Mixed Study On Medical Decision-Making Participation Of High-Risk Pregnant Women During Pregnancy Based On The Theory Of Planned Behavior

Objective:Based on the Theory of Planned Behavior（TPB）,this study aims to scan the situation of high-risk pregnant women’s medical decision-making participation during pregnancy,deeply explore the experience of this population’s medical decision-making participation and deeply analyze its influencing factors through mixed research methods,so as to provide reference for promoting high-risk pregnant women’s active medical decision-making participation and improving sharing decision-making.Methods:This study adopted an explanatory sequential mixed design.In the quantitative stage,a cross-sectional study was used.From November 2021 to May 2022,a questionnaire survey was conducted among eligible high-risk pregnant women in maternity wards of a tertiary hospital in Changchun from by convenience sampling method.The survey instrument consisted of Socio-demographic characteristics and Obstetric information questionnaire,Control Preference Scale（CPS）,Patient Participation in Medical Decision-Making Expectancy Scale,Participation Attitude Scale,Decision Self-Efficacy Scale（DSES）,and Social Support Rating Scale（SSRS）.Data were double-entered using Epidata 3.1 and statistically analyzed using SPSS 26.0.Frequency and percentages（%）were used to describe the count data;median and quartiles[M(P₂₅,P₇₅)]were used to describe the total scores of expectancy of decision-making participation,attitude and self-efficacy,and the scores on the three dimensions of social support because none of the scores on the measurement instruments in this study conformed to a normal distribution;nonparametric test was used to compare the socio-demographic characteristics and obstetric information of high-risk pregnant women;the multivariate ordered Logistic regression analysis was used to explore the predictive effect of the socio-demographic and obstetric factors on decision-making participation of high-risk pregnant women;Spearman’s correlation analysis was used to explore the correlation between five dimensions of TPB;finally,Mplus 8.3 was used to construct a TPB-based path analysis to explore the psychosocial factors of high-risk pregnant women’s decision-making participation behavior.In the qualitative research stage,a descriptive research design was adopted,and an interview guideline was designed based on TPB and quantitative results.And one-on-one,face-to-face semi-structured interview were conducted from May 2022 to September2022 using a maximum difference sampling strategy to select study participants with different types of decision-making participation and representative of the quantitative study results.The interview data were organized and analyzed using thematic analysis with the aid of Nvivo 12.0 software.Results:1.Quantitative section resultsThe types of medical decision making participation during pregnancy for high-risk pregnant women were 90（35.71%）passive,79（31.35%）active and 83（32.94%）shared decision-making participation.The nonparametric test showed that high-risk pregnant women’s age,work status,parity,mode of conception and the number of pregnancy risk factors significantly affected their medical decision-making participation during pregnancy（P<0.05）.Multiple ordered Logistic regression analysis showed that age（β=0.587,P<0.05）,work status（β=0.706,P<0.05）,and parity（β=-0.716,P<0.05）were significant predictors of medical decision-making participation behavior during pregnancy among high-risk pregnant women.And Spearman’s correlation analysis showed significant positive associations between decision-making participation,expectancy of decision-making participation,participation attitude,decision self-efficacy,objective support,subjective support,and utilization of support（P<0.01）.The results of path analysis showed that expectancy of decision-making participation（β=0.605,P<0.001）and decision self-efficacy（β=0.123,P<0.05）directly and positively predicted medical decision-making participation during pregnancy among high-risk pregnant women,and decision self-efficacy,participation attitude,subjective support and utilization of support indirectly contributed to decision-making participation by influencing expectancy of decision-making participation,with indirect effects of 0.156,0.127,0.085 and 0.091,respectively.The model explained 44.9%of the variance in medical decision-making participation during pregnancy among high-risk pregnant women.2.Qualitative section resultsThrough in-depth interviews and analysis of 20 high-risk pregnant women,it was found that the experience of decision-making participation during pregnancy varied among high-risk pregnant women,and eventually distilled into the theme of“Practice in Decision-making Participation”and four sub-themes.And it was revealed that the decision-making participation during pregnancy was influenced by four psychosocial factors of TPB,and five themes and eleven sub-themes were extracted,including“Internal Expectation”,“Cognitive Diversity”,“Perceived Social Support”,“Perceived Stress”and“Self-efficacy”.Conclusion:1.More than 1/3 of high-risk pregnant women’s medical decision-making participation during pregnancy was passive,and only nearly 1/3 of pregnant women have realized the ideal sharing decision-making mode in clinic.Therefore,the medical decision-making participation of high-risk pregnant women during pregnancy is not optimistic,and measures are urgently needed to promote their decision-making participation.2.Age（<35 years old）,working status（employment）and parity（≥2 times）can positively predict high-risk pregnant women’s medical decision-making participation during pregnancy.Researchers should pay attention to these variables when formulating intervention measures to improve the behavior of medical decision-making participation of high-risk pregnant women during pregnancy,so as to develop more scientific and effective intervention measures.3.Path analysis based on TPB can well explain the influencing factors of decision-making participation behavior of high-risk pregnant women,in which expectancy of decision-making participation and decision self-efficacy can directly and positively predict decision-making participation of high-risk pregnant women during pregnancy,while decision self-efficacy,participation attitude,subjective support and utilization of support can indirectly predict decision-making participation by influencing expectancy of decision-making participation.It is suggested that maternal and child healthcare providers should pay full attention to the influence of the above predictive factors on high-risk pregnant women’s medical decision-making participation during pregnancy,and devote themselves to formulating targeted intervention strategies to improve their medical decision-making participation to ensure maternal and child health and good pregnancy outcome.4.The TPB-based explanatory sequential mixed study comprehensively reveals the influencing factors of high-risk pregnant women’s medical decision-making participation during pregnancy from the aspects of behavioral intention,attitude,subjective norms and perceived behavior control.It is recommended that researchers can formulate comprehensive and targeted intervention strategies based on the four elements of TPB,so as to improve the decision-making participation behavior of high-risk pregnant women to the maximum extent and promote the clinical promotion of shared decision-making.