This study used focus groups to assess the feasibility and acceptability of adapting an Embodied Conversational Agent (ECA) to support decision-making about mode of birth after previous cesarean. Twelve women with previous cesareans, and eight prenatal providers at an academic, tertiary-care medical center, viewed a prototype ECA and were asked to share feedback on the potential role in helping women prepare for decision-making. Both groups felt that although it was somewhat “robot-like,” the ECA could provide easy access to information for patients and could augment the visit with providers. Future work is needed to improve ECA visual appeal and clarify the role and timing for utilization of decision aids using ECA technology to enhance the shared decision-making process.
Women were satisfied with the scripted counseling and found it useful in helping them make a birth mode decision. While the scripted counseling did not appear to influence preferred mode of birth, it appeared to help women follow through with the mode of birth they chose prenatally.
This study evaluated a shared decision-making (SDM) Toolkit (decision aid, counseling guide, and provider scripts) designed to prepare and engage racially diverse women in shared decision-making discussions about the mode of birth after cesarean. The pilot study, involving 27 pregnant women and 63 prenatal providers, assessed women's knowledge, preferences, and satisfaction with decision making, as well as provider perspectives on the Toolkit's acceptability. Most women experienced knowledge improvement, felt more in control and that providers listened to their concerns and supported them. Providers reported that the Toolkit helped women understand their options and supported their counseling. The SDM Toolkit could be used to help women and providers improve their SDM regarding mode of birth after cesarean.
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