Chen An, Tenhunen Henni, Torkki Paulus, Heinonen Seppo, Lillrank Paul, Stefanovic Vedran
Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland.
Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
PLoS One. 2017 Mar 29;12(3):e0173669. doi: 10.1371/journal.pone.0173669. eCollection 2017.
Nowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women's choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies.
This is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women's choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women's choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis.
Statistical data indicated that gestational age and counseling day were strong factors influencing women's choice. Interview data revealed that women's values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs.
Values are the determinants of women's choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.
如今，孕妇面临的一个重要决定是是否进行非整倍体的产前检测以及采用哪种检测方法。我们研究了在先验胎儿非整倍体风险升高的妊娠中，影响女性在无创产前检测（NIPT）和侵入性产前检测之间做出选择的因素。
这是一项混合方法研究。我们使用了（2015年1月1日至2015年12月31日）在赫尔辛基大学医院母婴医学中心参与进一步检测的女性的医学数据，并采用卡方检验和方差分析来比较选择不同方法的女性群体。多项逻辑回归揭示了影响女性选择的重要临床因素。我们通过运用计划行为理论框架访谈女性，探索了影响女性选择的潜在价值观、信念、态度和其他社会心理因素。半结构化访谈数据通过主题分析进行处理。
统计数据表明，孕周和咨询日期是影响女性选择的重要因素。访谈数据显示，女性在怀孕和分娩方面的价值观和道德原则主要决定了选择。行为信念（如安全性和准确性）以及感知到的选择控制（如简便性、快速性和便利性）也很重要，并且这些因素之间存在主要的权衡。
价值观是女性选择的决定因素。服务的可获得性和便利性是重要因素。在此选择背景下的医疗风险状况影响不大。可以通过帮助女性确定她们在产前检测中的主要价值观，并提供与价值观匹配的检测选项和属性列表来开发选择辅助工具。
