Helen M West

Health professionals' and service users' interpretation of screening test results: experimental study

Abstract Objective To investigate the accuracy of interpretation of probabilistic screening information by different stakeholder groups and whether presentation as frequencies improves accuracy. Design Between participants experimental design; participants responded to screening information embedded in a scenario. Setting Regional maternity service and national conferences and training days. Participants 43 pregnant women attending their first antenatal appointment in a regional maternity service; 40 companions accompanying the women to their appointments; 42 midwives; 41 obstetricians. Participation rates were 56%, 48%, 89%, and 71% respectively. Measures Participants estimated the probability that a positive screening test result meant that a baby actually had Downs syndrome on the basis of all the relevant information, which was presented in a scenario. They were randomly assigned to scenarios that presented the information in percentage (n = 86) or frequency (n = 83) format. They also gave basic demographic information and rated their confidence in their estimate. Results Most responses (86%) were incorrect. Obstetricians gave significantly more correct answers (although still only 43%) than either midwives (0%) or pregnant women (9%). Overall, the proportion of correct answers was higher for presentation as frequencies (24%) than for presentation as percentages (6%), but further analysis showed that this difference occurred only in responses from obstetricians. Many health professionals were confident in their incorrect responses. Conclusions Most stakeholders in pregnancy screening draw incorrect inferences from probabilistic information, and health professionals need to be aware of the difficulties that both they and their patients have with such information. Moreover, they should be aware that different people make different mistakes and that ways of conveying information that help some people will not help others.

Creative potential: mental well-being impact assessment of the Liverpool 2008 European capital of culture programme

OBJECTIVES Culture has a number of potential impacts upon health and well-being. This project was undertaken to assess the potential impacts of the Liverpool 2008 European Capital of Culture programme upon mental well-being, so that positive effects can be maximized and negative impacts reduced, in order that health and well-being are promoted and inequalities are reduced. STUDY DESIGN A mental well-being impact assessment (MWIA) toolkit has been developed, and was piloted in this study. MWIA uses a sequence of procedures designed to systematically assess the effect of projects, programmes and policies upon peoples mental well-being and health. METHODS The MWIA toolkit was used to explore the potential positive and negative impacts on mental well-being of a sample of projects and policies from the European Capital of Culture programme. This was achieved by asking stakeholders to answer a series of questions, holding participative workshops, constructing a community profile and reviewing the research literature. Recommendations were developed which aim to enhance the impact of the programme on peoples mental well-being. RESULTS As expected, both positive and negative impacts of the European Capital of Culture programme on mental well-being were identified. Fourteen themes were identified as emerging from the workshops, screening and reviewing the research evidence. Based on these data, 33 recommendations were developed by the project steering group and have been presented to the Liverpool Culture Company. CONCLUSIONS The process of conducting the assessment, particularly its participatory nature and its awareness-raising role, had impacts upon mental well-being. The findings demonstrate the potential for the Culture Company programme to have a profound impact upon mental well-being, and highlight areas which could be addressed to optimize the impact of the programme.

Do maternal screening tests provide psychologically meaningful results? Cognitive psychology in an applied setting

Prenatal screening tests such as maternal serum screening for Down Syndrome, Edwards Syndrome and neural tube defects are now a routine feature of antenatal care. These tests assess the probability that the foetus has one of these conditions, and those at high risk are offered further testing. This paper seeks to examine whether the screening tests provide a benefit to women being screened. Cognitive psychology research suggests that our reasoning based on probabilistic information is not usually consistent with the formal laws of mathematics. Instead, we may rely on reasoning heuristics such as ‘representativeness’. Research has consistently shown that, when provided with all information relevant to a screening test, we tend to either over‐ or underestimate the probability that the screening result indicates a ‘true’ as opposed to ‘false’ positive result. Applied research into the experience of prenatal screening has used very different methodologies, but the findings are consistent with those from lab‐based cognitive psychology research. The implications may be that probabilistic screening information does not provide useable information and therefore does not promote informed choice. Tests may also fail to offer reassurance, or offer false reassurance.