Prenatal screening for hemoglobinopathies. III. Applicability of the health belief model.

A comprehensive prenatal hemoglobinopathy screening program in Rochester, NY, has been described in a preceding paper in this issue of the Journal.A woman identified as a carrier may face three decisions.The first is whether to accept the offer of counseling.The second is whether to have her partner tested. If her partner also tests positive, then the third decision is whether to accept the offer of prenatal diagnosis.This report analyzes factors affecting her decision, with special attention being given to factors invoked by the Health Belief Model.Factors predicting that a patient who we identified as a carrier would come for counseling included the following: patient had no prior knowledge that she is a carrier (P less than .001), a gestational age less than 18 wk (P less than .01), and Caucasian race (P less than .05).For sickle cell trait counselees and beta-thalassamia trait counselees, factors found to predict patient's intent to have partner tested were the following: a greater postcounseling knowledge of the disease (P less than .009), a lesser perceived burden of Intervention (P less than .011), and belief that the partner is also a carrier (P less than .008).Also for sickle cell trait counselees and beta-thalassemia trait counselees, factors predicting that the partner actually will be tested were the following: living with the partner (P less than .001), gestational age at identification less than or equal to 18 wk (P less than .001), a lesser perceived burden of intervention (P less than .002), and a greater perceived seriousness of the disease (P less than .05).For all counselees, factors predicting that the partner would be tested included the following: living with the partner (P < .001),gestational age at counseling (18 wk (P < .001), and the patient's belief that the partner is a carrier (P < .05).Factors predicting acceptance of prenatal diagnosis were the following: wanting more children (P < .016), awareness of the risk of having a child with a hemoglobinopathy before identification by our program(P < .025), and an older patient age (P < .046).These findings lend support to the applicability of the HealthBelief Model to the prediction of partner testing in hemoglobinopathy screening.