title: Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey.
abstract: Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs.
  
  
  
  The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention.
  
  
  
  We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses.
  
  
  
  Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92).
  
  
  
  Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Agathe
authors: 0000-0001-9374-8904
authors: A
authors: Delanoë
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Johanie
authors: 0000-0001-8358-1362
authors: J
authors: Lépine
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Stéphane
authors: 0000-0002-4528-1315
authors: S
authors: Turcotte
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Maria Esther
authors: 0000-0002-9607-9117
authors: ME
authors: Leiva Portocarrero
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Hubert
authors: 0000-0001-5817-5602
authors: H
authors: Robitaille
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.|Quebec Centre of Excellence on Aging, CHU de Québec-Université Laval, Quebec City, QC, Canada.|Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
authors: Anik Mc
authors: 0000-0001-9928-7395
authors: AM
authors: Giguère
authors: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors: Brenda J
authors: 0000-0003-2145-5154
authors: BJ
authors: Wilson
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.|Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.|Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
authors: Holly O
authors: 0000-0003-4192-0682
authors: HO
authors: Witteman
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
authors: Isabelle
authors: 0000-0003-3436-2803
authors: I
authors: Lévesque
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.
authors: Laurence
authors: 0000-0003-1138-8285
authors: L
authors: Guillaumie
authors: Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.|Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.|Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
authors: France
authors: 0000-0002-2296-6696
authors: F
authors: Légaré
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D057220:Health Literacy / Q000379:methods*; D006801:Humans; D033182:Intention; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000523:psychology*; D011584:Psychology / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: behavior; decision aids; decision making; health literacy; intention; prenatal diagnosis