“It’s not about a question, it’s about the outcomes, isn’t it?”: pilot study for Scottish pregnancy screening tool provision of preconception health care in Scotland

Background
Pregnancy intention is not routinely asked about in most primary care settings, leading to missed opportunities for timely discussions about contraception or preconception care. This study evaluated a Scottish adaptation of the One Key Question® (OKQ®) screening tool, designed to prompt conversations about pregnancy desire with women of reproductive age.

Methods
The pilot was implemented in two GP practices in Scotland. All women aged 16 and over with the capacity to become pregnant were eligible to be asked the question, regardless of the reason for their visit. Information, services, or referrals were then offered based on their response. Quantitative and qualitative methods were used to evaluate acceptability from the perspective of patients and healthcare professionals (HCPs) over a 3-month period.

Results
Fifty-six women were asked the pregnancy intention question from October to December 2024. Thirty-eight (68%) provided feedback. Most found the conversation easy (92%) and felt listened to and supported (94%). Six HCPs were interviewed at the end of the pilot; they described the tool as a useful prompt, with contraception the most common outcome. However, some reported uncertainty about when it was appropriate to ask.

Conclusion
This pilot suggests that using a standardised pregnancy intention question may be a simple and acceptable way to initiate reproductive health conversations in routine care. The findings also highlight the need for flexible and sensitive use depending on patient context.


Plain english summary
Looking after health before becoming pregnant is important for improving outcomes for both mothers and babies. However, pregnancy intentions are not routinely discussed in primary care in Scotland, and this can mean missed opportunities to support women who are planning a pregnancy or who do not want to become pregnant.

This study tested a pregnancy screening tool in two GP practices in Scotland. The tool asked women of childbearing age about their pregnancy intentions and supported healthcare professionals to start conversations about reproductive health.

Over a three-month period, 56 women were asked about their pregnancy intention. Most found it acceptable, and healthcare professionals reported that it led to useful discussions, particularly around contraception and medication safety.

The study shows that this type of screening tool can be used in routine primary care to support open conversations about pregnancy planning and reproductive health. Further research is needed to explore the best ways of using the tool consistently in practice.