One Key Question® and the Desire to Avoid Pregnancy Scale: A comparison of two approaches to asking about pregnancy preferences.

Objective: To facilitate assessment of patients' pregnancy preferences, we compared responses to One Key Question® with the validated Desire to Avoid Pregnancy (DAP) scale and assessed their relationships to patient-reported reproductive health behaviors.

Methods: In this after-visit survey in primary care and obstetrics-gynecology practices, women ages 18-49 (n = 177) answered "Would you like to become pregnant in the next year?" and the 14-item DAP scale. We performed one-way ANOVA to compare DAP scores (0-4 scale, 4 = highest preference to avoid pregnancy) across One Key Question® responses ("Yes," "Unsure," "Ok either way," "No but sometime in the future," "No never"). We used logistic regression to test association of One Key Question® and DAP with contraceptive and folic acid use.

Results: Most patients did not want to become pregnant in the next year, based on One Key Question® (7% "Yes," 4% "Unsure," 11% "Ok either way," 53% "In the future," 25% "Never"). The mean DAP score overall was 2.52 (SD = 1.03, Range: 0-4, Cronbach's α = 0.96). Scores differed by One Key Question® response ("Yes" mean DAP = 0.84, "Unsure" 1.64, "Ok" 1.42, "In the future" 2.94, "Never" 2.78, p < 0.001) yet varied markedly within each One Key Question® response group. Contraceptive use was lower among those who answered "Yes" (46%; OR = 0.14, 95% CI 0.04-0.48) vs. "No, future" (86%). Similarly, odds of contraceptive use increased with DAP score (OR = 1.69, 9% CI 1.18-2.42; predicted 51% for DAP = 0, 90% for DAP = 4).

Conclusion: One Key Question® responses correlate with DAP scores, and contraceptive use correlates with not desiring pregnancy by both approaches.

Implications Statement: One Key Question® and the Desire to Avoid Pregnancy scale can both identify women wishing to avoid pregnancy to help clinicians address patients' contraceptive needs. Given the range of preferences associated with One Key Question® responses, clinicians who use it should proceed with further discussion to fully understand patients' feelings.