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Table 1 Six dimensions of women’s choice-making processes and experiences in prenatal screening

From: Facilitating autonomous, confident and satisfying choices: a mixed-method study of women’s choice-making in prenatal screening for common aneuploidies

Choice-making dimensions First trimester combined screening (22) Second trimester screening (6)
Active choice didn’t make active choices (16) “I didn’t choose the tests actively. I didn’t know much about the second trimester serum screening and I just participated in what was recommended” made active choices (6) “I made an active choice. It was my decision to participated in the first trimester combined screening, which is better than the other test” didn’t make active choices (5) “I didn’t choose the tests actively. The participation in screening is nothing, you just go and do what they (public health nurses) arrange for you.” made active choices (1) “I made an active choice. I consulted about the different options and I preferred the first trimester combined screening. But since I was traveling during the screening week, so I had to do the second trimester serum screening.
Informedness Information needs: the possible results of the tests (16); procedures of different programs (16); different options (10); the features, e.g. accuracy, risk and timing of the tests (7); advantages/disadvantage of tests (5); mechanisms and theories of tests (1) “I got the main information from Neuvola, including the practical information about the screening and its possible results, what it includes in the program and what the ultrasound means. This information is very important.” Information sources: Booklet in maternity care unit (16); Public health nurse of maternity care unit (10); Previous experience (8); Online information (4); Family members (1); Friends (1); “Information was given by Neuvola for sure, with the information about what it is and what is the expected outcome. I didn’t seek for information from other sources by myself.” Information needs: different options (6); the possible results of the tests (5); procedures of different programs (4); the features, e.g. accuracy, risk and timing of the tests (3); advantages/disadvantage of tests (3); mechanisms and theories of tests (0) “I could not take the first trimester screening. The midwife told me about the second trimester screening. The timing and schedule information were very important in my case.” Information sources: Booklet in maternity care unit (6); Public health nurse of maternity care unit (6); Online information (2); Previous experience (2); Family members (1); Friends (0); “The nurse told me about the second trimester screening. I did check the information about screening from internet after that (after I decided to do it). I didn’t ask any friends.”
Main preferences/considerations Reliability/Accuracy (19): the result is more reliable; certainty is higher; more information is provided. “Combined screening can give more information than just doing blood test” Easiness (18): the procedure is simple “It is quite easy. Some problems can be directly detected when I take the ultrasound.” Recommendation (17): the test is recommended by trusted persons. “The Neuvola nurse recommended the ultrasound to check if everything was ok.” Timing (10): the test can be organized in good time or suitable to the client’s schedule. “The nurse of Neuvola helped to book the time of blood testing and ultrasound, which is suitable to my schedule.” Rapidness (8): to get the test and result quickly with a short waiting time “Combined screening can give earlier information and the ultrasound can detect the problems very quickly, so that we can make preparations or take further steps earlier if there is any problem.” Timing (6): the test can be organized in good time or suitable to the client’s schedule. “I have scheduled a trip during that week, so I could not participate in the first trimester screening. Only the second trimester works for me. I missed the first trimester screening and I had little time left to do the screening” Reliability/Accuracy (3): the result is more reliable; certainty is higher; with more information. “I preferred the first trimester screening at the beginning because it can offer more reliable and early result. But I missed it because of the travelling. So I have to rely on the second trimester screening” Recommendation (2): the test is recommended by trusted persons. “The Neuvola nurse suggested that I could do the second trimester screening based on my situation.” Easiness (2): the procedure is simple “Just taking blood sample is quite easy” Access (1): the option is available and offered freely “It is not free to do the screening abroad. We participated in the second trimester screening when we came back to Finland.”
Social influence Perceived social support (19) “I agreed with the midwife’s arrangement. I also talked with my husband and it was a common decision. My husband supported me” Perceived social pressure (8) “Some of my friends experienced difficult pregnancies, so I want to participate in the screening and get the information earlier.” Social influence from who: Medical staff (18); Husband/partner (4); Friends (1); Family (1); “The Neuvola nurse discussed about prenatal screening and testing with me and provided the information to me. She recommended the first trimester screening.” Perceived social support (3) “The Neuvola nurse gave me suggestion and helped to arrange everything” Perceived social pressure (1) “Everyone participates in screening. I felt I have to do something for the baby. I missed the first trimester combined screening, and I felt upset and disappointed.” Social influence from who: Medical staff (3); Husband/partner (1); Family (1); Friends (0); “My husband was with me in the Neuvola visit and we made the decision together.”
Difficulty in making choice it was not difficult to make a choice (22) “I didn’t have any difficulties. It is a kind of routine. I just followed what the nurse recommended” it was not difficult to make a choice (4) “I was quite clear about choice and just followed the suggestion (given by the Neuvola nurse)” it was difficult to make a choice (2) “It was not easy to make decision, because of the information insufficiency. I was traveling in the beginning of the pregnancy. I thought I could do the screening abroad but it was difficult to organize. I didn’t get clear instruction from Neuvola for my situation.”
Emotional status Neutral (20) “It is just something straightforward and obvious to do. I didn’t feel there is something wrong.” Positive (3) “I felt content that I can choose the better one” Negative (1) “I was worried about the possible risks and bad results.” Positive (1) “I missed the first trimester screening, but I felt relieved the other test was still possible.” Negative (3) “I was annoyed that I missed the combination screening.”