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Facilitating autonomous, confident and satisfying choices: a mixed-method study of women's choice-making in prenatal screening for common aneuploidies.

ABSTRACT: BACKGROUND:Population-based prenatal screening has become a common and widely available obstetrical practice in majority of developed countries. Under the patient autonomy principle, women should understand the screening options, be able to take their personal preferences and situations into account, and be encouraged to make autonomous and intentional decisions. The majority of the current research focuses on the prenatal screening uptake rate, women's choice on screening tests, and the influential factors. However, little attention has been paid to women's choice-making processes and experiences in prenatal screening and their influences on choice satisfaction. Understanding women's choice-making processes and experiences in pregnancy and childbirth is the prerequisite for designing women-centered choice aids and delivering women-centered maternity care. This paper presents a pilot study that aims to investigate women's experiences when they make choices for screening tests, quantify the choice-making experience, and identify the experiential factors that affect women's satisfaction on choices they made. METHOD:We conducted a mixed-method research at Helsinki and Uusimaa Hospital District (HUS) in Finland. First, the women's choice-making experiences were explored by semi-structured interviews. We interviewed 28 women who participated in prenatal screening. The interview data was processed by thematic analysis. Then, a cross-sectional self-completion survey was designed and implemented, assessing women's experiences in choice-making and identifying the experiential factors that influence choice satisfaction. Of 940 distributed questionnaires, 185 responses were received. Multivariable linear regression analysis was used to detect the effects of the variables. RESULTS:We developed a set of measurements for women's choice-making experiences in prenatal screening with seven variables: activeness, informedness, confidence, social pressure, difficulty, positive emotion and negative emotion. Regression revealed that activeness in choice-making (??=?0.176; p?=?0.023), confidence in choice-making (??=?0.388; p?

SUBMITTER: Chen A

PROVIDER: S-EPMC5930782 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNon-invasive prenatal testing (NIPT) can be used to accurately detect fetal chromosomal anomalies early in pregnancy by assessing cell-free fetal DNA present in maternal blood. The rapid diffusion of NIPT, as well as the ease and simplicity of the test raises concerns around informed decision-making and the potential for routinization. Introducing NIPT in a way that facilitates informed and autonomous decisions is imperative to the ethical application of this technology. We approach this imperative by systematically reviewing and synthesizing primary qualitative research on women's experiences with and preferences for informed decision-making around NIPT.MethodsWe searched multiple bibliographic databases including Ovid MEDLINE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and ISI Web of Science Social Sciences Citation Index (SSCI). Our review was guided by integrative qualitative meta-synthesis, and we used a staged coding process similar to that of grounded theory to conduct our analysis.ResultsThirty empirical primary qualitative research studies were eligible for inclusion. Women preferred to learn about NIPT from their clinicians, but they expressed dissatisfaction with the quality and quantity of information provided during counselling and often sought information from a variety of other sources. Women generally had a good understanding of test characteristics, and the factors of accuracy, physical risk, and test timing were the critical information elements that they used to make informed decisions around NIPT. Women often described NIPT as easy or just another blood test, highlighting threats to informed decision-making such as routinization or a pressure to test.ConclusionsWomen's unique circumstances modulate the information that they value and require most in the context of making an informed decision. Widened availability of trustworthy information about NIPT as well as careful attention to the facilitation of counselling may help facilitate informed decision-making.Trial registrationPROSPERO 2018 CRD42018086261 .

Project description:Abstract:Potential protection from violence has been suggested as an explanation for women's preferences for more masculine partners. Previous studies, however, have not considered that violence may be multi-modal, and hence come from different sources. Therefore, we tested the effect of different fears of violence (i.e. vulnerability to public crime, likelihood of within-partnership violence) on masculinity preferences of women from Colombia, a country known for its high rates of violence. Eighty-three adult heterosexual women (mean age?±?SD?=?26.7?±?6.01) answered a survey that included questions about health (e.g. frequency of illnesses during the last year and during childhood), access to media (e.g. time spent watching television, frequency of internet use), education (i.e. highest level achieved) and violence perceptions. Participants' masculinity preferences for Salvadoran, European and Colombian male faces were recorded. Factor analysis revealed two different factors for the answers to questions related to violence. One factor loaded mostly on questions related to public violence and the second factor related to domestic violence. We found that women with higher scores on the domestic violence factor preferred significantly less masculine Colombian male faces. Even after controlling for participant age, education, access to media (TV and internet) and health-related factors, the domestic violence factor contributed significantly to explaining masculinity preferences. The results presented here suggest that women's preferences for masculinity may be a strategy to avoid aggressive partners and that the source of violence matters in mate choice. Significance statement:Women who perceive higher risks of domestic violence prefer less masculine looking partners. Using an experimental approach, we show that Colombian women who feel more in danger of violence within partnership prefer the faces of less masculine males. This was true even after controlling for women's education level, health and access to media.

Project description:BackgroundDown syndrome is a common chromosomal abnormality and prenatal screening can inform parents of the risk of their baby having Down syndrome. Little research has examined how decisions regarding both Down syndrome screening as well as diagnosis are made among women who are currently pregnant and how their decisions are influenced by their social contexts, specifically family and social media, using mixed methods. The study was to test the validity and reliability of a scale that measures pregnant women's attitudes and decision-making concerning prenatal Down syndrome screening and diagnosis in urban areas of Taiwan.MethodsWe developed an item pool based on a literature review and in-depth interviews with 30 pregnant women recruited at two district hospitals in urban areas. The item pool was reviewed by a panel of experts and then administered to 300 women who had been pregnant for less than 24 weeks and had not received the Down syndrome screening tests. We used item analysis and exploratory factor analysis to validate the scale and test its reliability.ResultsThe initial item pool had 54 items. After the expert review, three items were deleted. After the item analysis, 16 additional items were deleted. Exploratory factor analysis of the remaining items revealed four factors labeled - "Attitudes towards Down syndrome and Screening Tests," "Important others' Attitudes towards Down Syndrome," "Influence of Important Others on Decision-Making," and "Influence of Social Media on Decision-Making" - and 16 of the remaining items had satisfactory loadings on those factors, explaining 72.0% of the total variance. The Cronbach's α values of the dimensions ranged between 0.75 and 0.90, demonstrating satisfactory internal reliability.ConclusionsThe scale has satisfactory validity and reliability, and can be used to understand pregnant women's attitudes and decision-making regarding Down syndrome screening and diagnosis, and to help design tailored consultations for pregnant women in clinical settings.

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Facilitating autonomous, confident and satisfying choices: a mixed-method study of women's choice-making in prenatal screening for common aneuploidies.

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