Uptake of a prenatal screening test: the role of healthcare professionals' attitudes towards the test.

Objective: To investigate the association between healthcare professionals' attitudes towards prenatal Down syndrome screening and screening uptake in the women who consult them.

Methods: The attitudes of 71 midwives and 18 obstetricians towards Down syndrome screening and screening uptake in the women who consulted them were assessed at two UK hospitals where uptake rates of Down syndrome screening differed (26 vs 61%).

Results: Healthcare professionals based at the hospital with higher screening uptake had more positive attitudes towards Down syndrome screening than healthcare professionals based at the hospital with lower screening uptake (19 vs 17, p = 0.03). Pooling across hospitals, obstetricians had more positive attitudes than midwives (20 vs 17, p = 0.004). In a sub-group of women who discussed screening with one healthcare professional, there was no significant association between individual healthcare professionals' attitudes and screening uptake (Spearman correlation coefficient = 0.13, p = 0.51).

Conclusion: In this study powered to detect a correlation of 0.5 and over (i.e. a large effect), healthcare professionals' attitudes towards screening were unrelated to uptake of screening in the women consulting them. It remains to be determined if a smaller effect exists. The observed association between healthcare professionals' attitudes and uptake rates by hospitals raises the question of whether healthcare professionals' attitudes might influence systems of care, not just communication with pregnant women.