Discussion
thalassemia
THALASSEMIA, DISORDERS
We found that pregnant women’s knowledge of cell-free DNA screening increased after pretest traditional counseling and even higher when an animated educational video was added. The attitude toward positive screening test, level of satisfaction to the counseling, and screening acceptance rate were not statistically different between the video and non-video group.Data from the present study consistent with previous studies conducted in developed countries [Before counseling, the majority of the participants had misunderstanding that some non-chromosomal disorders, especially thalassemia, could be detected via cell-free DNA screening., which is in agreement with previous study [Prior to the counseling, one-fourth of the participants had correct knowledge that termination of pregnancy should not be considered solely based on cell-free DNA positive results and the traditional counseling had little effect on increasing this knowledge to the participant (Table Although individual counseling and information sheet are generally considered sufficient for genetic counseling, we thought that a video could add some advantages as follow: 1) images-linked to written or spoken text in animated video can expand patients’ comprehension and simplify complex technical terms about cell-free DNA screening, as a result an increase of patients’ knowledge [The acceptance rate of cell-free DNA screening in this study was high when compared with previous studies [To the best of our knowledge, this is the first study to compare the effectiveness of two methods of providing counseling about cell-free DNA screening in a developing country. It was a randomized control trial that all the counselors were blinded to the randomization sequence, which could decrease selection bias. The questionnaire was originally developed and validated using Thai language, therefore we believe that outcome measures were socio-culturally fitting. The video could be considered to use in other hospitals in Thailand or translated into other languages for use in other countries where the patient characteristics are similar.This study also had some limitations. Over half the participants had at least a bachelor’s degree. Although most of the pregnant women in our antenatal clinic were unaware of cell-free DNA screening before counseling, their high educational level may have affected their acquisition of knowledge about this screening technique [