Creating a Community-Based Protocol to Prevent Unintended Pregnancy in Homeless Women in Monongalia County, West Virginia

Background: At any given time, 10% of homeless women are pregnant, about twice the rate of all U.S. women of reproductive age (5%) (Healthcare for the Homeless, 2001). According to Healthcare for the Homeless Council ([HHC], 2012), approximately “73% of pregnancies among homeless women were unintended at the time of conception.” In addition, “about 12% of homeless children are placed in foster care compared to 1% of other children” (HHC, 2012). There is an evident need to address unintended pregnancy among homeless women. Objective: The overall objective was to create an accessible and useful community-based protocol to reduce the rate of unintended pregnancy in homeless women in Monongalia County, West Virginia. Methods: This project followed a quality improvement PDSA cycle (Plan, Do, Study, Act). It was completed in four phases: 1) phone interviews with homeless women, 2) focus group with community stakeholders, 3) protocol creation based on feedback from stakeholders and homeless women, and 4) survey completed by focus group participants evaluating acceptability and usefulness of the protocol. Results: Themes from interviews with women included timely and convenient access to safety, hygiene, transportation and help, housing, and views on pregnancy and contraception. Themes from focus group served as the organizing structure for the created protocol. Focus group participants surveys indicated an acceptability rating of 4.3-4.6, with 5 being strongly agree. Responses regarding usefulness of the protocol were 3.8-4.4, with 5 being strongly agree. Survey responses also recognized a need to include missing stakeholders and need for greater collaboration with other stakeholders. Discussion: The framework (PDSA cycle) was an effective way to create this protocol. The experiences described in the interviews with homeless women and during the focus group were reflective of the literature and the challenges associated with caring for this vulnerable population. Focus group participants, inclusion of missing stakeholders and community partnerships are vital to the sustainability of this project