Adams RJ, Stocks NP, Wilson DH, Hill CL, Gravier S, Kickbusch I, Beilby JJ. Health literacy – a new concept for general practice?. Australian Family Physician. 2009; 38:(3)144-147

Barbaro N, Pickett SM, Parkhill MR. Environmental attitudes mediate the link between need for cognition and pro-environmental goal choice. Personality and Individual Differences. 2015; 75:220-223

Bangsgaard L, Tabor A. Do pregnant women and their partners make an informed choice about first trimester risk assessment for Down syndrome, and are they satisfied with the choice?. Prenatal Diagnosis. 2013; 33:(2)146-152

Bensing J, Rimondini M, Visser A. What patients want. Patient Education and Counseling. 2013; 90:(3)287-90

Bilker WB, Hansen JA, Brensinger CM, Richard J, Gur RE, Gur RC. Development of abbreviated nine-item forms of the Raven's standard progressive matrices test. Assessment. 2012; 19:(3)354-369

Cacioppo JT, Petty RE. The need for cognition. Journal of Personality and Social Psychology. 1982; 42:(1)116-131

Cacioppo JT, Petty RE, Feng Kao C. The efficient assessment of need for cognition. Journal of Personality Assessment. 1984; 48:(3)306-307

Cacioppo JT, Petty RE, Feinstein JA, Jarvis WBG. Dispositional differences in cognitive motivation: the life and times of individuals varying in need for cognition. Psychological Bulletin. 1996; 119:(2)197-253

Campbell WH, Ritchie AJ. Proverb interpretation in forensic evaluations. American Academy of Psychiatry and the Law. 2002; 27:24-27

Carolan M. Health literacy and the information needs and dilemmas of first-time mothers over 35 years. Journal of Clinical Nursing. 2007; 16:(6)1162-1172

Cegala DJ, Street RL, Clinch CR. The impact of patient participation on physicians' information provision during a primary care medical interview. Health Communication. 2007; 21:(2)177-185

Coaley K. An introduction to psychological assessment and psychometrics.London: Sage; 2009

Cohen AR, Stotland E, Wolfe DM. An experimental investigation of need for cognition. Journal of Abnormal Psychology. 1955; 51:(2)291-294

Cole M. Cognitive development and formal schooling: the evidence from cross-cultural research. In: Moll LC (ed). Cambridge: Cambridge University Press; 1990

Davis TC, Humiston SG, Arnold CL, Bocchini JA, Bass PF, Kennen EM, Bocchini A, Williams D, Kyler P, Lloyd-Puryear M. Recommendations for effective NBS communication: results of focus groups with parents, providers, and experts. Pediatrics. 2006; 117:(3)S326-S430

Della Rosa PA, Catricalà E, Vigliocco G, Cappa SF. Beyond the abstract–concrete dichotomy: mode of acquisition, concreteness, imageability, familiarity, age of acquisition, context availability, and abstractness norms for a set of 417 Italian words. Behavior Research Methods. 2010; 42:(4)1042-1048

Department of Health. Midwifery 2020: Delivering expectations. 2010. (accessed 29 September 2019)

Der G, Batty GD, Deary IJ. The association between IQ in adolescence and a range of health outcomes at 40 in the 1979 US National Longitudinal Study of Youth. Intelligence. 2009; 37:(6)573-580

Gibbs RW, Beitel D. What proverb understanding reveals about how people think. Psychological Bulletin. 1995; 118:(1)133-154

Gibbs RW Proverbial themes we live by. Poetics. 2001; 29:(3)167-88

Goldstein K, Scheerer M. Abstract and concrete behavior: an experimental study with special tests. Psychological Monographs: General and Applied. 1941; 53:(2)1-151

Goldwater MB, Gentner D. On the acquisition of abstract knowledge: structural alignment and explication in learning causal system categories. Cognition. 2015; 137:137-53

Gorham DR. A proverbs test for clinical and experimental use. Psychological Reports. 1956; 2:(1)1-12

Gottfredson LS, Deary IJ. Intelligence predicts health and longevity, but why?. Current Directions in Psychological Science. 2004; 13:(1)1-4

Gray DL, Chang Y, Anderman EM. Conditional effects of mastery goal structure on changes in students' motivational beliefs: need for cognition matters. Learning and Individual Differences. 2015; 40:9-21

Ethical, legal and social issues arising from cell-free fetal DNA technologies. Appendix III to the report: cell-free fetal nucleic acids for non-invasive prenatal diagnosis. 2009. (accessed 29 September 2019)

Hargreaves KM, Stewart RJ, Oliver SR. Informed choice and public health screening for children: the case of blood spot screening. Health Expectations. 2005; 8:(2)161-171

Haugtvedt CP, Petty RE, Cacioppo JT. Need for cognition and advertising: understanding the role of personality variables in consumer behavior. Journal of Consumer Psychology. 1992; 1:(3)239-260

Hewison J. Psychological aspects of individualized choice and reproductive autonomy in prenatal screening. Bioethics. 2015; 29:(1)9-18

John S, Kirk M, Tonkin E, Stuart-Hamilton I. A new tool to assess understanding of Down syndrome screening information presented by midwives. British Journal of Midwifery. 2019; 27:(11)694-701

Jones S. Psychological testing: the essential guide to using and surviving the most popular recruitment and career development tests, 2nd edn. Petersfield, Hampshire: Harriman House; 2010

Keating D. Adolescent thinking. In: Adelson J (ed). New York: Wiley; 1979

Kreuter MW, Strecher VJ, Glassman B. One size does not fit all: the case for tailoring print materials. Annals of Behavioral Medicine. 1999; 21:(4)276-283

Lehman DR, Nisbett RE. A longitudinal study of the effects of undergraduate training on reasoning. Developmental Psychology. 1990; 26:(6)952-60

Martin L, Van Dulmen S, Spelten E, de Jonge A, de Cock P, Hutton E. Prenatal counseling for congenital anomaly tests: parental preferences and perceptions of midwife performance. Prenatal Diagnosis. 2013; 33:(4)341-353

Matthew CT, Stemler SE. Assessing mental flexibility with a new word recognition test. Personality and Individual Differences. 2013; 55:(8)915-920

Nippold MA, Uhden LD, Schwarz IE. Proverb explanation through the lifespan: a developmental study of adolescents and adults. Journal of Speech, Language, and Hearing Research. 1997; 40:(2)245-253

Parry R, Stuart-Hamilton I. Animism begins at forty: evidence that animism and other naïve beliefs are established before the onset of old age. Educational Gerontology. 2010; 36:(10–11)1043-1050

Petty RE, Briñol P, Loersch C, McCaslin MJ. The need for cognition. In: Leary MR, Hoyle RH (eds). New York: Guilford; 2009

Piaget J. Intellectual evolution from adolescence to adulthood. Hum Development. 1972; 15:(1)1-12

Potter BK, Etchegary H, Nicholls SG, Wilson BJ, Craigie SM, Araia MH. Education and parental involvement in decision-making about newborn screening: understanding goals to clarify content. Journal of Genetic Counseling. 2015; 24:(3)400-408

Ramsey C, Wright EN. The Raven progressive matrices: a review of literature relating to its selection for use in the New Canadian Study.Toronto: Board of Education for the City of Toronto, Research Department; 1968

Raven JC. Standard progressive matrices: sets A, B, C, D and E.London: HK Lewis; 1938

Schroeder DH, Salthouse TA. Age-related effects on cognition between 20 and 50 years of age. Personality and Individual Differences. 2004; 36:(2)393-404

Shestowsky D, Horowitz LM. How the need for cognition scale predicts behavior in mock jury deliberations. Law and Human Behavior. 2004; 28:(3)305-307

Stern RA, Prohaska ML. Neuropsychological evaluation of executive functioning. In: Dickstein LJ, Oldham JM, and Riba MB (eds). 1996

Stuart-Hamilton I, McDonald L. Do we need intelligence? Some reflections on the importance of ‘g’. Educational Gerontology. 2001; 27:(5)399-407

Tennant M. Psychology and adult learning, 3rd edn. Abingdon, Oxfordshire: Routledge; 2005

Wachholz TBO, Yassuda MS. The interpretation of proverbs by elderly with high, medium and low educational level: abstract reasoning as an aspect of executive functions. Dementia and Neuropsychologia. 2011; 5:(1)31-37

Wiemer-Hastings K, Krug J, Xu X. Imagery, context availability, contextual constraints and abstractness. Proceedings of the Annual Conference of the Cognitive Science Society. 2001; 23:1106-1111

Wilmore M, Rodger D, Humphreys S, Clifton VL, Dalton J, Flabouris M, Skuses A. How midwives tailor health information used in antenatal care. Midwifery. 2015; 31:(1)74-79

The influence of women's cognitive status on their understanding of Down syndrome screening

02 January 2020
13 min read
Volume 28 · Issue 1



To establish whether women's cognitive status influenced their understanding of Down syndrome screening information, and to determine whether midwives offer the same oral explanation of Down syndrome screening to all women or if information was tailored to each woman based on their cognitive status.


Midwives (n=16) and women (n=100) were recruited from a regional NHS unit in the UK. A mixed-methods design encompassed two components; audio-recorded antenatal consultations and quantitative surveys to assess women's cognitive status and their understanding of Down syndrome screening information.


While women with abstract reasoning skills and high need for cognition (NfC) could understand information sufficiently, women with more concrete skills and low NfC require further explanation from the midwife to reach an informed decision.


Midwives did not tailor their communication based on women's cognitive status. This has implications for midwifery education programmes to train midwives to communicate Down syndrome screening information effectively.

The booking appointment is the first antenatal appointment a woman has with her midwife. At this appointment, women are offered screening for numerous conditions, including Down syndrome. It is vital that women understand screening information because of the implications of the decisions they make. However, research has documented that women are not making informed decisions and undergo screening not realising the implications and subsequent decision-making required (Hall et al, 2009; Bangsgaard and Tabor, 2013). The current research aimed to investigate what factors influence women's understanding of Down syndrome screening information.

Cognitive status plays a role in how we process information in the world around us. Consequently, it may influence women's understanding of screening information. Cognitive ability encompasses a set of mental processes, including attention, memory, intelligence, problem solving, and reasoning.

Piaget (1972) proposed a theory of cognitive development from childhood to adulthood and distinguished between concrete and abstract thought. As humans age, their cognitive development becomes increasingly abstract and logical. Concrete terms and items, which are observable, tend to be acquired at an earlier age than abstract terms, which are not observable (Della Rosa et al, 2010). Abstract thinking forms the basis of logic; it allows individuals to solve problems correctly by imagining alternative solutions and apply knowledge to novel situations (Stern and Prohaska, 1996; Campbell and Ritchie, 2002; Tennant, 2005). The speed of cognitive development can vary between individuals, and it has been suggested that some adults may never gain abstract reasoning and abstract thought might only manifest itself in particular activities in which their strengths lie (Piaget, 1972; Keating, 1979; Cole, 1990; Lehman and Nisbett, 1990; Goldwater and Gentner, 2015).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month