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Theresa M. Marteau - One of the best experts on this subject based on the ideXlab platform.
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Enhancing Informed Choice to undergo health screening: a systematic review.
American journal of health behavior, 2013Co-Authors: Barbara B. Biesecker, Schwartz, Theresa M. MarteauAbstract:Health screening tests aim to identify and prevent or treat diseases in unsuspecting individuals. They are justified by their potential benefits to the population. There is a consensus that when screening tests are offered, individuals should be provided with the tools to make Informed Choice.1 Yet there remains little consensus on what constitutes an Informed Choice. This review summarizes data from randomized controlled trials (RCTs) of prescreening interventions aimed at improving Informed Choices about undergoing health-screening tests. A similar systematic literature review was published in 2000 summarizing evidence of Informed Choice about screening uptake.2 Six RCTs met Jepson's inclusion criteria for Informed uptake: the prescreening intervention was described in sufficient detail; information was provided on the benefits and risks of screening; knowledge and uptake and Informed decision making were assessed. Jepson and colleagues concluded that there was some evidence that changing the format of Informed-Choice interventions (videos, leaflets with decision trees or computer programs) from well-prepared leaflets does not increase knowledge, satisfaction, or test uptake. They also concluded that it remained unclear whether enhancing Informed Choice affects screening uptake. Over the ensuing decade, Informed Choice has been defined and measured more systematically; and additional predictors and outcomes related to decision quality, identified. One definition of Informed Choice states that it results from having sufficient understanding of relevant information and choosing a course of action that is consistent with one's values and beliefs.3 Informed Choice defined as such can be measured using the Multidimensional Measure of Informed Choice and includes knowledge, attitudes, and test Choice.3 Similarly it can be measured as an integrated decision: having sufficient relevant knowledge and values clarity as assessed by the Values subscale of the Decisional Conflict Scale.4-6 A core component of Informed Choice is relevant knowledge, often described as understanding the potential risks and benefits of a screening test. It is not easy to arrive at consensus, even among Informed experts, about what constitutes sufficient and balanced (risks and benefits) knowledge. Thus, for most prescreening interventions, development of the accompanying information needs to be systematically collected and reviewed not only by experts but also importantly by the intended participants. Literacy level and format of presenting information need to be taken into account to ensure that that target population can understand the relevant information. Essentially all interventions aimed at enhancing Informed Choice about health screening convey relevant knowledge, and many have been shown to be effective in increasing understanding. Another core component of Informed Choice is attitudes toward the behavior, in this case a health screening test. Attitudes reflect one's values and may be defined as a person's thoughts or feelings of favorableness or unfavorableness toward a Choice.3 Attitudes most predictive of intentions or behavior are positive towards undertaking the behavior. Less commonly, prescreening interventions address attitudes or their underlying values and beliefs. There is no consensus on the primacy of values and their resultant attitudes in enhancing Informed Choice. O'Connor and colleagues define decisional conflict as a state of uncertainty about a course of action.4 Uncertainty occurs more often when faced with decisions that involve risk or uncertain outcomes, exacerbated by feeling unInformed, unclear about one's values, and unsupported in making a decision. Making an Informed Choice is theoretically associated with reduced decisional conflict.7 Thus, the primary outcomes selected for this review were Informed Choice and/or decisional conflict. The current review is aimed at expanding our understanding of the empirical evidence of prescreening interventions aimed at enhancing Informed Choice in health screening decisions since 2000.
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Impact of Informed-Choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study
BMC public health, 2010Co-Authors: Eleanor Mann, Ann Louise Kinmonth, Ian Kellar, Stephen Sutton, Simon J. Griffin, Matthew Hankins, Theresa M. MarteauAbstract:Background Despite concerns that facilitating Informed Choice would decrease diabetes screening uptake, 'Informed Choice' invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate Informed Choices.
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is Informed Choice in prenatal testing universally valued a population based survey in europe and asia
British Journal of Obstetrics and Gynaecology, 2009Co-Authors: A Van Den Heuvel, Elizabeth Dormandy, Lyn S Chitty, Ainsley J Newson, Sophie Attwood, Bianca Masturzo, Eva Pajkrt, Theresa M. MarteauAbstract:Informed Choice has become an integral part of healthcare provision. We investigated the extent to which Informed Choice in the context of prenatal testing is universally valued. The value attached to parental Choice in prenatal testing and the perceived importance of significant others' views when making test decisions were assessed in a cross-sectional, descriptive study. Male and female participants from general population samples in six countries: the UK (n = 210), the Netherlands (n = 197), Italy (n = 200), Greece (n = 200), China (n = 200) and India (n = 199). The questionnaires assessed values attached to parental involvement and the perceived importance of the views of significant others when making prenatal test decisions. Attitudes towards parental Choice and attitudes towards the importance of others' views were analysed by age, gender and education using Chi-squared tests, Analysis of Variances and multiple logistic regression. The majority of respondents from Northern European countries believed that undergoing prenatal tests should reflect parental Choice. Conversely, only a minority of respondents from Southern European and Asian countries advocated parental Choice, with most expressing the belief that all pregnant women should have the procedure. The perceived importance of significant others' views when making test decisions also varied across countries: those in favour of parental Choice perceived others' views as less important in the test decision. A preference for prenatal testing decisions to reflect an Informed Choice was predicted by (i) country and (ii) the perceived importance of significant others' views. Education, age and gender did not predict decisions. The implications of these findings for policy and practice depend upon whether placing a low value on parental Choice, but a high value on the others' views regarding prenatal testing is considered an Informed Choice. Further research is needed to determine whether cultural variation in values remains significant in a multicultural society
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Evaluation of an Informed Choice invitation for type 2 diabetes screening
Patient education and counseling, 2008Co-Authors: Ian Kellar, Ann Louise Kinmonth, Stephen Sutton, Simon J. Griffin, A Toby Prevost, Theresa M. MarteauAbstract:Objective: To evaluate an innovative invitation designed to facilitate Informed Choices for undergoing screening for type 2 diabetes. Methods: Four hundred and seventeen people aged 40‐69 years (sex: F 53%/M 47%), without known diabetes, recruited from street locations. Participants were randomised to receive one of two hypothetical invitations for screening for type 2 diabetes; one based on General Medical Council guidelines and combined with a decisional balance sheet, the other a brief traditional invitation. Informed Choice was assessed immediately after the invitation and 3 weeks later using measures of knowledge, attitudes and intentions. Results: Twoweeksafter receiptoftheinvitation,theproportionofInformedChoices wassignificantlyhigheramongparticipants whoreceivedthe Informed Choice invitation compared with those who received the traditional invitation (42.9% versus 11.2%; difference = 31.7%, 95% CI: 22.5‐ 40.5%; p < 0.001). Mean knowledge scores were significantly higher after the receipt of the invitation designed to facilitate Informed Choices than after thetraditional invitation (5.49versus 3.90; t(405) = 10.106, p < 0.001). Intentionsto participate inscreeningwere unaffected byreceipt ofthe Informed Choice invitation. Conclusion: Compared with a traditional invitation, receipt of the invitation designed to facilitate Informed Choices increased the proportion of Informed Choices about type 2 diabetes screening attendance. Practice implications: : Although the new invitation was associated with better knowledge of screening it had no differential effect on intention and its effect on attendance still requires evaluation. # 2008 Elsevier Ireland Ltd. All rights reserved.
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Development of a measure of Informed Choice suitable for use in low literacy populations
Patient education and counseling, 2007Co-Authors: Elizabeth Dormandy, Elaine Y.l. Tsui, Theresa M. MarteauAbstract:Abstract Objective To assess the reliability and validity of a simplified questionnaire-based measure of Informed Choice in populations with low literacy. The measure comprises (a) knowledge about the test and (b) attitudes towards undergoing the test. Responses to (a) and (b) together with information on test uptake, are used to classify Choices as Informed or unInformed. Methods A cross-sectional study of 79 pregnant women (46 women with higher, and 33 with lower education levels) completed a simplified questionnaire, a standardised questionnaire and a semi-structured interview about antenatal sickle cell and thalassaemia (SCT) screening. The measures used were: (a) Informed Choice, based on knowledge about the test, attitudes towards undergoing the test, and uptake of the test and (b) ease of completion measures. Results The simplified measures of knowledge and attitudes were able to distinguish between women classified according to interview responses as having good or poor knowledge (knowledge scores 6.8 versus 3.2, p p =0.023). There was no difference in rates of Informed Choice derived from the simplified or standardised measures (54% versus 51%, 95% CI difference −11 to 19). Women with lower levels of education found the simplified questionnaire easier to complete than the standardised version (11.0 versus 9.6, p =0.009). Those with higher levels of education found no difference in ease of completion between the two versions of the questionnaire (11.8 versus 11.6, p =0.54). Conclusion A simplified questionnaire-based measure of Informed Choice in antenatal SCT screening is as reliable and valid as a more complex standardised version and for those with less education, easier to complete. Practice implications The simplified questionnaire-based measure of Informed Choice is suitable for use in populations with low and high levels of education.
Richard Edwards - One of the best experts on this subject based on the ideXlab platform.
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A qualitative analysis of Māori and Pacific smokers' views on Informed Choice and smoking
BMJ open, 2016Co-Authors: Heather Gifford, Janet Hoek, Rebecca Gray, El-shadan Tautolo, Stephanie Erick, Richard EdwardsAbstract:Objectives Tobacco companies frame smoking as an Informed Choice, a strategy that holds individuals responsible for harms they incur. Few studies have tested this argument, and even fewer have examined how Informed indigenous smokers or those from minority ethnicities are when they start smoking. We explored how young adult Māori and Pacific smokers interpreted ‘Informed Choice’ in relation to smoking. Participants Using recruitment via advertising, existing networks and word of mouth, we recruited and undertook qualitative in-depth interviews with 20 Māori and Pacific young adults aged 18–26 years who smoked. Analyses Data were analysed using an Informed-Choice framework developed by Chapman and Liberman. We used a thematic analysis approach to identify themes that extended this framework. Results Few participants considered themselves well Informed and none met more than the framework's initial two criteria. Most reflected on their unthinking uptake and subsequent addiction, and identified environmental factors that had facilitated uptake. Nonetheless, despite this context, most agreed that they had made an Informed Choice to smoke. Conclusions The discrepancy between participants' reported knowledge and understanding of smoking's risks, and their assessment of smoking as an Informed Choice, reflects their view of smoking as a symbol of adulthood. Policies that make tobacco more difficult to use in social settings could help change social norms around smoking and the ease with which initiation and addiction currently occur.
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A qualitative analysis of ‘Informed Choice’ among young adult smokers
Tobacco control, 2014Co-Authors: Rebecca Gray, Janet Hoek, Richard EdwardsAbstract:Objective The tobacco industry often relies on the assertion that smokers make ‘Informed adult Choices’. We tested this argument by exploring how young adults initiate smoking. Methods Fifteen in-depth interviews with young adults who had started smoking since turning 18, the legal age of adulthood and tobacco purchase in New Zealand. We undertook a thematic analysis of the interview transcripts. Results Although participants had a general awareness that smoking is harmful and knew some specific risks, they rarely saw these as personally relevant when they started smoking, and few had made a deliberate decision to smoke. Participants’ poor understanding of addiction meant most regarded smoking as a short-term phase they could stop at will. Initiation contexts discouraged the exercise of Informed Choice, as smoking onset often occurred when participants were influenced by alcohol or located in socially-pressured situations that fostered spur of the moment decisions. Conclusions Young adults’ ability to exercise ‘Informed Choice’ at the time of smoking uptake is constrained by cognitive and contextual factors. We propose an updated Informed Choice framework that recognises these factors; we outline environmental changes that could make default adoption of smoking less common while promoting more ‘Informed Choices’.
Rebecca Gray - One of the best experts on this subject based on the ideXlab platform.
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Smoking as an ‘Informed Choice’: implications for endgame strategies
Tobacco control, 2016Co-Authors: Janet Hoek, Jude Ball, Rebecca Gray, El-shadan TautoloAbstract:Objective Tobacco companies often assert that adults should be free to make an ‘Informed Choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘Informed Choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims. Methods In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘Informed Choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts. Results Participants thought ‘Informed Choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘Informed Choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it. Conclusions ‘Informed Choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government9s actions with its advice.
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A qualitative analysis of Māori and Pacific smokers' views on Informed Choice and smoking
BMJ open, 2016Co-Authors: Heather Gifford, Janet Hoek, Rebecca Gray, El-shadan Tautolo, Stephanie Erick, Richard EdwardsAbstract:Objectives Tobacco companies frame smoking as an Informed Choice, a strategy that holds individuals responsible for harms they incur. Few studies have tested this argument, and even fewer have examined how Informed indigenous smokers or those from minority ethnicities are when they start smoking. We explored how young adult Māori and Pacific smokers interpreted ‘Informed Choice’ in relation to smoking. Participants Using recruitment via advertising, existing networks and word of mouth, we recruited and undertook qualitative in-depth interviews with 20 Māori and Pacific young adults aged 18–26 years who smoked. Analyses Data were analysed using an Informed-Choice framework developed by Chapman and Liberman. We used a thematic analysis approach to identify themes that extended this framework. Results Few participants considered themselves well Informed and none met more than the framework's initial two criteria. Most reflected on their unthinking uptake and subsequent addiction, and identified environmental factors that had facilitated uptake. Nonetheless, despite this context, most agreed that they had made an Informed Choice to smoke. Conclusions The discrepancy between participants' reported knowledge and understanding of smoking's risks, and their assessment of smoking as an Informed Choice, reflects their view of smoking as a symbol of adulthood. Policies that make tobacco more difficult to use in social settings could help change social norms around smoking and the ease with which initiation and addiction currently occur.
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A qualitative analysis of ‘Informed Choice’ among young adult smokers
Tobacco control, 2014Co-Authors: Rebecca Gray, Janet Hoek, Richard EdwardsAbstract:Objective The tobacco industry often relies on the assertion that smokers make ‘Informed adult Choices’. We tested this argument by exploring how young adults initiate smoking. Methods Fifteen in-depth interviews with young adults who had started smoking since turning 18, the legal age of adulthood and tobacco purchase in New Zealand. We undertook a thematic analysis of the interview transcripts. Results Although participants had a general awareness that smoking is harmful and knew some specific risks, they rarely saw these as personally relevant when they started smoking, and few had made a deliberate decision to smoke. Participants’ poor understanding of addiction meant most regarded smoking as a short-term phase they could stop at will. Initiation contexts discouraged the exercise of Informed Choice, as smoking onset often occurred when participants were influenced by alcohol or located in socially-pressured situations that fostered spur of the moment decisions. Conclusions Young adults’ ability to exercise ‘Informed Choice’ at the time of smoking uptake is constrained by cognitive and contextual factors. We propose an updated Informed Choice framework that recognises these factors; we outline environmental changes that could make default adoption of smoking less common while promoting more ‘Informed Choices’.
Janet Hoek - One of the best experts on this subject based on the ideXlab platform.
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Smoking as an ‘Informed Choice’: implications for endgame strategies
Tobacco control, 2016Co-Authors: Janet Hoek, Jude Ball, Rebecca Gray, El-shadan TautoloAbstract:Objective Tobacco companies often assert that adults should be free to make an ‘Informed Choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘Informed Choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims. Methods In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘Informed Choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts. Results Participants thought ‘Informed Choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘Informed Choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it. Conclusions ‘Informed Choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government9s actions with its advice.
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A qualitative analysis of Māori and Pacific smokers' views on Informed Choice and smoking
BMJ open, 2016Co-Authors: Heather Gifford, Janet Hoek, Rebecca Gray, El-shadan Tautolo, Stephanie Erick, Richard EdwardsAbstract:Objectives Tobacco companies frame smoking as an Informed Choice, a strategy that holds individuals responsible for harms they incur. Few studies have tested this argument, and even fewer have examined how Informed indigenous smokers or those from minority ethnicities are when they start smoking. We explored how young adult Māori and Pacific smokers interpreted ‘Informed Choice’ in relation to smoking. Participants Using recruitment via advertising, existing networks and word of mouth, we recruited and undertook qualitative in-depth interviews with 20 Māori and Pacific young adults aged 18–26 years who smoked. Analyses Data were analysed using an Informed-Choice framework developed by Chapman and Liberman. We used a thematic analysis approach to identify themes that extended this framework. Results Few participants considered themselves well Informed and none met more than the framework's initial two criteria. Most reflected on their unthinking uptake and subsequent addiction, and identified environmental factors that had facilitated uptake. Nonetheless, despite this context, most agreed that they had made an Informed Choice to smoke. Conclusions The discrepancy between participants' reported knowledge and understanding of smoking's risks, and their assessment of smoking as an Informed Choice, reflects their view of smoking as a symbol of adulthood. Policies that make tobacco more difficult to use in social settings could help change social norms around smoking and the ease with which initiation and addiction currently occur.
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A qualitative analysis of ‘Informed Choice’ among young adult smokers
Tobacco control, 2014Co-Authors: Rebecca Gray, Janet Hoek, Richard EdwardsAbstract:Objective The tobacco industry often relies on the assertion that smokers make ‘Informed adult Choices’. We tested this argument by exploring how young adults initiate smoking. Methods Fifteen in-depth interviews with young adults who had started smoking since turning 18, the legal age of adulthood and tobacco purchase in New Zealand. We undertook a thematic analysis of the interview transcripts. Results Although participants had a general awareness that smoking is harmful and knew some specific risks, they rarely saw these as personally relevant when they started smoking, and few had made a deliberate decision to smoke. Participants’ poor understanding of addiction meant most regarded smoking as a short-term phase they could stop at will. Initiation contexts discouraged the exercise of Informed Choice, as smoking onset often occurred when participants were influenced by alcohol or located in socially-pressured situations that fostered spur of the moment decisions. Conclusions Young adults’ ability to exercise ‘Informed Choice’ at the time of smoking uptake is constrained by cognitive and contextual factors. We propose an updated Informed Choice framework that recognises these factors; we outline environmental changes that could make default adoption of smoking less common while promoting more ‘Informed Choices’.
Elizabeth Dormandy - One of the best experts on this subject based on the ideXlab platform.
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is Informed Choice in prenatal testing universally valued a population based survey in europe and asia
British Journal of Obstetrics and Gynaecology, 2009Co-Authors: A Van Den Heuvel, Elizabeth Dormandy, Lyn S Chitty, Ainsley J Newson, Sophie Attwood, Bianca Masturzo, Eva Pajkrt, Theresa M. MarteauAbstract:Informed Choice has become an integral part of healthcare provision. We investigated the extent to which Informed Choice in the context of prenatal testing is universally valued. The value attached to parental Choice in prenatal testing and the perceived importance of significant others' views when making test decisions were assessed in a cross-sectional, descriptive study. Male and female participants from general population samples in six countries: the UK (n = 210), the Netherlands (n = 197), Italy (n = 200), Greece (n = 200), China (n = 200) and India (n = 199). The questionnaires assessed values attached to parental involvement and the perceived importance of the views of significant others when making prenatal test decisions. Attitudes towards parental Choice and attitudes towards the importance of others' views were analysed by age, gender and education using Chi-squared tests, Analysis of Variances and multiple logistic regression. The majority of respondents from Northern European countries believed that undergoing prenatal tests should reflect parental Choice. Conversely, only a minority of respondents from Southern European and Asian countries advocated parental Choice, with most expressing the belief that all pregnant women should have the procedure. The perceived importance of significant others' views when making test decisions also varied across countries: those in favour of parental Choice perceived others' views as less important in the test decision. A preference for prenatal testing decisions to reflect an Informed Choice was predicted by (i) country and (ii) the perceived importance of significant others' views. Education, age and gender did not predict decisions. The implications of these findings for policy and practice depend upon whether placing a low value on parental Choice, but a high value on the others' views regarding prenatal testing is considered an Informed Choice. Further research is needed to determine whether cultural variation in values remains significant in a multicultural society
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Development of a measure of Informed Choice suitable for use in low literacy populations
Patient education and counseling, 2007Co-Authors: Elizabeth Dormandy, Elaine Y.l. Tsui, Theresa M. MarteauAbstract:Abstract Objective To assess the reliability and validity of a simplified questionnaire-based measure of Informed Choice in populations with low literacy. The measure comprises (a) knowledge about the test and (b) attitudes towards undergoing the test. Responses to (a) and (b) together with information on test uptake, are used to classify Choices as Informed or unInformed. Methods A cross-sectional study of 79 pregnant women (46 women with higher, and 33 with lower education levels) completed a simplified questionnaire, a standardised questionnaire and a semi-structured interview about antenatal sickle cell and thalassaemia (SCT) screening. The measures used were: (a) Informed Choice, based on knowledge about the test, attitudes towards undergoing the test, and uptake of the test and (b) ease of completion measures. Results The simplified measures of knowledge and attitudes were able to distinguish between women classified according to interview responses as having good or poor knowledge (knowledge scores 6.8 versus 3.2, p p =0.023). There was no difference in rates of Informed Choice derived from the simplified or standardised measures (54% versus 51%, 95% CI difference −11 to 19). Women with lower levels of education found the simplified questionnaire easier to complete than the standardised version (11.0 versus 9.6, p =0.009). Those with higher levels of education found no difference in ease of completion between the two versions of the questionnaire (11.8 versus 11.6, p =0.54). Conclusion A simplified questionnaire-based measure of Informed Choice in antenatal SCT screening is as reliable and valid as a more complex standardised version and for those with less education, easier to complete. Practice implications The simplified questionnaire-based measure of Informed Choice is suitable for use in populations with low and high levels of education.
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Informed Choice in antenatal down syndrome screening a cluster randomised trial of combined versus separate visit testing
Patient Education and Counseling, 2006Co-Authors: Elizabeth Dormandy, Susan Michie, Richard Hooper, Theresa M. MarteauAbstract:Objective: Building upon the results of an observational study, this clinical trial aimed to test the hypothesis that conducting antenatal Down syndrome screening (DSS) at the same time as other tests result in higher rates of Informed Choice to accept DSS, than when it is conducted separately from other tests. Methods: The trial used a cluster-randomised controlled design, with Informed Choice as the outcome measure. The post of midwife was randomised to offer DSS at the same time as other tests (combined visit) or separately from other tests (separate visit). Results: Overall 43.5% of women made an Informed Choice about DSS. There was no difference in rates of Informed Choice for women accepting DSS according to the method of conducting testing (23.7% at combined visit versus 22.5% at separate visit, OR = 1.1, 95% CI: 0.70-1.7, p = 0.67). Cconclusion: Rates of Informed Choice about DSS were low, but there was no evidence to support that hypothesis that conducting testing at that same time as other tests increased rates of Informed Choice. This may reflect the limitations of conducting the trial in one centre.
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Informed Choice: why measuring behaviour is important
Archives of disease in childhood, 2005Co-Authors: Theresa M. Marteau, Elizabeth Dormandy, Rachel CrockettAbstract:Olusanya et al debate the principles of Informed Choice within the context of infant hearing screening.1 In doing so they draw on our conceptualisation and measure of Informed Choice. Unfortunately they draw an erroneous conclusion, namely that it is inappropriate to measure uptake as part of assessing Informed Choice. This is based on a misinterpretation of both our definition of Informed Choice and its measurement. Based on the decision making literature,2 we have proposed an operational definition of Informed Choice: “one that is based on relevant knowledge, consistent with the decision maker’s values and behaviourally implemented”.3 There are two types of Informed Choice: an Informed Choice to decline screening, where someone with good knowledge and negative attitudes towards themselves undergoing screening does not undergo screening; and an Informed Choice to accept screening where someone with good knowledge and positive attitudes towards themselves undergoing screening, undergoes screening. An assessment of Informed Choice therefore requires an assessment of knowledge, attitudes, and the consistency between attitudes and screening behaviour, to determine whether screening behaviour, usually referred to as uptake, reflects the attitudes of the person offered screening. This definition and model places no value on whether the Choice made is to accept or to …
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Informed Choice to undergo prenatal screening a comparison of two hospitals conducting testing either as part of a routine visit or requiring a separate visit
Journal of Medical Screening, 2002Co-Authors: Elizabeth Dormandy, Susan Michie, Richard Hooper, Theresa M. MarteauAbstract:BACKGROUND: It is not known which of two common methods of conducting prenatal screening best facilitate women making Informed Choices. OBJECTIVE: To describe rates of Informed Choice in two hospitals: one where screening for Down’s syndrome was conducted at a routine visit; the other where screening was conducted as part of a separate visit. DESIGN: Prospective descriptive study. SETTING: Two hospitals in England. PARTICIPANTS: 1499 pregnant women offered screening for Down’s syndrome. Outcome measure: A multidimensional measure of Informed Choice derived from measures of (a) consistency between attitudes towards undergoing the test and uptake and (b) knowledge about the screening test. RESULTS: The proportion of women making an Informed Choice to accept the test was higher at the routine visit hospital than at the separate visit hospital (41% v 21%, 95% confidence interval (95% CI) of the difference 16% to 25%). The proportions of women making an Informed Choice to decline the test were similar at the t...