Abstract
BackgroundFor pregnant women and their partners, the decision to undergo Down syndrome prenatal screening is difficult. Patient decision aids (PtDA) can help them make an informed decision. We aimed to identify behaviour change techniques (BCTs) that would be useful in an intervention to promote the use of a PtDA for Down syndrome prenatal screening, and to identify which of these BCTs pregnant women found relevant and acceptable.MethodsUsing the Behaviour Change Wheel and the Theoretical Domains Framework, we conducted a qualitative descriptive study. First, a group of experts from diverse professions, disciplines and backgrounds (eg. medicine, engineering, implementation science, community and public health, shared decision making) identified relevant BCTs. Then we recruited pregnant women consulting for prenatal care in three clinical sites: a family medicine group, a birthing centre (midwives) and a hospital obstetrics department in Quebec City, Canada. To be eligible, participants had to be at least 18 years old, having recently given birth or at least 16 weeks pregnant with a low-risk pregnancy, and have already decided about prenatal screening. We conducted three focus groups and asked questions about the relevance and acceptability of the BCTs. We analysed verbatim transcripts and reduced the BCTs to those the women found most relevant and acceptable.ResultsOur group of experts identified 25 relevant BCTs relating to information, support, consequences, others’ approval, learning, reward, environmental change and mode of delivery. Fifteen women participated in the study with a mean age of 27 years. Of these, 67% (n = 10) were pregnant for the first time, 20% (n = 3) had difficulty making the decision to take the test, and 73% had made the decision with their partner. Of the 25 BCTs identified using the Behaviour Change Wheel, the women found the following 10 to be most acceptable and relevant: goal setting (behaviour), goal setting (results), problem solving, action plan, social support (general), social support (practical), restructuring the physical environment, prompts/cues, credible sources and modelling or demonstration of the behaviour.ConclusionsAn intervention to promote PtDA use among pregnant women for Down syndrome prenatal screening should incorporate the 10 BCTs identified.
Highlights
For pregnant women and their partners, the decision to undergo Down syndrome prenatal screening is difficult
We propose that the resulting intervention may improve pregnant women’s intention to adopt these tools for Down syndrome (DS) screening, and, potentially, their decisional and health outcomes
In Process 2, we identified Behaviour change techniques (BCT) related to our two Theoretical Domains Framework (TDF) domains
Summary
For pregnant women and their partners, the decision to undergo Down syndrome prenatal screening is difficult. We aimed to identify behaviour change techniques (BCTs) that would be useful in an intervention to promote the use of a PtDA for Down syndrome prenatal screening, and to identify which of these BCTs pregnant women found relevant and acceptable. DS prenatal screening can result in false positives that produce needless anxiety, or lead to unnecessary diagnostic testing with the risk of miscarriage [1, 3]. Positive results lead to increasingly difficult decisions, such as whether to do a more risky and invasive test (amniocentesis) and, possibly, whether to terminate the pregnancy or not [2, 4]. Given the difficult and value-laden nature of this decision [7], effective decision support is needed [8]
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