Table 2 Barriers and facilitators to the use of decision aids for Down syndrome prenatal screening and knowledge translation strategies as suggested by stakeholders
TDF domain | Facilitators | Barriers | Strategies |
|---|---|---|---|
Social influences | - Colleagues’ approval of the use of DAs - Women’s partners’ approval of the use of the DA - Women’s providers’ approval of the use of the DA | - Colleagues’ disapproval of the use of DAs - Women’s partners’ disapproval of the use of the DA - Women’s friends’ disapproval of the use of the DA | - Establish a multi-stakeholder steering committee to guide the implementation project that includes different health professionals involved in prenatal care, health managers, policymakers, researchers, and pregnant women and their partners - Develop a communication plan that promotes shared decision making and the use of the DA among prenatal care providers - Develop a tailored communication strategy to promote the use of the DA for health professionals working in hospital settings |
Social/professional role and identity | - Providers feel that it is their duty to provide the DA to women - Providers feel that using the DA is consistent with best practices - Not feeling forced to use the DA in all circumstances | None | |
Environmental context and resources | - Having the DA available in the provider’s office - Having the DA freely available on a website - Having Down syndrome risk factors in the family | - Not having the DA available in the provider’s office - The DA is available only in printed form - Not having time to present the DA during a visit | - Make the DA freely available on credible websites - Supply paper copies of the DA to prenatal care providers - Ensure that brochures and posters on prenatal care decision making are available for patients in clinic waiting rooms |
Memory, attention and decision processes | - The DA is presented and explained to women before their consultation with their main provider - DA viewed as promoting decision-making | - DA presents too much information - DA content is too complex for patients - DA content is incomplete - The provider presents the DA in an unconvincing or uninteresting way | - Review DA content and ensure that its evidence is up-to-date - Review the language used in the DA and consider issues of health literacy, numeracy and risk communication - Improve the graphic design of the DA and ensure an acceptable balance between length and completeness of information |
Beliefs about capabilities | - Providers feel comfortable using the DA - The DA increases decision-making competencies | None | - Encourage health professionals to complete the online training modules on shared decision making and the use of DAs in prenatal care - Make the video on the use of the DA easily accessible to patients online - Provide in-person training in inter-professional approaches to shared decision making to health professionals in hospital settings - Provide training to professionals in hospital settings to perform the role of decision coaches who will work with women, their partners, and OBGYNs to support prenatal care decision-making |
Knowledge | - DA viewed as a relevant source of information | - Lack of knowledge about DAs and how to use them | |
Skills | - Training in the use of DAs | - Lack of health literacy in some women | |
Intentions | - Intentions of women to use the DA are high - Intentions of some providers (e.g., midwives) to use the DA are high | - Intentions of some providers (e.g. OBGYN) to use the DA are lower | |
Motivation and goals | - Use of the DA consistent with women’s need to be informed | None | - Ensure that women receive the DA from a health professional early in the course of their prenatal care (e.g., during information sessions) before they meet with their main prenatal care provider; or - Ensure that couples receive the DA (from administrative assistant, secretary or nurse) prior to their first prenatal consultation with their health professional; and specify that this will be discussed at the meeting with the health professional. - Encourage prenatal care providers to use the DA during consultations to support prenatal care decisions - Encourage prenatal care providers to suggest to women that they reflect on their decisions at home with their partners - Identify a OBGYN who can champion shared decision making and the use of the DA in hospital settings - Make sure the women are accompanied when they consult the DA, or know that their questions will be answered by a health professional - Name a decision coach to discuss and present the DA before the consultation |
Beliefs about consequences | - Belief that the DA helps the women to think about the decision - Belief that the DA enables women to express their preferences - Belief that the DA helps the couple reflect on decisions together at home - Belief that the DA helps women make informed decisions - Belief that the DA reduces decisional regret - Belief that the DA’s visual content is helpful for patients | - Belief that the DA could create confusion during the decision-making process | |
Emotion | - Feelings of satisfaction when using the DA | - The DA induces stress by increasing knowledge or risks and benefits of the tests - The DA raises fears about the results of the tests | |
Behavioral regulation | None | None | N/A |
Reinforcement | None | None | N/A |
Optimism | None | None | N/A |