Assessing comprehension of the PATH questions through cognitive interviewing 

Background: Reproductive desires are nuanced, and change over time. In the clinical context, it may be difficult for providers to assess patient reproductive desires. PATH, which stands for "Parenting/Pregnancy Attitudes, Timing and How Important" is a method for providers to engage in a patient-centered discussion about reproductive goals and, when appropriate, contraception counseling, pre-pregnancy care, and fertility support. Few studies have sought to examine the patient experience with the PATH questions. Utilizing cognitive interviewing techniques, this study sought to understand patient understanding of and receptivity to the PATH questions. Methods: : Young adults (ages 18-29) participated in in-depth interviews about the PATH questions using cognitive interviewing techniques to probe for their perspectives on the wording of the questions and their comfort in engaging in a conversation during a visit to a healthcare provider. Results: : Ten participants completed cognitive interviews. The young adult participants receiving care at a FQHC Network demonstrate good comprehension of the PATH questions and general comfort with the idea of answering these specific questions about their reproductive health and pregnancy desires if asked by clinical providers and staff. These data suggest that PATH provides a patient-centered and open-ended tool for engaging in conversations around reproductive desires. Conclusions: : As primary care providers increasingly offer reproductive health services to address patients’ unmet needs, this setting provides an important venue in which to examine patient perspectives on tools aimed at supporting these interactions. These data provide needed patient-driven support for the Centers for Disease Control and Society of Family Planning’s recommendation to implement PATH questions, as a patient-centered method for identifying an individual’s reproductive health needs.