title: Ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome: a theoretical framework.
abstract: OBJECTIVE
  To develop a theoretical framework for analysing ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome.
  
  
  METHODS
  We applied Weinstein's Precaution Adoption Process (PAP) Model to the decision of whether or not to participate in prenatal screening for Down syndrome. The prenatal screening stage model was specified by reviewing the empirical literature and by data from seven focus group interviews with Dutch, Turkish and Surinamese pregnant women in the Netherlands.
  
  
  RESULTS
  We identified 11 empirical studies on ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. The focus group interviews showed that almost all stages and determinants in the stage model were relevant in women's decision-making process. However, there were ethnic variations in the relevance of determinants, such as beliefs about personal consequences of having a child with Down syndrome or cultural and religious norms.
  
  
  CONCLUSIONS
  The prenatal screening stage model can be applied as a framework to describe the decision-making process of pregnant women from different ethnic backgrounds. It provides scope for developing culturally sensitive, tailored methods to guide pregnant women towards informed decision-making on participation or non-participation in prenatal screening for Down syndrome.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. m.fransen@erasmusmc.nl
authors.forename: Mirjam P
authors.initials: MP
authors.lastname: Fransen
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: Anke
authors.initials: A
authors.lastname: Oenema
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Hajo I J
authors.initials: HI
authors.lastname: Wildschut
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis* / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D005817:Genetic Counseling / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D013532:Suriname / Q000208:ethnology; D014421:Turkey / Q000208:ethnology