Abstract
Background: Up to 25% of pregnant couples in the Netherlands do not make an informed decision about prenatal screening: their decisions are value-inconsistent or based on insufficient knowledge and deliberation. More than one-third (36%) of the population in the Netherlands has limited health literacy skills, with the majority being individuals with lower levels of education or a migration background. They experience serious problems in understanding health information and taking an active role in decision-making. Therefore, the Dutch Health Council recommends improving decision support for pregnant couples.
Objective: This study aimed to describe the rationale and systematic design of an online, interactive, and tailored video-based assistant to support pregnant couples with limited health literacy skills in decision-making on prenatal screening.
Methods: The intervention mapping framework was used for the iterative user-centered development of the decision aid prenatal screening. This includes the following steps: (1) a needs assessment among the target group (ie, pregnant couples and counselors), (2) defining change objectives based on the needs assessment, (3) selection of theoretical methods, (4) program production and prototype testing, (5) implementation planning, and (6) preparation for evaluation. Three prototypes of the decision aid were iteratively tested among pregnant couples (with low literacy), counselors, and stakeholders relevant for future implementation. This paper describes steps 1 to 4 of the decision aid development.
Results: We developed a decision aid guided by a virtual assistant to promote informed decision-making among pregnant couples (with low health literacy) on prenatal screening. To comply with users’ needs, it includes the following four interactive modules: (1) Other people’s experiences, (2) Information about the tests (and anomalies), (3) Help me decide, and (4) Further questions. To increase accessibility, it features a menu that allows for adapting the speed of speech, making use of subtitles, and is offered in 3 different languages. To increase implementation and future use of the decision aid, an e-learning tool was developed. The decision aid can be used either as a stand-alone tool by pregnant couples or in combination with a counselor during counseling sessions.
Conclusions: By describing the systematic development of a prenatal screening decision aid designed to support pregnant couples with low health literacy in making well-informed choices, we aimed to contribute to systematic reporting and transparent intervention design. Trial
Registration: International Standard Randomised Controlled Trial Registry ISRCTN18016226; https://formative.jmir.org/2026/1/e75391 XSL•FO RenderX JMIR Form Res 2026 | vol. 10 | e75391 | p. 1 (page number not for citation purposes) JMIR FORMATIVE RESEARCH Preuhs et al (JMIR Form Res 2026;10:e75391)