User experience of a computer-based decision aid for prenatal trisomy screening: A mixed methods explanatory study (Preprint)

Abstract

BACKGROUND Mobile health tools can support shared decision making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed value-congruent decisions about prenatal screening for trisomy. OBJECTIVE We assessed the usability and usefulness of the computer-based DA among pregnant women and their partners, clinicians and policy makers. METHODS For this mixed-methods sequential explanatory study, we planned to recruit a convenient sample of 45 pregnant women with or without their partners and 45 clinicians in three clinical sites, and 15 policy makers identified in organigrams of organizations or institutions of interest. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. Eligible clinicians and policy makers were involved in prenatal care. We asked participants to navigate the computer-based DA. Using validated tools, we collected data from pregnant women on its usefulness and their self-confidence about decision-making. From all participants, we collected data on usability, quality, acceptability, their satisfaction with its content and sociodemographic data. We also interviewed participants to explore their reactions to the computer-based DA and solicit suggestions. Our interview guide was based on the user version of the Mobile App Rating Scale. We performed descriptive analyses of quantitative data and thematic deductive and inductive analysis of qualitative data for each participant category. RESULTS Forty-five pregnant women (76% 25-34 years old, 93% Caucasian) with or without their partners (n=5) (51% 25-34 years old, 89% Caucasian), 14 clinicians (36% 35-44 years old, 79% female, all Caucasian) and eight policy makers (36% 45-54 years old, 62% female, all Caucasian) participated. Mean usefulness score for preparing for decision-making for women and their partners was 80/100 (SD 13), and mean self-efficacy score was 88 (SD 11). Mean usability score was 84 (SD 14) for pregnant women and their partners, 77 (SD 14) for clinicians and 79 (SD 23) for policy makers. Mean global score for quality was 80 (SD 9) for pregnant women and their partners, 72 (SD 12) for clinicians, and 80 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (79%), that it was balanced (88%), useful (50%) and sufficient (76%). Mean satisfaction score with content was 84 (SD 13) for pregnant women and their partners, 73 (SD 16) for clinicians, and 73 (SD 20) for policy makers. Participants thought the decision aid could be more engaging (e.g. more customizable), and suggested strategies for implementation such as incorporating it into clinical guidelines. CONCLUSIONS Pregnant women and their partners, clinicians and policy makers found the DA was usable and useful. Next steps are to incorporate users’ suggestions for improving engagement and implement the computer-based DA in clinical practice.