MUSIC for midwives: A framework for Down syndrome communication during antenatal booking appointments

  • Sophie John

    Student thesis: Doctoral Thesis


    Objective: The aim of the research was to identify whether women’s understanding of Down syndrome screening information is influenced by their cognitive status and the midwives’ communicative style.

    Method: The research was in two phases.

    Phase 1: A new framework was developed, Measuring Understanding of Screening Information and Communication (MUSIC), which investigates the cognitive ability (abstract vs. concrete, Need for Cognition) of women, and midwives’ verbal communication, to assess how these influence women’s understanding of screening information.

    Phase 2: The framework was tested within practice. A mixed methods design encompassed two components; audio-recorded consultations and quantitative surveys.

    First antenatal appointments between the midwife (n=16) and woman (n=100) were audio-recorded and transcribed to analyse midwife communication. Women were surveyed twice, immediately after the consultation to assess their cognitive ability and understanding, and one week later to assess their satisfaction. Data were analysed using multiple regression and Pearson’s correlation.

    Findings: Questionnaire results revealed that not all women were fully informed regarding Down syndrome screening although they had made a decision to accept or reject screening. Women with abstract cognitive ability and high Need for Cognition could understand information sufficiently, whereas women with concrete cognitive ability and low Need for Cognition left appointments not well informed. Midwife communication was not significantly correlated with women’s understanding of Down syndrome screening information. However, midwives often communicated information using complex language (average Flesch-Kincaid Grade Level score was 10.36) which was not always interactive, and only 28 women were asked if they understood the provided information.

    Implications: The new MUSIC framework is the first to encompass both women’s cognitive status and midwife communication as an influence on women’s understanding. From the results a new conceptual framework has been proposed to outline what constitutes an “ideal” Down syndrome screening discussion where
    communication is woman-centred, accurate, empathic and supports decision-making.
    Date of Award24 Apr 2017
    Original languageEnglish
    SupervisorMaggie Kirk (Supervisor), Emma Tonkin (Supervisor) & Ian Stuart-Hamilton (Supervisor)


    • Prenatal
    • Pregnancy
    • Screening
    • Cognition
    • Counselling

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