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

• Published in: BMC health services research 2018-06, Vol.18 (1), p.434-434, Article 434
• Main Authors: Agbadjé, Titilayo Tatiana, Menear, Matthew, Dugas, Michèle, Gagnon, Marie-Pierre, Rahimi, Samira Abbasgholizadeh, Robitaille, Hubert, Giguère, Anik M C, Rousseau, François, Wilson, Brenda J, Légaré, France
• Format: Article
• Language: English
• Subjects: Adult; Amniocentesis; Attitude to Health; Behavior modification; Behavior Therapy - methods; Behaviour change techniques; Behaviour change wheel; Beliefs, opinions and attitudes; Cardiovascular disease; Clinical decision making; Decision Making; Decision Support Techniques; Design; Diabetes; Down syndrome; Down Syndrome - diagnosis; Family Practice - statistics & numerical data; Female; Focus Groups; Health aspects; Health services; Humans; Intervention; Medical screening; Patient decision aid; Pregnancy; Pregnant women; Pregnant Women - psychology; Prenatal care; Prenatal Care - psychology; Prenatal Diagnosis - psychology; Prenatal Diagnosis - statistics & numerical data; Procedures and Techniques Utilization; Qualitative Research; Quebec; Referral and Consultation - statistics & numerical data; Reward; Social Support; Systematic review; Theoretical domains framework; Theory; Theory of planned behaviour; Womens health; Young Adult
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3244-1

For pregnant women and their partners, the decision to undergo Down syndrome prenatal screening is difficult. Patient decision aids (PtDA) can help them make an informed decision. We aimed to identify behaviour change techniques (BCTs) that would be useful in an intervention to promote the use of a PtDA for Down syndrome prenatal screening, and to identify which of these BCTs pregnant women found relevant and acceptable. Using the Behaviour Change Wheel and the Theoretical Domains Framework, we conducted a qualitative descriptive study. First, a group of experts from diverse professions, disciplines and backgrounds (eg. medicine, engineering, implementation science, community and public health, shared decision making) identified relevant BCTs. Then we recruited pregnant women consulting for prenatal care in three clinical sites: a family medicine group, a birthing centre (midwives) and a hospital obstetrics department in Quebec City, Canada. To be eligible, participants had to be at least 18 years old, having recently given birth or at least 16 weeks pregnant with a low-risk pregnancy, and have already decided about prenatal screening. We conducted three focus groups and asked questions about the relevance and acceptability of the BCTs. We analysed verbatim transcripts and reduced the BCTs to those the women found most relevant and acceptable. Our group of experts identified 25 relevant BCTs relating to information, support, consequences, others' approval, learning, reward, environmental change and mode of delivery. Fifteen women participated in the study with a mean age of 27 years. Of these, 67% (n = 10) were pregnant for the first time, 20% (n = 3) had difficulty making the decision to take the test, and 73% had made the decision with their partner. Of the 25 BCTs identified using the Behaviour Change Wheel, the women found the following 10 to be most acceptable and relevant: goal setting (behaviour), goal setting (results), problem solving, action plan, social support (general), social support (practical), restructuring the physical environment, prompts/cues, credible sources and modelling or demonstration of the behaviour. An intervention to promote PtDA use among pregnant women for Down syndrome prenatal screening should incorporate the 10 BCTs identified.