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BMC Health Serv Res. 2018 Jun 8;18(1):434. doi: 10.1186/s12913-018-3244-1.

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

Author information

1
Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada.
2
Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.
3
Faculty of Nursing, Université Laval, Quebec, Canada.
4
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.
5
Quebec Centre of Excellence on Aging, Quebec, Canada.
6
Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec, Canada.
7
MSSS/FRQS/CHUQ Research Chair in Health Technology Assessment and Evidence Based Laboratory Medicine, CHU de Québec, Quebec, Canada.
8
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
9
Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada. france.legare@mfa.ulaval.ca.
10
Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada. france.legare@mfa.ulaval.ca.
11
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada. france.legare@mfa.ulaval.ca.
12
Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, entrée A-1-2, bureau A-4574, 2525, Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada. france.legare@mfa.ulaval.ca.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

An intervention to promote PtDA use among pregnant women for Down syndrome prenatal screening should incorporate the 10 BCTs identified.

KEYWORDS:

Behaviour change techniques; Behaviour change wheel; Down syndrome prenatal screening; Intervention; Patient decision aid; Pregnant women; Promotion; Shared decision making; Theoretical domains framework; Theory of planned behaviour

PMID:
29884169
PMCID:
PMC5994018
DOI:
10.1186/s12913-018-3244-1
[Indexed for MEDLINE]
Free PMC Article

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