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Journal of Pregnancy
Volume 2017, Article ID 4975091, 13 pages
Research Article

A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England

1Department of Public Health, Saudi Electronic University, P.O. Box 93499, Riyadh 11673, Saudi Arabia
2School of Healthcare, University of Leeds, Baines Wing, Room 3.10, Leeds LS2 9JT, UK
3School of Healthcare, University of Leeds, 2.25 Baines Wing, Leeds LS2 9UT, UK
4Margaret and Wallace McCain Chair in Human Development and Health, University of Prince Edward Island, Charlottetown, PE, Canada C1A 4P3

Correspondence should be addressed to Hyacinth O. Ukuhor; moc.oohay@0002oocayh

Received 29 August 2016; Revised 14 February 2017; Accepted 22 February 2017; Published 22 March 2017

Academic Editor: Jeffrey Keelan

Copyright © 2017 Hyacinth O. Ukuhor et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users’ interactions and decision-making in the context of Down’s syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a purposive sample of 34 community midwives, 35 pregnant women, and 15 partners from two maternity services in different health districts in England. Data were analysed using a combination of grounded theory principles and content analysis and a framework was developed. Results. The main emerging concepts were organisational constraints, power, routinisation, and tensions. Providers were concerned about being time-limited that encouraged routine, minimal information-giving and lacked skills to check users’ understanding. Users reported their participation was influenced by providers’ attitudes, the ambience of the environment, asymmetric power relations, and the offer and perception of screening as a routine test. Discordance between the national programme’s policy of nondirective informed choice and providers’ actions of recommending and arranging screening appointments was unexpected. Additionally, providers and users differing perceptions of emotional effects of information, beliefs, and expectations created tensions within them, between them, and in the antenatal environment. Conclusions. A move towards a social model of care may be beneficial to empower service users and create less tension for providers and users.