Effect of culturally competent educational films about prenatal screening on informed decision making of pregnant women in the Netherlands

Picture this: Evaluating the efficacy of genetic counseling visual aids

Visual aids have been validated as effective tools for educating patients in a variety of medical settings. However, research exploring the efficacy and potential benefit of genetic counseling visual aids is lacking. To begin to address this gap, this study assessed participant knowledge of genetic counseling concepts after viewing either visual or non-visual educational content. Participants were recruited from the general population using the crowdsourcing platform Mechanical Turk. Wilcoxon rank-sum tests were carried out to evaluate differences in knowledge survey scores between the visual and non-visual groups, and Poisson regression models were fitted to evaluate these differences across a variety of demographic backgrounds. The visual group had equal or higher scores than the non-visual group across all analyses. The difference in group scores was statistically significant for autosomal recessive inheritance knowledge scores (p < 0.05). In addition, this difference was approaching significance for higher-level knowledge scores (p = 0.05) and total knowledge scores in individuals who have not completed post-secondary education (p = 0.05). These results indicate that visual aids improve knowledge of specific genetic counseling concepts such as inheritance patterns; the education of which is often integral to genetic counseling. These results also indicate that visual aids may facilitate a deeper understanding of genetic counseling concepts and may be particularly valuable for individuals with lower educational backgrounds. Together, the results of this study support the inclusion of visual aids in genetic counseling education to help improve patient understanding and the accessibility of genetic healthcare information.

Evaluation of a Web-Based Culturally Sensitive Educational Video to Facilitate Informed Cervical Cancer Screening Decisions Among Turkish- and Moroccan-Dutch Women Aged 30 to 60 Years: Randomized Intervention Study

Background

In the Netherlands, since 1996, a national cervical cancer (CC) screening program has been implemented for women aged 30 to 60 years. Regional screening organizations send an invitation letter and information brochure in Dutch to the home addresses of targeted women every 5 years. Although this screening is free of charge, Turkish- and Moroccan-Dutch women, especially, show low screening participation and limited informed decision-making (IDM). As Turkish- and Moroccan-Dutch women indicated their need for information on the practical, emotional, cultural, and religious aspects of CC screening, we developed a culturally sensitive educational video (CSEV) as an addition to the current information brochure.

Objective

In this study, we aimed to evaluate the added effect of the CSEV on IDM regarding CC screening participation among Turkish and Moroccan women aged 30 to 60 years in the Netherlands through a randomized intervention study.

Methods

Initial respondents were recruited via several social media platforms and invited to complete a web-based questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social networks to complete the same questionnaire. Respondents were randomly assigned to the control (current information brochure) or intervention condition (brochure and CSEV). We measured respondents’ knowledge and attitude regarding CC screening and their intention to participate in the next CC screening round before and after the control or intervention condition. We evaluated the added effect of the CSEV (above the brochure) on their knowledge, attitude, intention, and IDM using intention-to-treat analyses.

Results

The final sample (n=1564) included 686 (43.86%) Turkish and 878 (56.14%) Moroccan-Dutch women. Of this sample, 50.7% (793/1564) were randomized to the control group (350/793, 44.1% Turkish and 443/793, 55.9% Moroccan) and 49.3% (771/1564) to the intervention group (336/771, 43.6% Turkish and 435/771, 56.4% Moroccan). Among the Turkish-Dutch women, 33.1% (116/350) of the control respondents and 40.5% (136/336) of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% (125/443) and 37.9% (165/435), respectively (P=.003). Of all intervention respondents, 96.1% (323/336; Turkish) and 84.4% (367/435; Moroccan) consulted the CSEV. The CSEV resulted in more positive screening attitudes among Moroccan-Dutch women than the brochure (323/435, 74.3% vs 303/443, 68.4%; P=.07). Women, who had never participated in CC screening before, showed significantly more often a positive attitude toward CC screening compared with the control group (P=.01).

Conclusions

Our short and easily implementable CSEV resulted in more positive screening attitudes, especially in Moroccan-Dutch women. As the CSEV was also watched far more often than the current brochure was read, this intervention can contribute to better reach and more informed CC screening decisions among Turkish- and Moroccan-Dutch women.

Trial Registration

International Clinical Trial Registry Platform NL8453; https://tinyurl.com/2dvbjxvc

The development of a culturally sensitive educational video: How to facilitate informed decisions on cervical cancer screening among Turkish- and Moroccan-Dutch women

Background

In the Netherlands, all women aged 30–60 years are invited to participate in the national cervical cancer screening programme, which is aimed at early detection and treatment of precancerous lesions. One fourth of the Dutch population has a migration background, with Turkish and Moroccan immigrants being the largest immigrant populations. Turkish‐ and Moroccan‐Dutch women show lower screening participation rates and a higher incidence of cervical cancer, compared to native Dutch women. Since current information materials are not tailored to these women's needs, we developed a short culturally sensitive educational video to facilitate informed decision‐making for cervical cancer screening among Turkish‐ and Moroccan‐Dutch women. This article describes the development process of this video and the lessons learned.

Methods

Using the Entertainment–Education communication strategy, we collaborated with an interdisciplinary team of Turkish‐ and Moroccan‐Dutch women, researchers, public health experts, and creative media professionals. We developed the video following the different stages of the Media Mapping model: Orientation, Crystallization, Design/Production, Implementation, and Dissemination. Each stage is described in the paper.

Results

The video was developed in Moroccan‐Arabic, ‐Berber and Turkish, and emphasized three main themes: (1) more certainty about having cervical (pre)cancer and the possibility to prevent treatment, surgery, or premature death, and because of this, being there for the children, (2) according to the Islam, a woman should take good care of her health, and (3) anxiety, shame, and privacy.

Conclusions

A short culturally sensitive educational video, delivered as part of a larger intervention together with the current information brochure, was developed based on theory and grounded in the needs of Turkish‐ and Moroccan‐Dutch women. The value and effectiveness of this intervention to facilitate informed cervical cancer screening decisions are evaluated in a randomised controlled trial.

Patient or Public Contribution

We collaborated with Turkish‐ and Moroccan‐Dutch women during the development process of a short culturally sensitive educational video. Turkish‐ and Moroccan‐Dutch women were also invited to watch the raw footage to verify whether the content and presentation matched their needs and requirements.

Effectiveness of alternative prenatal genetic counselling methods in a cohort of pregnant women from a low socio-economic population

BACKGROUND

There are concerns about the capacity of healthcare providers to adequately counsel women on the implications of noninvasive prenatal screening (NIPS). Studies suggest that more resource-efficient counselling methods are needed for broad adoption.

AIMS

We prospectively examined the effectiveness of alternative methods of prenatal counselling on a patient's knowledge and understanding of prenatal testing choices, with a focus on NIPS. We also evaluated prenatal test choice and emotional well-being after making this decision.

METHODS

Women from a low socio-economic population were offered NIPS at no additional cost along with typical prenatal screening and diagnosis. Study participants underwent prenatal counselling via a web-based video consultation or a telephone consultation with a genetic counsellor. Participants were asked to complete pre-counselling and post-counselling questionnaires.

RESULTS

Of 1000 women enrolled, 600 completed both surveys in full and were included in the analysis. Of these, 354 (59%) underwent counselling via a telephone consultation and 246 (41%) via the web-based video consultation. Both counselling methods led to a significant increase in patient knowledge (P < 0.01). NIPS uptake was equivalent between groups. Patients expressed a high level (90%) of satisfaction with their prenatal screen choice, with no significant difference (P > 0.10) between telephone and web participants.

CONCLUSIONS

Alternative methods of counselling such as a web-based education portal can be highly effective and should be considered to enable informed decision-making prior to undergoing prenatal screening such as NIPS. Further, web-based education tools could be beneficial for those in rural areas with limited access to healthcare providers and non-native speakers.

To what extent do decision aids for prenatal screening and diagnosis address involvement of partners in decision-making? - An environmental scan

OBJECTIVE

Numerous decision aids (DAs) have been developed to inform pregnant people about prenatal screening as the decision whether or not to accept the prenatal screening offer may be difficult. Currently, little is known about the role of the decisional partner of the pregnant people in this decision-making process and to what extent DAs involve and engage the partner.

METHODS

A broad search was conducted to identify publicly available DAs in English and/or Dutch regarding prenatal screening and diagnosis. These DAs were analysed on aspects of partner involvement.

RESULTS

Ten of the 19 identified DAs (52.6%) contained at least one aspect of partner involvement. Several DAs acknowledged that both partners should be involved in the decision (n = 7). The content that was least likely to contain aspects of partner involvement in the DA was value clarification content (n = 2) and only one DA contained content with plural addressing.

CONCLUSION

Just over half of the included DAs included some aspect(s) of partner involvement.

PRACTICAL IMPLICATIONS

More research is needed to determine to what extent, and how, the partner should be involved in the decision-making process as expectant people consider the input of their partner as important.

Counselling and education for prenatal screening and diagnostic tests for pregnant women: Randomized controlled trial

AIM

The aim of this study is to evaluate the effect of education and counselling on prenatal screening and diagnostic tests on pregnant women's decisional conflict, anxiety levels and attitudes towards the tests.

BACKGROUND

Clinical practice guidelines recommend prenatal genetic counselling for pregnant women before participation in the tests.

METHODS

A total of 210 pregnant women participated in the study by completing the State-Trait Anxiety Inventory-I, Decisional Conflict Scale, SURE Scale, Knowledge Assessment Forms, Decision Satisfaction Form and Attitudes Scale between June 2017 and March 2018. In the first stage, pregnant women were evaluated who had only prenatal genetic screening tests and in the second stage, pregnant women who had been recommended to receive diagnostic tests. The intervention group received face-to-face individual education and counselling about prenatal genetic tests. Independent samples t test, t tests and Pearson correlation tests were used.

RESULTS

Education and counselling for prenatal screening tests and diagnostic tests from the first weeks of pregnancy were effective in decreasing anxiety, decisional conflict, increasing attitudes towards tests and had positive effects on pregnant women's knowledge level and decision satisfaction (P < 0.005).

CONCLUSION

Prenatal genetic counselling and education are more effective if provided from the first weeks of pregnancy. Decreasing anxiety, decisional conflict and increasing knowledge levels of pregnant women are important to make informed decisions.

A Systematic Review of Perinatal Social Support Interventions for Asylum-seeking and Refugee Women Residing in Europe

Asylum-seeking and refugee women currently residing in Europe face unique challenges in the perinatal period. A range of social support interventions have been developed to address these challenges. However, little is known about which women value and why. A critical interpretive synthesis was undertaken using peer reviewed and grey literature to explore the nature, context and impact of these perinatal social support interventions on the wellbeing of asylum-seeking and refugee women. Four types of interventions were identified which had varying impacts on women's experiences. The impacts of the interventions were synthesised into five themes: Alleviation of being alone, Safety and trust, Practical knowledge and learning, being cared for and emotional support, and increased confidence in and beyond the intervention. The interventions which were most valued by women were those using a community-based befriending/peer support approach as these provided the most holistic approach to addressing women's needs.

Clients' perspectives on the quality of counseling for prenatal anomaly screening. A comparison between 2011 and 2019

OBJECTIVE

There have been substantial medical developments in prenatal anomaly and aneuploidy screening. However, the quality of counseling about these tests tends to lag behind. Additional quality requirements were therefore implemented in the Netherlands in 2017 to optimize this counseling. We compared clients' counseling preferences and experiences before and after implementation of these requirements.

METHODS

We used the validated 57-item QUOTE^prenatal questionnaire, to measure clients' counseling preferences and experiences before and after counseling in 20 obstetric organizations throughout the Netherlands. Clients' preferences and experiences were compared between pregnant women and partners, nulliparous versus multiparous clients and between results of a Dutch survey in 2011 and the current one.

RESULTS

Sixty-five counselors and 649 clients (353 pregnant women and 296 partners) participated in this study. Compared to 2011, slightly more clients considered the three QUOTE^prenatal components of counseling (client-counselor relationship, health education, and decision-making support) to be either important or very important, especially decision-making support. More clients than in 2011 perceived their needs as being well addressed, with the lowest percentages for decision-making support.

CONCLUSION

Quality requirements seem to benefit the quality of counseling, as perceived by clients.

PRACTICAL IMPLICATIONS

Counselors should consider tailoring their decision-making support more to clients' needs.

Interventions aiming to improve informed decision on prenatal screening and testing: A scoping review of the literature

The aim of this scoping review was to explore interventions and their effect in facilitating decision making on prenatal screening and testing among pregnant women. This review was conducted according to the Joanna Briggs Institute Methods Manual for scoping reviews. Studies published 2000-2019 that consist of interventions to facilitate pregnant women's decision making in prenatal screening and testing were specifically reviewed. A total of 27 studies are included in this scoping review. In these studies, various methods, including face-to-face individual or group interventions, e-Health interventions, video-based interventions, written educational materials, and decision aid interventions, were developed and tested for their effectiveness in facilitating informed decision making on prenatal screening and testing. While these methods appeared to be effective, further studies involving diverse populations are needed to integrate them into practice. Genetic counselors and healthcare providers working with individuals who are referred for genetic education and counseling need to work collaboratively to facilitate informed decisions on prenatal screening of women and/or their partners.

"No one to consult! That is the hardest part" choice-making experiences for prenatal screening tests among Japanese women and their spouses in Austria - A qualitative interview study

OBJECTIVE

Japan is the only country in the world that allows abortions due to economic reasons but illegalise them due to foetal anomaly. The objective of this study was to explore the choice-making experiences for prenatal screening among Japanese women and their spouses in Austria.

METHODS

We conducted a qualitative study using semi-structured face-to-face interviews with Japanese women and their spouses in Austria. Data were analysed using thematic analysis.

RESULTS

Twenty-five participants (14 women and 11 men) took part in the interviews. Four themes were identified: 1) Knowledge, information and memory; 2) Communication and interactions with health professionals; 3) Reasons for choice; and 4) Emotional support. Participants had limited knowledge and experienced directive counselling. Women expressed negative emotions in the choice-making processes, did not perceive husbands as a source of support and lacked a person to consult.

CONCLUSION

There are common characteristics among East Asian population despite different context and differences found between our Japanese participants and women in other European countries.

PRACTICE IMPLICATION

Proactive interventions aimed at increasing knowledge that help women to develop their preferences and reflect on their values could be further promoted among women of all socio-cultural backgrounds in Austria.

Inequalities in uptake of prenatal screening according to ethnicity and socio-economic status in the four largest cities of the Netherlands (2011-2013)

OBJECTIVES

In the Netherlands, all women are claimed to have equal access to prenatal screening (PS). Prior research demonstrated substantial inequalities in PS uptake associated with socioeconomic status (SES) and ethnic background. The suggested pathway was a lack of intention to participate in PS among these subgroups. We studied the background of inequalities in PS participation, challenging intention heterogeneity as the single explanation.

METHODS

Multivariable logistic regression analyses of the national PS registry, focusing on the four largest cities in the Netherlands (n = 4578, years 2011-2013), stratified by SES.

OUTCOME MEASURES

(1) any uptake of PS (yes/no) and (2) uptake (one/two tests) for women who intended to participate in two tests. Determinants included intention, ethnicity, practice, and age.

RESULTS

Of non-Western women, 85.7% were screened versus 89.7% of Western women. Intention was an important explanatory factor in all models. However, after correction for intention, ethnicity remained a significant determinant for differences in uptake. Ethnicity and SES also interacted, indicating that non-Western women in low SES areas had the lowest uptake (corrected for intention).

CONCLUSIONS FOR PRACTICE

Socioeconomic status and ethnicity related inequalities in PS uptake are only partially explained by intention heterogeneity; other pathways, in particular provider-related determinants, may play a role. © 2017 John Wiley & Sons, Ltd.