Role of Psychosocial Factors and Health Literacy in Pregnant Women’s Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

Abstract

BackgroundDeciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs.ObjectiveThe objective of this study was to identify the influence of psychosocial factors on pregnant women’s intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women’s intention.MethodsWe conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses.ResultsOf the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92).ConclusionsImplementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.

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

“…In this larger initiative, our overarching aim was to produce a DA to foster SDM in the context of prenatal screening for Down syndrome. Our study complements a similar survey of the intentions of pregnant women to use a DA for decisions about prenatal screening for Down syndrome [ 29 ]. We obtained ethics approval from the research ethics boards of the Centre de Santé et de Services Sociaux de la Vieille-Capitale (#2013-2014-29) and the CHU de Quebec (#B14-02-1929).…”

“…These results are congruent with previous studies showing high levels of intention among health professionals to engage in SDM in clinical contexts (including prenatal screening) [ 44 ]. Interestingly, some of our previous work has shown that pregnant women also have high levels of intention to use a DA for Down syndrome screening decisions [ 29 , 45 ]. Together, these results suggest that both health professionals and pregnant women seem inclined to use a DA in Down syndrome prenatal screening, and that lack of intention among either health professionals or pregnant women is not the cause of failure to implement DAs in this context.…”

“…The questionnaire was pilot tested (2-week test-retest). The aim of the questionnaire was to assess the theory-based factors influencing the use of a DA to decide about prenatal screening [ 29 ]. Attitude was measured with 5 items using bipolar adjectives assessing health professionals’ cognitive and affective attitudes (ie, very difficult to very easy, useless to very useful).…”

Pregnant women’s views on how to promote the use of a decision aid for Down syndrome prenatal screening: a theory-informed qualitative study

“…In a study by our team (referred to hereinafter as the Delanoë study), 31% of pregnant women had little intention to use PtDAs for DS prenatal screening (i.e. their intention was “weak” or “neutral”) [ 16 ]. Intention is defined as a conscious decision to perform a behaviour, a resolution to act in a certain way or an impulse for purposeful action [ 17 ].…”

Desirable features in a decision aid for prenatal screening – what do pregnant women and their partners think? A mixed methods pilot study

“…To be eligible, women had to: (a) be at least 18 years old; (b) be more than 16 weeks pregnant (we did not want to influence the outcome of their decision, and in Quebec, at 16 weeks women will have already taken the public screening test or refused it); or having given birth in the previous year; (c) be able to speak and write in French or English; (d) be able to give informed consent. We excluded women who: (i) participated in certain phases of our earlier studies on DAs (30,31) and/or (ii) presented a high-risk pregnancy (e.g. preeclampsia, gestational diabetes, multiple pregnancy).…”