title: Socioeconomic Differences in Informed Decisions About Down Syndrome Screening: A Systematic Review and Research Agenda.
abstract: Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.
authors.affiliation: a Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine , University of New South Wales , Sydney , New South Wales , Australia.
authors.forename: Sian K
authors.initials: SK
authors.lastname: Smith
authors.affiliation: b Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia.|c Prince of Wales Clinical School , University of New South Wales , Sydney , New South Wales , Australia.
authors.forename: Mariana S
authors.initials: MS
authors.lastname: Sousa
authors.affiliation: d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: e Murdoch Children's Research Institute , Royal Children's Hospital , Melbourne , Victoria , Australia.|f Department of Paediatrics , University of Melbourne , Parkville , Victoria , Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Halliday
authors.affiliation: g Department of Obstetrics and Gynaecology, Royal Women's Hospital , University of Melbourne , Parkville , Victoria , Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Peate
authors.affiliation: d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Fransen
mesh_terms: D002755:Choice Behavior; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007258:Informed Consent; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors