Women’s preferences for antenatal screening for Downsyndrome in Northern Ireland: a choice experiment

Bernie Reid, Marlene . Sinclair, Owen Barr, Frank Dobbs, Grainnne crealey

Research output: Contribution to journalArticle

Abstract

Background. Despite an increasing international trend towards the implementation of antenatal screening programmesfor Down syndrome, there is currently limited information relating to women’s choices or preferences for such screening.Information about women’s preferences for and insight into the potential value they may derive from any change to screeningprogramme design are essential components of evidence-based policy decision-making. This paper reports on a choiceexperiment undertaken to examine the preferences of a sample of pregnant and non-pregnant women of childbearing agewith respect to antenatal screening for Down syndrome in Northern Ireland, where the offer of screening is not universal andselective abortion on the grounds of fetal abnormality is legally inaccessible.Method. The choice experiment was conducted using an internet-based survey to obtain the preferences of a volunteer sampleof 50 pregnant and 73 non-pregnant women for screening tests that varied according to six test characteristics or attributesderived from an earlier focused ethnographic study. These attributes were: source of screening information, time of testin pregnancy, accuracy of test results, cost of test as an ‘out of pocket’ expense, waiting time for test results, and risk ofmiscarrying a baby unaffected by Down syndrome as a result of subsequent diagnostic testing.Results. Pregnant and non-pregnant women prefer screening tests for Down syndrome offering results with accuracy levelsof 90% and above, and where the risk of subsequent diagnostic procedure-associated miscarriage is 2% and below. Womenpreferred screening tests offering more accurate results over no risk of miscarriage. Pregnant women place more value thannon-pregnant women on tests carried out during the first trimester.Conclusion. Policies for the implementation of antenatal screening programmes for Down syndrome must consider thepreferences of pregnant and non-pregnant women to ensure that the needs of current and potential future service users aremet. Effective pre-test counselling is essential to ensure that women understand the attributes of any screening test and itspossible implications.
LanguageEnglish
Pages112-120
JournalEvidence Based Midwifery
Volume12
Issue number4
Publication statusPublished - Dec 2014

Fingerprint

Northern Ireland
Prenatal Diagnosis
Down Syndrome
Spontaneous Abortion
Pregnant Women
Pregnancy Tests
Policy Making
First Pregnancy Trimester
Health Expenditures
Internet
Counseling
Volunteers
Decision Making
Costs and Cost Analysis

Keywords

  • Choice experiment
  • Down syndrome
  • screening
  • women’s preferences
  • evidence-based midwifery

Cite this

@article{6cb78220309041e59bc1d20a33695dac,
title = "Women’s preferences for antenatal screening for Downsyndrome in Northern Ireland: a choice experiment",
abstract = "Background. Despite an increasing international trend towards the implementation of antenatal screening programmesfor Down syndrome, there is currently limited information relating to women’s choices or preferences for such screening.Information about women’s preferences for and insight into the potential value they may derive from any change to screeningprogramme design are essential components of evidence-based policy decision-making. This paper reports on a choiceexperiment undertaken to examine the preferences of a sample of pregnant and non-pregnant women of childbearing agewith respect to antenatal screening for Down syndrome in Northern Ireland, where the offer of screening is not universal andselective abortion on the grounds of fetal abnormality is legally inaccessible.Method. The choice experiment was conducted using an internet-based survey to obtain the preferences of a volunteer sampleof 50 pregnant and 73 non-pregnant women for screening tests that varied according to six test characteristics or attributesderived from an earlier focused ethnographic study. These attributes were: source of screening information, time of testin pregnancy, accuracy of test results, cost of test as an ‘out of pocket’ expense, waiting time for test results, and risk ofmiscarrying a baby unaffected by Down syndrome as a result of subsequent diagnostic testing.Results. Pregnant and non-pregnant women prefer screening tests for Down syndrome offering results with accuracy levelsof 90{\%} and above, and where the risk of subsequent diagnostic procedure-associated miscarriage is 2{\%} and below. Womenpreferred screening tests offering more accurate results over no risk of miscarriage. Pregnant women place more value thannon-pregnant women on tests carried out during the first trimester.Conclusion. Policies for the implementation of antenatal screening programmes for Down syndrome must consider thepreferences of pregnant and non-pregnant women to ensure that the needs of current and potential future service users aremet. Effective pre-test counselling is essential to ensure that women understand the attributes of any screening test and itspossible implications.",
keywords = "Choice experiment, Down syndrome, screening, women’s preferences, evidence-based midwifery",
author = "Bernie Reid and Sinclair, {Marlene .} and Owen Barr and Frank Dobbs and Grainnne crealey",
note = "Reference text: American College of Obstetricians and Gynecologists: ACOG Practice Bulletin Number 77: Screening for Fetal and Chromosomal Abnormalities. Obstetrics and Gynecology 2007, 109(1), 217 – 228. Bishop AJ, Marteau TM, Armstrong D, Chitty LS, Longworth L, Buxton MJ, et al.: Women and health care professionals’ preferences for Down’s Syndrome screening tests: a conjoint analysis study. BJOG An International Journal of Obstetrics and Gynaecology 2004, 111(8), 775 - 779. Boyd PA, DeVigan C, Khoshood B, Loane M, Garne E, Dolk H, et al.: Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down’s syndrome. BJOG: An International Journal of Obstetrics and Gynaecology 2008, 115(6), 689 – 696. Bridges JF, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, et al.: Conjoint analysis applications in health – a checklist: a report of ISPOR Good Research Practices for Conjoint Analysis Task Force. Value in Health 2011, 14(4), 403 – 413. Bryan S, Dolan P: Discrete choice experiments in health care: for better or for worse? European Journal of Health Economics 2004, 5(3), 199 – 202. Department of Health, Social Services and Public Safety: A Maternity Strategy for Northern Ireland 2012 – 2018. Belfast: DHSSPS; 2012. Department of Health, Social Services and Public Safety: Guidance on the Termination of Pregnancy: The Law and Clinical Practice in Northern Ireland. Belfast: DHSSPS; 2009. Department of Health: Maternity Matters: Choice, Access and Continuity of Care in a Safe Service. London: HMSO; 2007. Drummond MF, Sculphur MJ, Torrace GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2005. Fraenkel L, Bogardus ST, Concato J, Felson DT, Wittink DR: Patient preferences for treatment of rheumatoid arthritis. Annals of Rheumatic Disease 2004, 63(11), 1372 – 1378 Gyrd-Hansen D, Sogaard J: Analysing public preferences for cancer screening programmes. Health Economics 2001, 10(7), 617 - 634. Halman L, Abela AM, Anheier H, Harding S: The European Values Study: A Third Wave. Source Book of the 1999/2000 European Values Study Surveys. European Values Study, Tilburg: 2001. Hensher DA, Rose JM, and Greene WH: Applied Choice Analysis: A Primer. Cambridge: Cambridge University Press; 2005. Hewson C, Yule P, Laurent D, Vogel C: Internet Research Methods: A Practical Guide for the Social and Behavioural Sciences. London: Sage Publications; 2003. Heyman B, Hundt G, Sandall J, Spencer K, Williams C, Grellier R, et al.: On being at higher risk: a qualitative study of prenatal screening for chromosomal anomalies. Social Science and Medicine 2006, 62(10): 2360 – 2372. Johansson-Stenman O, Sveds{\"a}ter H: Hypothetical bias in choice experiments: Within versus between subject tests. Working Papers in Economics. School of Business, Economics and Law, Goteborg University, Sweden: 2007. Johnson FR, Lancsar E, Marshall D, Kilambi V, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value in Health 2013, 16(1), 3 – 13. Kruijshaar ME, Essink-Bot M-L, Donkers B, Looman CWN, Siersema PD, Steyerberg EW: A labelled discrete choice experiment adds realism to the choices presented: preferences for surveillance tests for Barrett esophagus. BMC Medical Research Methodology 2009 , 9(31), doi:10.1186/1471- 2288-9-31. Lanscar E, Louviere JJ: Conducting discrete choice experiments to inform healthcare decision making: A user’s guide. Pharmacoeconomics 2008, 26, 661 - 667. Lewis SM, Cullinane FM, Carlin JB, Halliday JL: Women’s and health professionals preferences for prenatal testing for Down syndrome in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2006, 46(3), 205 – 211. List JA, Sinha P, Taylor, MH: Using choice experiments to value non-market goods and services. Advances in Economic Analysis and Policy 2006, 6(2), 1-37. Lloyd AJ: Threats to the estimation of benefit: are preference elicitation methods accurate? Health Economics 2003, 12(5): 393 – 402. Lusk JL, Schroeder TC: Are choice experiments incentive compatible? A test with quality differentiated beef steaks. American Journal of Agricultural Economics 2003, 85, 840 – 856, Mangham LJ, Hanson K, McPake B: How to do (or not to do) … designing a discrete choice experiment for application in a low-income country. Health Policy and Planning 2008, 24(2), 151 – 158. Mujezinovic F, Alfirevic Z: Procedure-related complications of amniocentesis and chorionic villus sampling: a systematic review. Obstetrics and Gynecology 2007, 110(3), 687 – 694. National Institute for Health and Clinical Excellence: Antenatal Care: Routine Care for Healthy Pregnant Women. NICE, London; 2008. National Screening Unit: Guidelines for Maternity Providers offering Antenatal Screening for Down Syndrome and Other Conditions in New Zealand. National Screening Unit, Wellington, New Zealand; 2009. Orme BK: Getting started with Conjoint Analysis: Strategies for Product Design and Pricing Research. Madison, Wisconsin: Research Publishers LLC; 2006. Petrou S, McIntosh E: Commentary: using stated preference discrete choice experiments to elicit women’s preferences for aspects of maternity care. Birth 2011, 38(1), 47 – 48. Quadrelli R, Quadrelli A, Mechoso B, Laufer M, Jaumandreu C, Vaglio A: Parental decisions to abort or continue a pregnancy following prenatal diagnosis of chromosomal abnormalities in a setting where termination of pregnancy is not legally available. Prenatal Diagnosis 2007, 27(3), 228 – 232. Reid B, Sinclair M, Barr O, Dobbs F, Crealey G: Eliciting women’spreferences for maternity care using choice experiments: a methodological review. Evidence Based Midwifery 2008, 6(4), 119 – 125. Reid B: An Examination of Pregnant and Non-Pregnant Women’s Decision- Making Processes with respect to Antenatal Screening for Down Syndrome. Unpublished PhD Thesis, University of Ulster, Jordanstown, Northern Ireland; 2010. Rose JM, Bliemer MCJ: Sample size requirements for stated choice experiments. Transportation 2013, 40, 1021 – 1041. Ryan M, Farrar S: Using conjoint analysis to elicit preferences in healthcare. British Medical Journal 2000, 320(7248), 1530 – 1533. Ryan M, Gerard K, Amaya-Amaya M: Using Discrete Choice Experiments to Value Health and Health Care. Dordrecht, The Netherlands: Springer; 2009. Ryan M, Watson V, Entwistle V: Rationalising the ‘irrational’: a think aloud study of discrete choice experiment responses. Health Economics 2009, 18(3), 321 – 336. Ryan M: Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilisation. Social Science and Medicine 1999, 48(4), 535 – 546. Seror V, Ville Y: Prenatal screening for Down syndrome: women’s involvement in decision-making and their attitudes to screening. PrenatalDiagnosis 2009, 29(2), 120 – 128. Spencer K, Aitken D: Factors affecting women’s preferences for type of prenatal screening test for chromosomal anomalies. Ultrasound in Obstetrics and Gynaecology 2004, 24(7), 735 – 739. Street DJ, Burgess L, Viney R, Louviere J: Designing discrete choice experiments for healthcare. In Using Discrete Choice Experiments to Value Health and Health Care. Edited by Ryan M, Gerard K, Amaya- Amaya M. Dordrecht, Netherlands: Springer; 2008. Street DJ, Burgess L: Discrete Choice Experiments (Computer Software). Syndney: University of Technology; 2007. [http://crsu.science.uts.edu.au/ choice/]. UK National Screening Committee: Down’s Syndrome (Tri 21) First and Second Trimester Screening and Diagnostic Pathway. Kettering, Northants.: UK National Screening Committee; 2009. UK National Screening Committee: National Screening Committee policy: Down’s Syndrome screening: 2006. [http://www.library.nhs.uk/screening/ ViewResource.aspx?resID=35689] UK National Screening Committee: Screening for Down’s syndrome: UK NSC Policy Recommendations 2011–2014 Model of Best Practice. Exeter: UK National Screening Committee: 2011.",
year = "2014",
month = "12",
language = "English",
volume = "12",
pages = "112--120",
journal = "Evidence Based Midwifery",
issn = "1479-4489",
number = "4",

}

Women’s preferences for antenatal screening for Downsyndrome in Northern Ireland: a choice experiment. / Reid, Bernie; Sinclair, Marlene .; Barr, Owen; Dobbs, Frank; crealey, Grainnne.

In: Evidence Based Midwifery, Vol. 12, No. 4, 12.2014, p. 112-120.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Women’s preferences for antenatal screening for Downsyndrome in Northern Ireland: a choice experiment

AU - Reid, Bernie

AU - Sinclair, Marlene .

AU - Barr, Owen

AU - Dobbs, Frank

AU - crealey, Grainnne

N1 - Reference text: American College of Obstetricians and Gynecologists: ACOG Practice Bulletin Number 77: Screening for Fetal and Chromosomal Abnormalities. Obstetrics and Gynecology 2007, 109(1), 217 – 228. Bishop AJ, Marteau TM, Armstrong D, Chitty LS, Longworth L, Buxton MJ, et al.: Women and health care professionals’ preferences for Down’s Syndrome screening tests: a conjoint analysis study. BJOG An International Journal of Obstetrics and Gynaecology 2004, 111(8), 775 - 779. Boyd PA, DeVigan C, Khoshood B, Loane M, Garne E, Dolk H, et al.: Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down’s syndrome. BJOG: An International Journal of Obstetrics and Gynaecology 2008, 115(6), 689 – 696. Bridges JF, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, et al.: Conjoint analysis applications in health – a checklist: a report of ISPOR Good Research Practices for Conjoint Analysis Task Force. Value in Health 2011, 14(4), 403 – 413. Bryan S, Dolan P: Discrete choice experiments in health care: for better or for worse? European Journal of Health Economics 2004, 5(3), 199 – 202. Department of Health, Social Services and Public Safety: A Maternity Strategy for Northern Ireland 2012 – 2018. Belfast: DHSSPS; 2012. Department of Health, Social Services and Public Safety: Guidance on the Termination of Pregnancy: The Law and Clinical Practice in Northern Ireland. Belfast: DHSSPS; 2009. Department of Health: Maternity Matters: Choice, Access and Continuity of Care in a Safe Service. London: HMSO; 2007. Drummond MF, Sculphur MJ, Torrace GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2005. Fraenkel L, Bogardus ST, Concato J, Felson DT, Wittink DR: Patient preferences for treatment of rheumatoid arthritis. Annals of Rheumatic Disease 2004, 63(11), 1372 – 1378 Gyrd-Hansen D, Sogaard J: Analysing public preferences for cancer screening programmes. Health Economics 2001, 10(7), 617 - 634. Halman L, Abela AM, Anheier H, Harding S: The European Values Study: A Third Wave. Source Book of the 1999/2000 European Values Study Surveys. European Values Study, Tilburg: 2001. Hensher DA, Rose JM, and Greene WH: Applied Choice Analysis: A Primer. Cambridge: Cambridge University Press; 2005. Hewson C, Yule P, Laurent D, Vogel C: Internet Research Methods: A Practical Guide for the Social and Behavioural Sciences. London: Sage Publications; 2003. Heyman B, Hundt G, Sandall J, Spencer K, Williams C, Grellier R, et al.: On being at higher risk: a qualitative study of prenatal screening for chromosomal anomalies. Social Science and Medicine 2006, 62(10): 2360 – 2372. Johansson-Stenman O, Svedsäter H: Hypothetical bias in choice experiments: Within versus between subject tests. Working Papers in Economics. School of Business, Economics and Law, Goteborg University, Sweden: 2007. Johnson FR, Lancsar E, Marshall D, Kilambi V, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value in Health 2013, 16(1), 3 – 13. Kruijshaar ME, Essink-Bot M-L, Donkers B, Looman CWN, Siersema PD, Steyerberg EW: A labelled discrete choice experiment adds realism to the choices presented: preferences for surveillance tests for Barrett esophagus. BMC Medical Research Methodology 2009 , 9(31), doi:10.1186/1471- 2288-9-31. Lanscar E, Louviere JJ: Conducting discrete choice experiments to inform healthcare decision making: A user’s guide. Pharmacoeconomics 2008, 26, 661 - 667. Lewis SM, Cullinane FM, Carlin JB, Halliday JL: Women’s and health professionals preferences for prenatal testing for Down syndrome in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2006, 46(3), 205 – 211. List JA, Sinha P, Taylor, MH: Using choice experiments to value non-market goods and services. Advances in Economic Analysis and Policy 2006, 6(2), 1-37. Lloyd AJ: Threats to the estimation of benefit: are preference elicitation methods accurate? Health Economics 2003, 12(5): 393 – 402. Lusk JL, Schroeder TC: Are choice experiments incentive compatible? A test with quality differentiated beef steaks. American Journal of Agricultural Economics 2003, 85, 840 – 856, Mangham LJ, Hanson K, McPake B: How to do (or not to do) … designing a discrete choice experiment for application in a low-income country. Health Policy and Planning 2008, 24(2), 151 – 158. Mujezinovic F, Alfirevic Z: Procedure-related complications of amniocentesis and chorionic villus sampling: a systematic review. Obstetrics and Gynecology 2007, 110(3), 687 – 694. National Institute for Health and Clinical Excellence: Antenatal Care: Routine Care for Healthy Pregnant Women. NICE, London; 2008. National Screening Unit: Guidelines for Maternity Providers offering Antenatal Screening for Down Syndrome and Other Conditions in New Zealand. National Screening Unit, Wellington, New Zealand; 2009. Orme BK: Getting started with Conjoint Analysis: Strategies for Product Design and Pricing Research. Madison, Wisconsin: Research Publishers LLC; 2006. Petrou S, McIntosh E: Commentary: using stated preference discrete choice experiments to elicit women’s preferences for aspects of maternity care. Birth 2011, 38(1), 47 – 48. Quadrelli R, Quadrelli A, Mechoso B, Laufer M, Jaumandreu C, Vaglio A: Parental decisions to abort or continue a pregnancy following prenatal diagnosis of chromosomal abnormalities in a setting where termination of pregnancy is not legally available. Prenatal Diagnosis 2007, 27(3), 228 – 232. Reid B, Sinclair M, Barr O, Dobbs F, Crealey G: Eliciting women’spreferences for maternity care using choice experiments: a methodological review. Evidence Based Midwifery 2008, 6(4), 119 – 125. Reid B: An Examination of Pregnant and Non-Pregnant Women’s Decision- Making Processes with respect to Antenatal Screening for Down Syndrome. Unpublished PhD Thesis, University of Ulster, Jordanstown, Northern Ireland; 2010. Rose JM, Bliemer MCJ: Sample size requirements for stated choice experiments. Transportation 2013, 40, 1021 – 1041. Ryan M, Farrar S: Using conjoint analysis to elicit preferences in healthcare. British Medical Journal 2000, 320(7248), 1530 – 1533. Ryan M, Gerard K, Amaya-Amaya M: Using Discrete Choice Experiments to Value Health and Health Care. Dordrecht, The Netherlands: Springer; 2009. Ryan M, Watson V, Entwistle V: Rationalising the ‘irrational’: a think aloud study of discrete choice experiment responses. Health Economics 2009, 18(3), 321 – 336. Ryan M: Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilisation. Social Science and Medicine 1999, 48(4), 535 – 546. Seror V, Ville Y: Prenatal screening for Down syndrome: women’s involvement in decision-making and their attitudes to screening. PrenatalDiagnosis 2009, 29(2), 120 – 128. Spencer K, Aitken D: Factors affecting women’s preferences for type of prenatal screening test for chromosomal anomalies. Ultrasound in Obstetrics and Gynaecology 2004, 24(7), 735 – 739. Street DJ, Burgess L, Viney R, Louviere J: Designing discrete choice experiments for healthcare. In Using Discrete Choice Experiments to Value Health and Health Care. Edited by Ryan M, Gerard K, Amaya- Amaya M. Dordrecht, Netherlands: Springer; 2008. Street DJ, Burgess L: Discrete Choice Experiments (Computer Software). Syndney: University of Technology; 2007. [http://crsu.science.uts.edu.au/ choice/]. UK National Screening Committee: Down’s Syndrome (Tri 21) First and Second Trimester Screening and Diagnostic Pathway. Kettering, Northants.: UK National Screening Committee; 2009. UK National Screening Committee: National Screening Committee policy: Down’s Syndrome screening: 2006. [http://www.library.nhs.uk/screening/ ViewResource.aspx?resID=35689] UK National Screening Committee: Screening for Down’s syndrome: UK NSC Policy Recommendations 2011–2014 Model of Best Practice. Exeter: UK National Screening Committee: 2011.

PY - 2014/12

Y1 - 2014/12

N2 - Background. Despite an increasing international trend towards the implementation of antenatal screening programmesfor Down syndrome, there is currently limited information relating to women’s choices or preferences for such screening.Information about women’s preferences for and insight into the potential value they may derive from any change to screeningprogramme design are essential components of evidence-based policy decision-making. This paper reports on a choiceexperiment undertaken to examine the preferences of a sample of pregnant and non-pregnant women of childbearing agewith respect to antenatal screening for Down syndrome in Northern Ireland, where the offer of screening is not universal andselective abortion on the grounds of fetal abnormality is legally inaccessible.Method. The choice experiment was conducted using an internet-based survey to obtain the preferences of a volunteer sampleof 50 pregnant and 73 non-pregnant women for screening tests that varied according to six test characteristics or attributesderived from an earlier focused ethnographic study. These attributes were: source of screening information, time of testin pregnancy, accuracy of test results, cost of test as an ‘out of pocket’ expense, waiting time for test results, and risk ofmiscarrying a baby unaffected by Down syndrome as a result of subsequent diagnostic testing.Results. Pregnant and non-pregnant women prefer screening tests for Down syndrome offering results with accuracy levelsof 90% and above, and where the risk of subsequent diagnostic procedure-associated miscarriage is 2% and below. Womenpreferred screening tests offering more accurate results over no risk of miscarriage. Pregnant women place more value thannon-pregnant women on tests carried out during the first trimester.Conclusion. Policies for the implementation of antenatal screening programmes for Down syndrome must consider thepreferences of pregnant and non-pregnant women to ensure that the needs of current and potential future service users aremet. Effective pre-test counselling is essential to ensure that women understand the attributes of any screening test and itspossible implications.

AB - Background. Despite an increasing international trend towards the implementation of antenatal screening programmesfor Down syndrome, there is currently limited information relating to women’s choices or preferences for such screening.Information about women’s preferences for and insight into the potential value they may derive from any change to screeningprogramme design are essential components of evidence-based policy decision-making. This paper reports on a choiceexperiment undertaken to examine the preferences of a sample of pregnant and non-pregnant women of childbearing agewith respect to antenatal screening for Down syndrome in Northern Ireland, where the offer of screening is not universal andselective abortion on the grounds of fetal abnormality is legally inaccessible.Method. The choice experiment was conducted using an internet-based survey to obtain the preferences of a volunteer sampleof 50 pregnant and 73 non-pregnant women for screening tests that varied according to six test characteristics or attributesderived from an earlier focused ethnographic study. These attributes were: source of screening information, time of testin pregnancy, accuracy of test results, cost of test as an ‘out of pocket’ expense, waiting time for test results, and risk ofmiscarrying a baby unaffected by Down syndrome as a result of subsequent diagnostic testing.Results. Pregnant and non-pregnant women prefer screening tests for Down syndrome offering results with accuracy levelsof 90% and above, and where the risk of subsequent diagnostic procedure-associated miscarriage is 2% and below. Womenpreferred screening tests offering more accurate results over no risk of miscarriage. Pregnant women place more value thannon-pregnant women on tests carried out during the first trimester.Conclusion. Policies for the implementation of antenatal screening programmes for Down syndrome must consider thepreferences of pregnant and non-pregnant women to ensure that the needs of current and potential future service users aremet. Effective pre-test counselling is essential to ensure that women understand the attributes of any screening test and itspossible implications.

KW - Choice experiment

KW - Down syndrome

KW - screening

KW - women’s preferences

KW - evidence-based midwifery

M3 - Article

VL - 12

SP - 112

EP - 120

JO - Evidence Based Midwifery

T2 - Evidence Based Midwifery

JF - Evidence Based Midwifery

SN - 1479-4489

IS - 4

ER -