CNMs within BCHC about OKQ and increase knowledge about the barriers and facilitators to OKQ integration in order to develop a strategy for successful integration into the BCHC clinical practice. Taking time to review clinical data, talk with key stakeholders, and identify the key barriers and facilitators to implementation of OKQ screening was critical to creating an informed implementation plan. This process revealed a lack of consistency in conducting, documenting, and billing for preconception and contraception counseling. It was discovered that all levels of healthcare providers felt standardization of pregnancy intention screening and counseling through the use of OKQ, along with implementation into the EMR, would increase ease of use, improve consistency, and help to overcome the number one barrier which was lack of time. The Data obtained through this process was then utilized to develop an informed implementation plan designed to overcome barriers and bolster facilitators and will likely improve the success of implementation.