To determine the factors influencing a woman's acceptance of the expanded alpha-fetoprotein (AFP) test.Methods
A population-based case-control study. All women (age <35) who declined the expanded AFP test were identified as eligible cases. Controls were randomly selected from all women (age <35) who accepted the test.Results
We interviewed 199 cases and 229 controls before 30 weeks of gestation. While 47% of cases reported opposition to abortion as one of their reasons for declining the test (Group A), the remaining 53% of cases had a variety of other reasons for declining (Group B). After controlling for potential confounders, factors significantly associated with declining the test included: skepticism of the usefulness of the test results (odds ratio (OR) = 33.0), influence from family members (OR = 11.4), low educational level (OR = 7.1), willingness to keep a malformed fetus (OR = 6.2), failure to use providers as useful sources of information (OR = 5.0), and misunderstanding of the purpose of the test (OR = 2.0). Polytomous logistic regression revealed that Groups A and B had different determining factors as well as common factors.Conclusion
While many influential factors for participating in prenatal screening remain unmodifiable, some of them may be addressed to improve women's acceptance of prenatal screening tests.