Psychosocial Factors of Health Professionals’ Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study

Abstract

BackgroundDecisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women’s knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context.ObjectiveOne of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening.MethodsWe conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals’ intention to use a decision aid.ResultsAmong 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11.0% (34/310). Of these, 80.9% were female (251/310). Mean age was 39.6 (SD 11.5) years. Less than half were aware of any decision aids at all. In decreasing order of importance, factors influencing their intention to use a decision aid for Down syndrome prenatal screening were as follows: self-identity (beta=.325, P<.001), attitude (beta=.297, P<.001), moral norm (beta=.288, P<.001), descriptive norm (beta=.166, P<.001), and anticipated regret (beta=.099, P=.003). Underlying behavioral beliefs significantly related to intention were that the use of a decision aid would promote decision making (beta=.117, 95% CI 0.043-0.190), would reassure health professionals (beta=.100, 95% CI 0.024-0.175), and might require more time than planned for the consultation (beta=−.077, 95% CI −0.124 to −0.031).ConclusionsWe identified psychosocial factors that could influence health professionals’ intention to use a decision aid about Down syndrome screening. Strategies should remind them of the following: (1) using a decision aid for this purpose ...

Web-Based Training for Nurses on Shared Decision Making and Prenatal Screening for Down Syndrome: Protocol for a Randomized Controlled Trial

“…The intention to use a DA was chosen as an outcome because it facilitates the implementation of SDM in clinical practice [ 27 ]. Intentions have already been documented as a strong measure of predicting a behavior [ 28 ].…”

“…The sample size was determined in reference to a previous study in the field [ 27 ] that examined the intention to use a DA for Down syndrome screening among other prenatal care providers, namely gynecologists, general practitioners, and midwives. The mean intention score for midwives in this study was 5.78 (SD 0.84).…”

Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients

“…A total of 14 studies were available from which to select relevant data sets. 14–27 Almost all the studies were conducted within or in collaboration with the Université Laval Primary Care Practice-Based Research Network across provinces in Canada. This network comprises 12 family practice teaching units affiliated with Université Laval and collaborates with other research networks nationally and internationally.…”

Theory-based approach to developing an implementation plan to support the adoption of a patient decision aid for Down syndrome prenatal screening

“…Articles were eligible if they related to decision-making or the implementation of SDM or decision aids in decisions about Down syndrome prenatal screening. The articles described results from: (a) a systematic review of the decisional needs of participants in Down syndrome prenatal testing [29], (b) a crosssectional study examining the levels of SDM and decisional conflict during routine consultations about Down syndrome prenatal testing [13,30,31], (c) an environmental scan of decision aids for Down syndrome prenatal screening [32], (d) two mixed-methods studies examining pregnant women's [33][34][35] and health professionals' [36,37] intentions to use a decision aid for Down syndrome prenatal screening, and (e) a theorybased qualitative study examining women's perceptions of strategies to enhance the use of a decision aid for Down syndrome prenatal screening [38].…”

“…Using the Theoretical Domains Framework as a guide, our team found that women's intentions to use decision aids were influenced by a range of factors, including their attitudes and beliefs, their knowledge and skill levels, the nature of the decision aid itself, and the context in which they encountered it [34,35]. Health professionals also generally showed strong intentions to use decision aids but this varied by type of professional, with midwives having the highest intentions and obstetrician/gynecologists having the lowest [37]. Professionals' intentions to use decision aids were similarly influenced by many factors, including their attitudes and beliefs about the decision aidand their own professional identity, the compatibility and availability of the decision aid within their practice, and the use of decision aids by their peers [36,37].…”