title: Factors associated with utilization of maternal serum screening for Down syndrome in mainland China: a cross-sectional study.
abstract: BACKGROUND
  Knowledge of the factors that influence maternal serum screening (MSS) service utilization can be used to develop health policies to promote equitable access to MSS and further diagnostic tests. The purpose of this study was to find the factors associated with utilization of MSS as well as the current status of service utilization in mainland China.
  
  
  METHODS
  This was a hospital-based cross-sectional study with respondents interviewed with a questionnaire designed based on Andersen's behavioral model. Descriptive statistics, univariate analysis, and multilevel logistic regression analysis were used to identify the factors associated with MSS utilization, and to explore potential methods to improve screening uptake.
  
  
  RESULTS
  A total of 8110 women who had given birth within the previous 7 days in one of 111 participating institutions from six provinces in mainland China were interviewed. Approximately 36% of the participants had used MSS. Women between 20 and 35 years, who resided in urban areas, were educated, were in a stable occupation, who had health knowledge, who attended maternal preparation classes, who had received eight or more prenatal checkups, who were from a region of higher social economic status, and who delivered in a tertiary healthcare institution were significantly more likely to use MSS than their counterparts. As compared with other factors, insufficient education is the single most important demographic factor for service underutilization.
  
  
  CONCLUSIONS
  Efforts should not only be made to target the population that underuses MSS, but the overall organization of MSS service delivery should be assessed during policy development to make access to MSS equitable to the entire population of mainland China.
authors.affiliation: School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC. lichuanlin@shdc.org.cn.
authors.forename: Chuanlin
authors.initials: C
authors.lastname: Li
authors.affiliation: Primary Care Policy Center, Johns Hopkins, Baltimore, MD, 21205, USA. lshi2@jhu.edu.
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.affiliation: School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC. jyhuang@shmu.edu.cn.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC. jyhuang@shmu.edu.cn.
authors.forename: Jiayan
authors.initials: J
authors.lastname: Huang
authors.affiliation: School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC. xqian@shmu.edu.cn.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC. xqian@shmu.edu.cn.
authors.forename: Xu
authors.initials: X
authors.lastname: Qian
authors.affiliation: School of Public Health, Key Lab of Health Technology Assessment (Ministry of Health), Fudan University, No.138 Yixueyuan Rd, Post box No. 197, Shanghai, 200032, PRC. yychen@shmu.edu.cn.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC. yychen@shmu.edu.cn.
authors.forename: Yingyao
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D004314:Down Syndrome / Q000097:blood* / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D005820:Genetic Testing / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011296:Prenatal Diagnosis / Q000379:methods*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires