Document Type : Original Article


1 Gynecology and Obstetrics,

2 Biostatistics, School of Medicine, Mashhad University of Medical Sciences

3 Department of Educational Sciences, School of Education and Psychology, Ferdowsi University, Mashhad, Iran


BACKGROUND AND GOAL: Screening of fetal anomalies is assumed as a necessary
measurement in antenatal cares. The screening plans aim at empowerment of individuals to
make the informed choice. This study was conducted in order to compare the effect of group and
face‑to‑face education and decisional conflicts among the pregnant females regarding screening
of fetal abnormalities.
METHODS: This study of the clinical trial was carried out on 240 pregnant women at <10‑week
pregnancy age in health care medical centers in Mashhad city in 2014. The form of
individual‑midwifery information and informed choice questionnaire and decisional conflict scale
were used as tools for data collection. The face‑to‑face and group education course were held
in two weekly sessions for intervention groups during two consecutive weeks, and the usual
care was conducted for the control group. The rate of informed choice and decisional conflict
was measured in pregnant women before education and also at weeks 20–22 of pregnancy in
three groups. The data analysis was executed using SPSS statistical software (version 16), and
statistical tests were implemented including Chi‑square test, Kruskal–Wallis test, Wilcoxon test,
Mann–Whitney U‑test, one‑way analysis of variance test, and Tukey’s range test. The P < 0.05
was considered as a significant.
RESULTS: The results showed that there was statically significant difference between three groups
in terms of frequency of informed choice in screening of fetal abnormalities (P = 0.001) in such
a way that at next step of intervention, 62 participants (77.5%) in face‑to‑face education group,
64 members (80%) in group education class, and 20 persons (25%) in control group had the informed
choice regarding screening tests, but there was no statistically significant difference between two
individual and group education classes. Similarly, during the postintervention phase, there was a
statistically significant difference in mean score of decisional conflict scale among pregnant women
regarding screening tests in three groups (P = 0.001).
DISCUSSION AND CONCLUSION: With respect to effectiveness of group and face‑to‑face
education methods in increasing the informed choice and reduced decisional conflict in pregnant
women regarding screening tests, each of these education methods may be employed according
to the clinical environment conditions and requirement to encourage the women for conducting the
screening tests.


1. Ghorbani M, Parsiyan N, Mahmodi M, Jalalmanesh S. The study
of incidence of congenital anomalies and relationship between
anomakies and personal and family‑social factors. Iran J Obstet
Gynecol Infertil 2004;6:66‑73.
2. Cuningham GF, leveno KJ, Bloom SL, Hauth JC, Rouse DJ,
Spong CY. Williams Obstetrics. 24th ed. Tehran Golban Medical
Publisher 2014.
3. Farhad DD, Walizadeh DH, Sharif‑Kamali M. Congenital
malformations and genetic diseases in 1. Iranian infants. Hum
Genet 1986;74:382‑5.
4. Styles screening and diagnosis of fetal abnormalities. Ministry of
Health and Medical Education. 2011.Available at: http://www. [Last accessed on 2014 Oct 21].5. Hwa HL, Huang LH, Hsieh FJ, Chow SN. Informed consent for
antenatal serum screening for Down syndrome. Taiwan J Obstet
Gynecol 2010;49:50‑6.
6. Kleinveld JH. Psychological Consequences of Prenatal Screening.
VU University Medical Center in Amsterdam 2008; 1‑152.
7. van den Berg M, Timmermans DR, Ten Kate LP, van Vugt JM,
van der Wal G. Are pregnant women making informed choices
about prenatal screening? Genet Med 2005;7: 332‑8.
8. Jepson RG, Hewison J, Thompson AG, Weller D. How should we
measure informed choice? The case of cancer screening. J Med
Ethics 2005;31:192‑6.
9. Lewis J, Leach J. Discussion of socio‑scientific issues: The role of
science knowledge. Int J Sci Educ 2006;28:1267‑87
10. Prokop P, Leskova A, Kubiatko M, Diran C. Slovakian students
knowledge of and attitudes toward biotechnology. Int J Sci Educ
11. Chiang HH, Chao YM, Yuh YS. Informed choice of pregnant
women in prenatal sceening tests for Down’s syndrome. J Med
Ethics 2006;32:273‑77.
12. Gourounti K, Sandall J. Do pregnant women in Greece
make informed choices about antenatal screening for
Down’s syndrome? A questionnaire survey. Midwifery
13. Dormandy E, Michie S, Hooper R, Marteau TM. Low uptake
of prenatal screening for Down syndrome in minority ethnic
groups and socially deprived groups: A reflection of women’s
attitudes or a failure to facilitate informed choices? Int J Epidemiol
14. Bekker HL, Hewison J, Thornton JG. Applying decision analysis
to facilitate informed decision making about prenatal diagnosis
for Down syndrome: A randomised controlled trial. Prenat Diagn
15. Hunt L. Routine prenatal genetic screening in a public clinic:
Informed choice or moral imperative? Medical Humanities Report
16. Niaki MT, Behmanesh F, Mashmoli F, Azimi H. Impact of prenatal
group education on knowledge, attitude and choice of delivery
in nulliparous women. Iran J Med Educ 2010;10:124‑30.
17. Barimnegad L, Asemi S, Samieehaghani N. Effect of individual
and group training on therapy, and the rate of complications in
patients taking warfarin after heart valve replacement. Iran J Med
Educ 2012;12:10‑8.
18. Golaghayi F, Khosravi SH. Patient education process in clinical
care and outpatient. Tehran: Boshra Tohfe Publishers; 2010.
19. O’Connor AM. Validation of a decisional conflict scale. Med Decis
Making 1995;15:25‑30.
20. Nagle C, Gunn J, Bell R, Lewis S, Meiser B, Metcalfe S, et al. Use of
a decision aid for prenatal testing of fetal abnormalities to improve
women’s informed decision making: A cluster randomised
controlled trial. BJOG 2008;115:339‑47.
21. Mathieu E, Barratt A, Davey HM, McGeechan K, Howard K,
Houssami N. Informed choice in mammography screening: A
randomized trial of a decision aid for 70‑year‑old women. Arch
Intern Med 2007;167:2039‑46.
22. Smith SK, Trevena L, Simpson JM, Barratt A, Nutbeam D,
McCaffery KJ. A decision aid to support informed choices about
bowel cancer screening among adults with low education:
Randomised controlled trial. BMJ 2010;341:c5370.
23. Schoonen M. Prenatal Screening for Down Syndrome and for
Structural Congenital Anomalies in the Netherlands: PhD Thesis.
Netherlands Institute for Health Sciences, Rotterdam; 2011.
24. Arbabi HY. Education Health and Communications. Tehran:
Boshra Publishers; 2007.
25. Skelly CL, Ulrich S. Enhancing informed choice for genetic
screening: A pilot study. Nurs Health 2014;2:126‑30.
26. Yee LM, Wolf M, Mullen R, Bergeron AR, Cooper Bailey S,
Levine R, et al. A randomized trial of a prenatal genetic testing
interactive computerized information aid. Prenat Diagn 2014;
27. Michie S, Smith D, Marteau TM l. Patient decision making: An
evaluation of two different methods of presenting information
about a screening test. Br J Health Psychol 1997;2:317‑26
28. Stefansdottir V, Skirton H, Jonasson K, Hardardottir H, Jonsson JJ.
Effects of knowledge, education, and experience on acceptance of
first trimester screening for chromosomal anomalies. Acta Obstet
Gynecol Scand 2010;89:931‑8.
29. Hewison J, Cuckle H, Baillie C, Sehmi I, Lindow S, Jackson F, et al.
Use of videotapes for viewing at home to inform choice in Down
syndrome screening: A randomised controlled trial. Prenat Diagn
30. Toghyani R, Ramezani MA, Izadi M, Shahidi S, Aghdak P,
Motie Z, et al. The effect of prenatal care group education on
pregnant mothers’ knowledge, attitude and practice. Iran J Med
Educ 2008;7:317‑24.
31. O’Connor AM, Jacobsen MJ. Decisional Conflict: Assessing and
Supporting Patient Experiencing Uncertainty About Decisions
Affecting their Health, Ottawa; 1998.
32. Kaiser AS, Ferris LE, Katz R, Pastuszak A, Llewellyn‑Thomas H,
Johnson JA, et al. Psychological responses to prenatal NTS
counseling and the uptake of invasive testing in women of
advanced maternal age. Patient Educ Couns 2004;54:45‑53.
33. Hunter AG, Cappelli M, Humphreys L, Allanson JE, Chiu TT,
Peeters C, et al. A randomized trial comparing alternative
approaches to prenatal diagnosis counseling in advanced
maternal age patients. Clin Genet 2005;67:303‑13.
34. Petersen JJ, Paulitsch MA, Guethlin C, Gensichen J, Jahn A.
A survey on worries of pregnant women – Testing the German
version of the Cambridge worry scale. BMC Public Health
35. Guidelines for maternity providers offering antenatal screening
for Down syndrome and other conditions in New Zealand.
Wellington, National Screening Unit. 2009. Available at: http:// [Last accessed on 2016 Feb 12].
36. Mohammadi N, Tizhosh M, Seyedoshohadaye M, Haghani H.
Comparison of effect of group and individual training
on consciousness and anxiety in patients hospitalized for
coronary angiography. J Nurs Midwifery Tehran Univ Med Sci