Abstract
Introduction
We aimed to understand the degree to which pregnant individuals exposed to emerging
infections, such as Zika, are engaged by providers in shared decision-making and explore
potential barriers to inform strategies to improve care for those most at risk for
inequities. Studies have demonstrated that Latinx and Black people are less likely
to engage in shared decision-making and are less engaged by providers. Limited research
explores factors impacting shared decision-making in prenatal care and in the setting
of recent epidemics.
Methods
We conducted an exploratory qualitative study of individuals eligible for prenatal
screening owing to Zika exposure during pregnancy. Given an established connection
between autonomy and shared decision-making, we used the Reproductive Autonomy Scale
and the Three Talk Model for shared decision-making to inform our semistructured interview
guide. Interviews were conducted in Spanish or English. and participants were recruited
from a federally qualified health center and a tertiary care obstetric clinic until
thematic saturation was achieved. Interviews were recorded, translated, and transcribed
and two coders used modified grounded theory to generate themes.
Results
We interviewed 18 participants from May to December 2017. Participant narratives demonstrated
reproductive autonomy in pregnancy decision-making, with decision support from families,
fatalism in pregnancy planning, and limited engagement by providers around decisions
and implications of Zika virus testing. Hierarchy in provider dynamics, perceived
stigma around emigration and travel, and language barriers impacted participant engagement
in shared decision-making.
Conclusions
Participants demonstrated personal autonomy in reproductive decision-making, but demonstrated
limited engagement in shared decision-making with regard to prenatal Zika testing.
Provider promotion of shared decision-making using culturally centered decision tools
to elicit underlying beliefs and deepen context for option, choice, and decision talk
is critical in prenatal counseling to support equitable outcomes during evolving pandemics.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prenatal diagnostic testing for genetic disorders: ACOG practice bulletin, number 162.Obstetrics and Gynecology. 2016; 127: e108-e122
- COVID 19 Vaccination considerations for obstetric - gynecologic care: Practice advisory.(Available:)www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-careDate: 2020Date accessed: July 1, 2022
- Informed consent and shared decision making in obstetrics and gynecology: ACOG committee opinion, number 819.Obstetrics and Gynecology. 2021; 137: e34-e41
- Determinants associated with making prenatal screening decisions in a national study.Journal of Obstetrics and Gynaecology. 2019; 39: 41-48
- Women’s reproductive health knowledge, attitudes and practices in relation to the Zika virus outbreak in northeast Brazil.PLoS One. 2018; 13: e0190024
- Pregnant women and possible Zika virus infection.(Available:)
- Qualitative research in healthcare: An introduction to grounded theory using thematic analysis.Journal of the Royal College of Physicians of Edinburgh. 2015; 45: 201-205
- Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.American Journal of Obstetrics and Gynecology. 2021; 224: 470-478
- Qualitative research guidelines project.(Available:)
- Using simulation to assess the influence of race and insurer on shared decision-making in periviable counseling.Simulation in Healthcare. 2014; 9: 353-359
- Implementing shared decision making in the NHS.BMJ. 2010; 341: c5146
- Shared decision making: A model for clinical practice.Journal of General Internal Medicine. 2012; 27: 1361-1367
- Reproductive coercion: A systematic review.Trauma, Violence & Abuse. 2018; 19: 371-390
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support.Journal of Biomedical Informatics. 2009; 42: 377-381
- Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks.Epidemiology and Health. 2018; 4 (Article e2018003)
- Mixing quantitative and qualitative research.in: Elsbach K.D. Kramer R.M. Handbook of qualitative organizational research: Innovative pathways and methods. Routledge, London2015: 423-432
- Not all patients want to participate in decision making. A national study of public preferences.Journal of General Internal Medicine. 2005; 20: 531-535
- Development of a short acculturation scale for Hispanics.Hispanic Journal of Behavioral Sciences. 1987; 9: 183-205
- Women’s preferences for and experiences with prenatal genetic testing decision making: Sociodemographic disparities in preference-concordant decision making.Patient Education and Counseling. 2019; 102: 595-601
- Stakeholder insights from Zika virus infections in Houston, Texas, USA, 2016–2017.Emerging Infectious Diseases. 2018; 24: 2049-2055
- Evidence-based process for prioritizing positive behaviors for promotion: Zika prevention in Latin America and the Caribbean and applicability to future health emergency responses.Global Health, Science and Practice. 2019; 7: 404-417
- Relationship power, condom use and HIV risk among women in the USA.AIDS Care. 2002; 14: 789-800
- Basics of qualitative research – Techniques and procedures for developing grounded theory.2nd ed. Sage Publications, Thousand Oaks, CA1998
- Development and validation of a reproductive autonomy scale.Studies in Family Planning. 2014; 45: 19-41
- Perceived barriers to care and attitudes towards shared decision-making among low socioeconomic status parents: role of health literacy.Academic Pediatrics. 2012; 12: 117-124
- Awareness, knowledge, and travel-related risk factors for Zika virus among Latinas attending a federally qualified health center in rural North Carolina.North Carolina Medical Journal. 2020; 81: 14-22
- Pregnancy, breastfeeding and the SARS-CoV-2 vaccine: an ethics-based framework for shared decision-making.Canadian Medical Association Journal. 2021; 193: E312-E314
Biography
Paula Latortue-Albino, MD, is an Assistant Professor in Obstetrics and Gynecology at the Boston University Chobanian & Avedisian School of Medicine. Her interests include shared decision making with diverse populations, health disparities, and medical trainee education and mentorship.
Biography
Stephanie Delgado, MD, is an Assistant Professor in Obstetrics and Gynecology at University of Miami School of Medicine, and a minimally invasive gynecologic surgery specialist. Her work focuses on addressing health disparities in access to Ob/Gyn Care.
Biography
Rebecca Perkins, MD, MSc, is a Professor in Obstetrics and Gynecology at the Boston University Chobanian & Avedisian School of Medicine. She has extensive research experience. Her current work focuses on cervical cancer prevention in underserved populations, and the effect of cervical cancer screening guidelines on cervical dysplasia and cancer outcomes.
Biography
Christina Yarrington, MD, is an Assistant Professor in Obstetrics and Gynecology at the Boston University Chobanian & Avedisian School of Medicine. Her research focuses on health inequities in the detection and management of postpartum hypertension and the effects of hypertensive diseases of pregnancy in long term cardiovascular health.
Biography
Pooja Mehta, MD, MSHP, is the Women's Health Lead for Cityblock Health and an Attending Physician in Obstetrics and Gynecology at Boston Medical Center. Previously, she served as Interim Chief Medical Officer and then Chief of Clinical Innovation Officer of Louisiana Medicaid, and Medical Director of the Louisiana Perinatal Quality Collaborative and Maternal Mortality Review. Her research addresses health disparities in reproductive, maternal and child health and care delivery innovation.
Article info
Publication history
Published online: December 22, 2022
Accepted:
November 22,
2022
Received in revised form:
November 9,
2022
Received:
December 10,
2021
Publication stage
In Press Corrected ProofFootnotes
Supported by a 2017 Seed Grant grant from the Boston University Clinical & Translational Science Institute.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
