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

02 January 2020
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).

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