Key Lab of Health Technology Assessment (Ministry of Health), School of Public Health, Fudan University, Shanghai, China.
School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
Int J Technol Assess Health Care. 2020 Jun;36(3):239-244. doi: 10.1017/S0266462320000136. Epub 2020 Apr 28.
Physicians' attitudes and adoption behavior toward the delivery of prenatal tests take vital significance for its influence on their professional practice and patient acceptance. This study aimed to identify how physicians have perceived the diffusion of non-invasive prenatal testing (NIPT) in China.
A cross-sectional study was conducted from July 2016 to October 2016 in Shanghai, and Fujian and Sichuan Provinces in China. Physicians working on prenatal screening completed a self-report questionnaire. Following Roger's diffusion of innovation model, multivariable logistic regressions were performed separately for the following key elements of the theory which influence diffusion: physician-perceived attributes of NIPT, communication channels, the nature of the social system, the extent of change agent (who introduces innovations into a society), promotion efforts, and physicians' benefits from adopting NIPT.
Most specialists had a positive attitude (53.2 percent) toward NIPT, whereas 58.9 percent of physicians had already adopted NIPT in their clinical practice. Physician adoption of NIPT was positively associated with the strength of HTA evidence (p = .03), perceived communication frequency with colleagues (p = .04), adoption by other physicians (p = .07), hospital competition (p = .06), hospital teaching status (p = .02), perceived for-profit genetic testing company's promotion (p < .001), and perceived clinical practice skill improvement (p = .02). However, the adoption behavior toward NIPT may be negatively associated with physician-perceived ethical concerns of NIPT (p = .06).
Obstetricians and gynecologists' positive perceptions facilitate the adoption of NIPT. Combined with cost-effectiveness analysis of prenatal screening methods, health policy makers can promote the adoption of appropriate, cost-effective prenatal screening in pregnant women.
医生对产前检查的态度和采用行为对其专业实践和患者接受程度具有重要意义。本研究旨在确定医生如何看待中国无创产前检测（NIPT）的传播。
本研究于 2016 年 7 月至 10 月在中国上海、福建和四川进行了一项横断面研究。从事产前筛查的医生完成了一份自我报告问卷。根据罗杰斯创新扩散理论，我们分别对影响扩散的理论的以下关键要素进行了多变量逻辑回归分析：医生对 NIPT 的感知属性、沟通渠道、社会系统的性质、变革推动者（将创新引入社会的人）的程度、推广力度以及医生采用 NIPT 的收益。
大多数专家对 NIPT 持积极态度（53.2%），而 58.9%的医生已经将 NIPT 应用于临床实践。医生采用 NIPT 与 HTA 证据的强度呈正相关（p=0.03），与与同事沟通的频率（p=0.04）、其他医生的采用（p=0.07）、医院竞争（p=0.06）、医院教学地位（p=0.02）、感知营利性基因检测公司的推广（p<0.001）和感知临床实践技能提高（p=0.02）呈正相关。然而，NIPT 的采用行为可能与医生对 NIPT 的伦理关注呈负相关（p=0.06）。
妇产科医生的积极看法有助于 NIPT 的采用。结合产前筛查方法的成本效益分析，卫生政策制定者可以促进在孕妇中采用适当、具有成本效益的产前筛查。
