Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

Abstract

BackgroundAlthough there is a call for patient-centred prenatal care, women’s preferences for and concerns about preterm birth (PTB) prevention have not been well-studied. Therefore, we conducted a cross-sectional survey to determine women’s preferences for PTB prevention and their likelihood of following their healthcare provider’s recommendations for PTB prevention, as well as factors associated with these responses.MethodsA piloted self-administered questionnaire was completed by pregnant women who could read English. Data were collected about their preferences for and concerns about PTB prevention, and the likelihood of following their healthcare provider’s recommendations, using multivariable logistic regression to control for other factors.ResultsThree hundred and eleven women at a median of 32-weeks of gestation completed the survey, a response rate of 85.2%. Most women reported that if they were told they were at increased risk for PTB, they preferred not to use PTB prevention (65.8%), of whom almost all (93.4%) reported they preferred close-monitoring and 6.6% preferred neither monitoring nor prevention. A much smaller proportion of women reported that they would not follow their healthcare provider’s recommendation for progesterone (10.9%) compared to pessary (28.7%) or cerclage (50.2%). Women who were neither married nor in a common-law relationship were more likely to report that they would not follow recommendations for progesterone (aOR = 5.88 [95% CI: 1.72, 20.00]). Most women (84.5%) reported they would use other sources of information other than their main healthcare provider to learn more about PTB prevention, with the most popular source being the internet.ConclusionsMost women reported that if they were told they were at increased risk of PTB, they preferred close-monitoring over using PTB prevention. Their reported likelihood of not following their healthcare provider’s recommendations for PTB prevention varied from 10.9% for progesterone to 50.2% for cerclage. These findings suggest that more education about the risk of PTB, PTB preventions, as well as compliance with progesterone is needed and that the internet would be an important source of information. However as our study was completed by women at a median of 32 weeks of gestation, future surveys targeted at women earlier in their pregnancy are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1221-z) contains supplementary material, which is available to authorized users.

A systematic review of questionnaires about patient’s values and preferences in clinical practice guidelines

“… 43 For acceptability, the time to complete the questionnaires ranged from 10 to 30 minutes, with nine studies (45%) reporting such data. 35 , 36 , 38 , 40 , 42 , 43 , 47 , 48 Furthermore, response rates of the questionnaires exceeded 50% as reported by 10 studies. 31 , 33 – 35 , 38 , 40 , 42 – 44 , 46 In addition, only two studies showed the highest questionnaire content quality following psychometric analysis; 35 , 44 four studies did not follow the psychometric methods to use the questionnaire measuring patient’s preferences and values since neither did they describe item generation and pilot testing nor did they report the related information of validity, reliability, and acceptability.…”

“…Furthermore, nine (45%) studies did not report the study design, 30 , 34 , 38 , 40 , 41 , 43 , 44 , 46 12 (60%) studies provided training to the study participants, 32 – 38 , 40 , 41 , 45 , 47 , 49 while four (20%) studies did not report information about patient training. 42 – 44 , 48 In addition, only five (25%) studies provided the method used to calculate the sample size 35 – 39 , 39 – 42 , 42 – 47 and only six (30%) studies investigated patient’s family members. 31 , 34 – 37 , 49 Finally, 17 (85%) studies provided information assessing patient knowledge and beliefs.30,32–35,37–45,47–49…”

“…Most questionnaires were found to be easy to administer; 16 questionnaires (80%) were conducted through an interview survey, 31 – 40 , 43 – 47 , 49 whereas only one questionnaire (5%) was conducted via an online survey; 48 three questionnaires (15%) did not report the method used for survey administration. 30 , 41 , 42 The mean number of pages per questionnaire was 4.4 (range, 1–17), the mean number of items per questionnaire was 14 (range, 2–50), and 16 (80%) questionnaires were filled anonymously.30,32–42,44,45,47–49 Further, 16 studies (80%) obtained informed consent from the patients before the study, 30 , 31 , 33 , 34 , 44 – 49 whereas four studies (20%) did not report if informed consent had been obtained. 32 , 35 , 42 , 43 Most questionnaires used 4- to 7-point scales of measurement.…”

“…30 , 41 , 42 The mean number of pages per questionnaire was 4.4 (range, 1–17), the mean number of items per questionnaire was 14 (range, 2–50), and 16 (80%) questionnaires were filled anonymously.30,32–42,44,45,47–49 Further, 16 studies (80%) obtained informed consent from the patients before the study, 30 , 31 , 33 , 34 , 44 – 49 whereas four studies (20%) did not report if informed consent had been obtained. 32 , 35 , 42 , 43 Most questionnaires used 4- to 7-point scales of measurement. The single-choice question format with open-ended questions and a choice task was the most common type of survey setting (25%), followed by single-choice questions with a choice task (33%).…”

“… 33 , 35 , 36 , 38 , 39 , 41 , 42 , 44 – 46 As for pretest and pilot testing, only four questionnaires (20%) mentioned that the survey had undergone cognitive pretesting or pilot testing. 33 , 35 , 39 , 44 Regarding validity, seven questionnaires (35%) assessed validity by asking patients if there were other aspects of care that were not mentioned in the questionnaires, 34 – 36 , 42 – 44 whereas only one questionnaire (5%) assessed internal consistency using Cronbach’s α with values of 0.74–0.87. 43 For acceptability, the time to complete the questionnaires ranged from 10 to 30 minutes, with nine studies (45%) reporting such data.…”