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Kater-Kuipers A, Bakkeren IM, Riedijk SR, Go ATJI, Polak MG, Galjaard RJH, de Beaufort ID, Bunnik EM. Non-invasive prenatal testing (NIPT): societal pressure or freedom of choice? A vignette study of Dutch citizens' attitudes. Eur J Hum Genet 2020; 29:2-10. [PMID: 32759960 DOI: 10.1038/s41431-020-0686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
The introduction of the accurate and procedurally easy non-invasive prenatal test (NIPT) raises ethical concerns that public attitudes towards prenatal screening may change, leading to societal pressure to participate in aneuploidy screening. This study examined Dutch citizens' attitudes towards a pregnant woman's decision to (1) decline NIPT in the context of two different funding policies and (2) to terminate or continue a pregnancy affected by different disorders. The attitudes of 1096 respondents were assessed with the contrastive vignette method, using two pairs of vignettes about declining NIPT and termination of pregnancy. Most respondents either agreed with a woman's decision to decline NIPT or were neutral about it, stating that this decision should be made independently by women, and does not warrant judgement by others. Interestingly, funding policies did influence respondents' attitudes: significantly more respondents disagreed with declining NIPT when it was fully reimbursed. Respondents had similar attitudes to the vignettes on termination and continuation of pregnancy in case of Down's syndrome. In case of Edwards' or Patau's syndrome, however, significantly more respondents disagreed with continuation, citing the severity of the disorder and the child's best interests. This study demonstrates broad acknowledgement of women's freedom of choice in Dutch society; a finding that may help to rebut existing concerns about societal pressure for pregnant women to participate in prenatal screening. As the reimbursement policy and the scope of NIPT may influence people's attitudes and elicit moral judgements, however, maintaining freedom of choice warrants sustained efforts by health professionals and policy makers.
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Affiliation(s)
- Adriana Kater-Kuipers
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Iris M Bakkeren
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sam R Riedijk
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marike G Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eline M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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2
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Peters IA, Heetkamp KM, Ursem NTC, Steegers EAP, Denktaş S, Knapen MFCM. Ethnicity and Language Proficiency Differences in the Provision of and Intention to Use Prenatal Screening for Down's Syndrome and Congenital Anomalies. A Prospective, Non-selected, Register-Based Study in the Netherlands. Matern Child Health J 2019; 22:343-354. [PMID: 28884405 PMCID: PMC5845051 DOI: 10.1007/s10995-017-2364-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective We aimed to conduct an analysis of the associations between the information provision procedure of prenatal screening for Down's syndrome and congenital anomalies and the intention to participate in prenatal screening (PS) of ethnicity groups and Dutch language proficiency groups. Design Using a prospective web-based registration form, we asked counselors (midwives, general practitioners, nurses and gynecologists) to report whether and how they offered information about PS to pregnant women. Duration The study was conducted from 2008 to 2010. Participants We collected data on the characteristics of the women who received an information offer about PS from counselors. Measurements Measures included socio-demographic and language proficiency level (LPL) characteristics, key elements of the provision procedure of PS, and intentional participation in PS. Findings The dataset represents 37% of the total population in the study area. Women with a non-native Dutch background and/or insufficient Dutch LPL received fewer information offers about PS, faced a reduced chance of receiving counseling, and showed lower intentional participation rates for PS. Key Conclusions Women with a non-native Dutch background and/or with an insufficient LPL are underserved in the Dutch PS program. These findings present evidence indicating that the fundamental principle of the Dutch Population Screening Act, namely, equal access to PS for all pregnant women, is not being realized. Implications for Practice Therefore, the study findings are important for national and international healthcare, policy makers and governmental professionals to allow ethnic and LPL-related differences in the provision and intentional uptake of PS.
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Affiliation(s)
- Ingrid A Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands. .,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands.
| | - Kirsten M Heetkamp
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - Nicolette T C Ursem
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands
| | - Semiha Denktaş
- Department Social and Behavioural Sciences, EUC/Erasmus University Rotterdam, Nieuwemarkt 1a, 3011 HP, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
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Hjort-Pedersen K, Olesen AW, Garne E, Sperling L. Reasons for non-participation in malformation scans in Denmark: a cohort study. BMC Pregnancy Childbirth 2018; 18:231. [PMID: 29898683 PMCID: PMC6001061 DOI: 10.1186/s12884-018-1877-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background The aim of the study was to estimate the proportion of women giving birth in two hospitals in the Region of Southern Denmark who did not attend the malformation scan and to elucidate the reasons for not participating. Methods In this register-based descriptive study, we used patient administration systems to identify women who had given birth at two Danish hospitals between March 2013 and January 2015. We then linked this information with the hospital database for fetal medicine (Astraia) to identify women who did not attend the malformation scan at week 18–20. We reviewed the medical records of these women to validate the data and to identify the reason for non-participation. Results Of 7690 births, 153 (2%) women did not attend the malformation scan. The main reason for non-participation was a passive deselection (81%). Most of these women were not present in Denmark at the time of the malformation scan (61%) and few women declined (8%). Conclusions Less than 2% of a birth cohort in two major hospitals in Denmark did not attend the free offer of a malformation scan. Most of these women (81%) did not actively decide against the malformation scan. Very few (0.2%) declined the malformation scan. Non-attendance is not always due to an active decision made by the pregnant woman. Electronic supplementary material The online version of this article (10.1186/s12884-018-1877-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karina Hjort-Pedersen
- Research Unit of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kloevervaenget 10, 10th floor, 5000, Odense C, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Annette Wind Olesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Soendre Blvd., 5000, Odense C, Denmark
| | - Ester Garne
- Paediatric Department, Lillebaelt Hospital, Kolding, Denmark
| | - Lene Sperling
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Soendre Blvd., 5000, Odense C, Denmark
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Chen A, Tenhunen H, Torkki P, Peltokorpi A, Heinonen S, Lillrank P, Stefanovic V. Facilitating autonomous, confident and satisfying choices: a mixed-method study of women's choice-making in prenatal screening for common aneuploidies. BMC Pregnancy Childbirth 2018; 18:119. [PMID: 29720125 PMCID: PMC5930782 DOI: 10.1186/s12884-018-1752-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background Population-based prenatal screening has become a common and widely available obstetrical practice in majority of developed countries. Under the patient autonomy principle, women should understand the screening options, be able to take their personal preferences and situations into account, and be encouraged to make autonomous and intentional decisions. The majority of the current research focuses on the prenatal screening uptake rate, women’s choice on screening tests, and the influential factors. However, little attention has been paid to women’s choice-making processes and experiences in prenatal screening and their influences on choice satisfaction. Understanding women’s choice-making processes and experiences in pregnancy and childbirth is the prerequisite for designing women-centered choice aids and delivering women-centered maternity care. This paper presents a pilot study that aims to investigate women’s experiences when they make choices for screening tests, quantify the choice-making experience, and identify the experiential factors that affect women’s satisfaction on choices they made. Method We conducted a mixed-method research at Helsinki and Uusimaa Hospital District (HUS) in Finland. First, the women’s choice-making experiences were explored by semi-structured interviews. We interviewed 28 women who participated in prenatal screening. The interview data was processed by thematic analysis. Then, a cross-sectional self-completion survey was designed and implemented, assessing women’s experiences in choice-making and identifying the experiential factors that influence choice satisfaction. Of 940 distributed questionnaires, 185 responses were received. Multivariable linear regression analysis was used to detect the effects of the variables. Results We developed a set of measurements for women’s choice-making experiences in prenatal screening with seven variables: activeness, informedness, confidence, social pressure, difficulty, positive emotion and negative emotion. Regression revealed that activeness in choice-making (β = 0.176; p = 0.023), confidence in choice-making (β = 0.388; p < 0.001), perceived social pressure (β = − 0.306; p < 0.001) and perceived difficulty (β = − 0.274; p < 0.001) significantly influenced women’s choice satisfaction in prenatal screening. Conclusions This study explores the experiential dimension of women’s choice-making in prenatal screening. Our result will be useful for service providers to design women-centered choice environment. Women’s willingness and capabilities of making active choices, their preferences, and social reliance should be well considered in order to facilitate autonomous, confident and satisfying choices. Electronic supplementary material The online version of this article (10.1186/s12884-018-1752-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, 00076, Espoo, Finland.
| | - Henni Tenhunen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, 00076, Espoo, Finland
| | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, 00076, Espoo, Finland.,Department of Public Health, Faculty of Medicine, Helsinki University, Biomedicum 1, 00290, Helsinki, Finland
| | - Antti Peltokorpi
- Department of Civil Engineering, Aalto University, Rakentajanaukio 4, 02150, Espoo, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Paul Lillrank
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, 00076, Espoo, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
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Voorwinden JS, Buitenhuis AH, Birnie E, Lucassen AM, Verkerk MA, van Langen IM, Plantinga M, Ranchor AV. Expanded carrier screening: what determines intended participation and can this be influenced by message framing and narrative information? Eur J Hum Genet 2017; 25:793-800. [PMID: 28594415 PMCID: PMC5520082 DOI: 10.1038/ejhg.2017.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/10/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022] Open
Abstract
Next-generation sequencing enabled us to create a population-based expanded carrier screening (ECS) test that simultaneously tests for 50 serious autosomal recessive diseases. Before offering this test universally, we wanted to know what factors are related to intended participation and how the general public can be informed about the test without being influenced in their intention to participate. We studied this by measuring to what extent 'message framing' and 'narrative information' can influence people's intended participation. Data were collected by means of an online survey of 504 potential users, and the factors examined were based on the Theory of Planned Behaviour and on previous research on intended participation in preconception carrier screening. Message framing was manipulated by explaining the risk of couple carriership in different ways, while narrative information was provided to only half of the respondents. The factors most positively related to intended participation were perceiving benefits of the screening, having a positive attitude towards the screening, having no religion, having an actual child wish and experiencing the choice to participate as easy. Perceived benefits and a positive attitude were most influential factors by far. Message framing and narrative information had no significant effect on intended participation, reinforcing that message framing and narrative information can help to inform the general public about ECS without influencing their intended participation. Future research should study if the importance of perceived benefits and a positive attitude can be replicated when other factors are included and when actual participation is measured instead of intended participation.
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Affiliation(s)
- Jan S Voorwinden
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne H Buitenhuis
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke M Lucassen
- Department of Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marian A Verkerk
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mirjam Plantinga
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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6
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Crombag NMTH, Lamain-de Ruiter M, Kwee A, Schielen PCJI, Bensing JM, Visser GHA, Franx A, Koster MPH. Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women: a qualitative study. BMC Pregnancy Childbirth 2017; 17:12. [PMID: 28061818 PMCID: PMC5219667 DOI: 10.1186/s12884-016-1195-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/13/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation. METHOD Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers. RESULTS Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety. CONCLUSION Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.
| | - Marije Lamain-de Ruiter
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,The Netherlands Institute for Health Services Research Utrecht, Utrecht, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.,Department of obstetrics and gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Petersson K, Lindkvist M, Persson M, Conner P, Åhman A, Mogren I. Prenatal diagnosis in Sweden 2011 to 2013-a register-based study. BMC Pregnancy Childbirth 2016; 16:365. [PMID: 27876014 PMCID: PMC5120496 DOI: 10.1186/s12884-016-1165-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal diagnosis involves methods used in early pregnancy as either screening tests or diagnostic methods. The aims of the study were to i) investigate guidelines on prenatal diagnosis in the counties of Sweden, ii) investigate uptake of prenatal diagnosis, and iii) background characteristics and pregnancy outcomes in relation to different prenatal diagnostic methods. METHODS A retrospective cross-sectional study using data from the Swedish Pregnancy Register 2011 to 2013 (284,789 pregnancies) was performed. Additionally, guidelines on prenatal diagnosis were collected. Biostatistical and epidemiological analyses were performed including calculation of odds ratios (OR) and their 95% confidence intervals in univariate and multivariate logistic regression analyses. RESULTS The national uptake of routine ultrasound examination, Combined Ultrasound and Biochemical test (CUB), Amniocentesis (AC) and Chorionic Villus Sampling (CVS) were 97.6, 33.0, 2.6 and 1.1%, respectively. From 2012, 6/21 counties offered CUB test to all pregnant women, nine counties at specific indications, and five counties did not offer CUB at all. Advanced maternal age demonstrated the highest impact on uptake of prenatal diagnosis. Further, university educational level in relation to lower educational level was associated with an increased likelihood of undergoing CUB (OR 2.30, 95% CI 2.26-2.35), AC (OR 1.54, 95% CI 1.46-1.63) and CVS (OR 2.68, 95% CI 2.44-2.93). CONCLUSION Offers of prenatal diagnosis varied considerably between counties resulting in unequal access to prenatal diagnosis for pregnant women. The intentions of the Swedish Health and Medical Services Act stating equal care for all, was thus not fulfilled.
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Affiliation(s)
- Kerstin Petersson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Marie Lindkvist
- Department of Statistics, USBE; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Peter Conner
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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8
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Naqvi M, Goldfarb IT, Hanmer KJ, Bryant A. Chromosomal microarray use among women undergoing invasive prenatal diagnosis. Prenat Diagn 2016; 36:656-61. [DOI: 10.1002/pd.4835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Mariam Naqvi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; Massachusetts General Hospital; Boston MA USA
| | - Ilona T. Goldfarb
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; Massachusetts General Hospital; Boston MA USA
| | - Kaitlin J. Hanmer
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; Massachusetts General Hospital; Boston MA USA
| | - Allison Bryant
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; Massachusetts General Hospital; Boston MA USA
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9
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Crombag NMTH, Boeije H, Iedema-Kuiper R, Schielen PCJI, Visser GHA, Bensing JM. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics: a qualitative study. BMC Pregnancy Childbirth 2016; 16:121. [PMID: 27229318 PMCID: PMC4880977 DOI: 10.1186/s12884-016-0910-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicalisation, with pregnant women initially considered to be at low risk. Prenatal screening for Down syndrome is offered to all women, with a 'right not to know' for women who do not want to be informed on this screening. At the time this study was performed, the test was not reimbursed for women aged 35 and younger. METHODS We conducted a qualitative study to explore reasons for participation and possible influences of healthcare system characteristics. Data were collected via ten semi-structured focus groups with women declining or accepting the offer of Down syndrome screening (n = 46). All focus groups were audio- and videotaped, transcribed verbatim, coded and content analysed. RESULTS Women declining Down syndrome screening did not consider Down syndrome a condition severe enough to justify termination of pregnancy. Young women declining felt supported in their decision by perceived confirmation of their obstetric caregiver and reassured by system characteristics (costs and age restriction). Women accepting Down syndrome screening mainly wanted to be reassured or be prepared to care for a child with Down syndrome. By weighing up the pros and cons of testing, obstetric caregivers supported young women who accepted in the decision-making process. This was helpful, although some felt the need to defend their decision to accept the test offer due to their young age. For some young women accepting testing, costs were considered a disincentive to participate. CONCLUSIONS Presentation of prenatal screening affects how the offer is attended to, perceived and utilised. By offering screening with age restriction and additional costs, declining is considered the preferred choice, which might account for low Dutch uptake rates. Autonomous and informed decision-making in Down syndrome screening should be based on the personal interest in knowing the individual risk of having a child with Down syndrome and system characteristics should not influence participation.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands.
| | - Hennie Boeije
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Rita Iedema-Kuiper
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands
| | - Jozien M Bensing
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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10
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Li C, Shi L, Huang J, Qian X, Chen Y. Factors associated with utilization of maternal serum screening for Down syndrome in mainland China: a cross-sectional study. BMC Health Serv Res 2016; 16:8. [PMID: 26762138 PMCID: PMC4712508 DOI: 10.1186/s12913-016-1260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/07/2016] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Chuanlin Li
- 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.
| | - Leiyu Shi
- Primary Care Policy Center, Johns Hopkins, Baltimore, MD, 21205, USA.
| | - Jiayan Huang
- 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.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
| | - Xu Qian
- 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.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
| | - Yingyao Chen
- 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.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, 200032, PRC.
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