Evaluation of the Health Belief Model and Decision Making Regarding Amniocentesis in Women of Advanced Maternal Age

Abstract

The Health Belief Model (HBM) was developed as an attempt to explain an individual's decision regarding obtaining preventive health care. This model was applied to predict the decisions of women of advanced maternal age regarding their obtaining amniocentesis in a one-year study conducted in Toledo, Ohio.

A questionnaire based on the HBM was administered to a sample of 98 pregnant women of advanced maternal age. A total of 96 questionnaires were eligible for inclusion in the study. Sixty-one women reported that they would have amniocentesis, 22 would not, and 13 were unsure.

A multivariate analysis of variance among amniocentesis decision groups was performed using the health belief components (perceived susceptibility, perceived seriousness, perceived benefit, perceived barrier) and knowledge as variables. There was a significant difference (Wilks' criterion, p < .0001) among the three decision groups, but the differences were in the health belief components and not in knowledge. A stepwise discriminant function analysis was used to classify subjects on the amniocentesis decision.

Of the variables examined, only the HBM component perceived benefit factor was a significnat discriminant (p = .0001). It is not necessarily the lack of knowledge that prevents women who are at risk because of advanced maternal age from having amniocentesis but their perceptions regarding amniocentesis. Genetic counselors need to focus more on exploring the perceptions of amniocentesis benefits in this population to facilitate the decision making process.

Get full access to this article

View all access options for this article.

References

U.S. Bureau of the Census : Projections of the population of the United States by age, sex, and race: 1983-2080. Series P-25 No. 952 U.S Government Printing Office, Washington, D.C., 1984.

Kane S : Advancing age and primigravida Obstet Gynecol 29:409-414, 1967.

Forman M. , Meinik O. , Berendes H. : Delayed childbearing in Sweden JAMA 252:3135-3139, 1984.

Turpin R. , Lejeune G. : Human Afflictions and Chromosomal Aberrations. London, Pergamon Press, 1969.

Hook E. , Chambers G. : Estimated rates of Down syndrome in live births by one year maternal age intervals for mothers aged 20-49 in a New York State study: Implications of the risk figures for genetic counseling and cost-benefit analysis of prenatal diagnosis programs Birth Defects 13:123-141, 1977.

Cohen F. : Clinical Genetics in Nursing Practice. Philadelphia, Lippincott, 1984.

Thompson J. , Thompson M. : Genetics in Medicine. Philadelphia, W.B. Saunders,1986.

Fuchs, R. : Genetic amniocentesis Sci Am 242:47-53, 1980.

NICHD National Registry for Amniocentesis Study Group : Midtrimester amniocentesis for prenatal diagnosis: Safety and accuracy JAMA 236:1471-1476, 1976.

10.

Simpson N. , Daillaire L. , Miller J. : Prenatal diagnosis of genetic disease in Canada: Report of a collaborative study Can Med Assoc J 115:739-746, 1976.

11.

Medical Research Council Working Party : An assessment of the hazards of amniocentesis Br J Obstet Gynaecol 85:489-497, 1978.

12.

Adams M. , Finley S. , Hansen H. , Jahiel R. , Oakley G. , Sanger W. , Wells G. , Wertelecki W. : Utilization of prenatal genetic diagnosis in women 35 years of age and older in the United States, 1977-1978 Am J Obstet Gynecol 139:673-677, 1981.

13.

Volodkevich H. , Huether C. : Causes of low utilization of amniocentesis by women of advanced maternal age Soc Biol 28:176-186, 1981.

14.

Hook E. , Schreinemachers D. : Trends in utilization of prenatal cytogenetic diagnosis by New York State residents in 1979 and 1980 Am J Public Health 73:198-202, 1983.

15.

Naber J. , Huether C. , Goodwin R. : Temporal changes in Ohio: Amniocentesis utilization during the first twelve years (1972-1983), and frequency of chromosome abnormalities observed Prenat Diagn 7:51-65, 1987.

16.

Bundey S. : Attitudes of 40-year-old college graduates towards amniocentesis Br Med J 2:1475-1477, 1978.

17.

Rice N. , Doherty R. : Reflections on prenatal diagnosis: The consumers' views Soc Work Health Care 8:47-57, 1982.

18.

Rosenstock I. : Why people use health services Milbank Mem Fund Q 44:94-112, 1966.

19.

Rosenstock I. : Historical origins of the health belief model Health Educ Monogr 2:328-335, 1974.

20.

Rosenstock I. , Derryberry M. , Carriger B. : Why people fail to seek poliomyelitis vaccination Public Health Rep 74:98-103, 1959.

21.

Kegeles S. : Attitudes and behavior of the public regarding cervical cytology: Current findings and new directions for research J Chronic Dis 20:911-922, 1967.

22.

Hallal J. : The relationship of health beliefs, health locus of control, and self concept to the practice of breast self-examination in adult women Nurs Res 31:137-142, 1982.

23.

Becker M. , Kaback M. , Rosenstock I. , Ruth M. : Some influences on public participation in a genetic screening program J Community Health 1:3-14, 1975.

24.

Davies B. , Doran T. : Factors in a woman's decision to undergo genetic amniocentesis for advanced maternal age Nurs Res 31:56-59, 1982.

25.

Herold E. : The Health Belief Model: Can it help us to understand contraceptive use among adolescents J Sch Health 53:19-21, 1983.

26.

Janz N. , Becker M. : The Health Belief Model: A decade later Health Educ Q 11:1-47, 1984.

27.

Zweig S. , LeFevre M. , Kruse J. : The health belief model and attendance for prenatal care Fam Pract Res J 8:32-41, 1988.

28.

Rosenstock I. : Patients' compliance with health regimens JAMA 234:402-403, 1975.

29.

Becker M. , Maiman L. : Sociobehavior determinants of compliance with health and medical care recommendations Med Care 13:10-24, 1975.

30.

Lippman-Hand A. , Piper M. : Prenatal diagnosis for the detection of Down syndrome: Why are so few eligible women tested? Prenat Diagn 1:249-257, 1981.

31.

Dixon B. , Richards T. , Reinsch S. , Edrich V. , Matson M. , Jones O. : Midtrimester amniocentesis: Subjective maternal responses J Reprod Med 26:10-16, 1981.

32.

Orem D. : Nursing: Concepts of Practice. New York, McGraw-Hill Book Co., 1985.

33.

Price J. , Galli N. , Slenker S. : Consumer Health: Contemporary Issues and Choices. Dubuque, William Brown Co., 1985 .

34.

Knowles J. : The responsibility of the individual, in Flynn P (ed): The Healing Continuum: Journeys in the Philosophy of Holistic Health. Bowie, MD, Robert J. Brady Co., 1980.

35.

Doelp A. : Autumn's Children. New York, Macmillan Publishing Co., 1985.

36.

Polit D. , Hungler B. : Nursing Research: Principles and Methods. Philadelphia, Lippincott, 1983.