The role of attitudinal ambivalence towards Down

1
The role of attitudinal ambivalence towards
Downs syndrome in prenatal testing
decisions Louise Bryant, Josephine Green, Jenny
Hewison
2
Attitudes and informed decisions

• An informed choice is one that is based on
  relevant knowledge, consistent with the decision
  makers values and behaviourally implemented
  (Marteau et al., 2001)
• An attitude can be said to be an evaluation of an
  object as favourable or unfavourable (Eagly and
  Chaiken, 1993).
• Attitudes influencing prenatal testing decisions
  include those towards the test (behaviour) and
  the condition (target).

3
Attitudinal ambivalence

• Ambivalenz the simultaneous
• occurrence of incompatible emotions,
• cognitions or intentions in one person
• (Bleuler, 1911)
• This ambivalency leads, even with
• normal people, to difficulties of decision and to
  
• inner conflict
• (Bleuer, 1913, American Journal of Insanity)
• People are ambivalent when their attitudes
• contain conflicting positive negative
• elements (Maio et al, 2000)

4
Why is attitudinal ambivalence of interest in
this context?

• Ambivalence moderates AB relationship attitudes
  low in ambivalence are better predictors of
  screening behaviour (Dormandy et al, 2006)
• Ambivalent individuals influenced by new
  information rather than existing beliefs
• Need to reduce psychological tension
• Beliefs less confidently held
• Apply systematic thinking more complex schemas
• Ambivalent attitudes more susceptible to
  persuasive messages
• Ambivalent individuals alter opinion in line with
  consensus

Ambivalent individuals are more likely to be
influenced by external factors may seek use
information in order to resolve ambivalence
5
Research study

• Aim
• To investigate the role of attitudinal
  ambivalence in the relationships between prenatal
  testing and termination intentions, serum
  screening uptake and attitudes towards Downs
  syndrome
• Sample
• 140 pregnant women attending antenatal clinic in
  UK
• Measures
• Intentions questionnaire (serum screening, amnio,
  termination)
• Screening uptake from patient notes
• Open-ended measures of attitudes towards Downs
  syndrome (Esses, Haddock, and Zanna, 1993)
  incorporating measure of ambivalence (Maio et al,
  2000)

6
Open-ended measure of attitude ambivalence

• Stereotypical beliefs (cognition)
• How would you describe a person with Downs
  syndrome?
• Emotions (affect)
• How do people with Downs syndrome make you feel?
• Experiences (behavioural)
• Your experiences of people with Downs syndrome
• Parental Quality of Life beliefs (cognition)
• How do you think having a child with Downs
  syndrome would impact on your life?

7
Example measuring affect
When I meet or see people with Downs syndrome I
feel
(P N) 2 P - N 12. (minimum ambivalence
0, maximum 24)
8
Analysis

• Attitude ambivalence scores calculated for each
  component, then a mean score calculated
• Comparative tests of attitudes ambivalence
  across intentions to test and terminate
  (Kruskal-Wallis tests)
• Ability of attitudes towards Downs syndrome and
  ambivalence to predict testing and termination
  intentions (Discriminant function analysis)

9
Results

• Attitude towards Downs syndrome
• Attitude associated with intentions to screen,
  use amnio and terminate
• But not good predictor intentions/actions not to
  screen
• Moderate predictor of amniocentesis intentions
• Good predictor of termination intentions in both
  directions (esp. Affect PQOL belief components)
• Ambivalence
• No significant effects for intention to
  screen/screening behaviour
• Unfavourable attitude to DS/low PQOL Affect
  ambivalence associated with intentions to use
  amnio and to terminate
• Favourable attitude to DS/low Exp SB
  ambivalence associated with intentions not to use
  amnio or terminate
• Dont know termination intention predicted by
  PQOL ambivalence

10
Ambivalence and external factors
Most ambivalent group dont know to
termination

• More likely to mention the need for discussion
  with partner
• Awareness of potential to change minds in the
  actual situation
• A need to have all the facts before deciding

I would have to discuss it with my partner and
wed both have to agree on what to do. (most
ambiv., DK to TOP)
11
Ambivalence and religiosity

• Q Does your religion or religious upbringing
  affect the sorts of decisions that you make about
  your life?
• Ambivalence scores significantly correlated with
  religiosity (p lt 0.01)
• 34 of most ambivalent quartile said that
  religion influenced their life decisions a
  little or quite a lot compared with 9 of the
  least ambivalent quartile

12
Ambivalence and religiosity
Why might ambivalence towards Downs syndrome be
linked with the influence of (Christian)
religion?

• Perceived conflict of beliefs/ Christian
  teaching (love, acceptance of all Gods
  children, the cross to bear) with personal
  desires and goals?
• Personal experience of disability complex
  schemas?

13
Attitudes and informed decisions revisited role
of ambivalence

• 41 of participants gave at least one dont
  know response
• Ambivalence towards Downs syndrome one
  contributing factor least evident in screening
  decisions (very few dont knows), most evident
  in termination intentions
• Do highly ambivalent women use information about
  Downs syndrome differently from those with low
  ambivalence?
• Can you be ambivalent and make informed
  choices?

14
Dr Louise Bryant Leeds Institute Health
Sciences University of LeedsCharles Thackrah
Building101 Clarendon RoadLeeds, United
KingdomLS2 9LJwww.leeds.ac.uk/lihs