Shared decision making on mode of delivery following a prior cesarean delivery in Dar es Salaam, Tanzania

Background:  Shared decision-making between clinicians and pregnant women with prior cesarean on the subsequent mode of delivery improves trial of labor rates, and reduces the number of repeat cesarean sections and their related complications. However, this practice is insufficient worldwide and the factors influencing it are still unknown. The study aimed at determining the proportion of pregnant women involved in shared decision-making and its associated factors in Dar es Salaam. Methods: A cross-sectional analytical study among 350 pregnant women with one prior cesarean section. Data was collected using a structured questionnaire and SPSS 23 was used for analysis. A score of 80 or higher on the nine-item Shared Decision-Making Questionnaire (SDM-Q9) was used to calculate the proportion of women, and the associated factors were obtained using a logistic regression model. A p-value of < 0.05 was considered significant. Results: The proportion of pregnant women involved in shared decision-making was 38%. Factors that were significantly associated with sharing decision-making were; having low level of education (AOR 0.55 95% CI 0.33–0.91), being married/having partner (AOR 2.58 95% CI 1.43–4.63), having a companion who had active participation (AOR 3.31 95% CI 1.03–10.6) and being familiar with the clinician (AOR 5.01 95% CI 1.30–19.2). Conclusion: To promote the practice of shared decision-making in our setting, encouragement of socially vulnerable pregnant women's participation in decision-making by health care professionals, encouragement of companion participation during antenatal care and promotion of personal continuity of care to improve familiarity to clinicians are needed. A cross-sectional analytical study among 350 pregnant women with one prior cesarean section. Data was collected using a structured questionnaire and SPSS 23 was used for analysis. A score of 80 or higher on the nine-item Shared Decision-Making Questionnaire (SDM-Q9) was used to calculate the proportion of women, and the associated factors were obtained using a logistic regression model. A p-value of < 0.05 was considered significant. ## Shared decision making on mode of delivery following a prior cesarean delivery in Dar es Salaam, Tanzania [doi.org](doi.org) Dataset contains variables such as demographic and economic characteristics of the participants, questions on mode of delivery as taken from SDM-Q9 tool, and response to questions with regards to active participation during clinics and familiarity to clinicians. ## Description of the data and file structure Variables in the data set * (QN1\_age) represents age in groups-1<20, 2-20–34, 3-> 35 years as used during analysis. * (Qn2\_education ) represents group of education level * Marital status( QN3-marital status) 1-married, 2- single, 3-separated, 4-Divorced. * Occupation (QN4\_occupation) 1-employed, 2-self-employed, 3- un-employed. * mode of payment (QN5\_insurance status) 1-health insurance, 2-cash, 3-cost sharing * (qn6-qn-14) shows response to 9 questions adopted from SDMQ9 tool, responses were scored; completely disagree=0, strongly disagree=1, somewhat disagree=2 somewhat agree=3, strongly agree=4, completely agree=5 * qn6. The Doctor/ Doctors made clear that a decision on mode of delivery needs to be made. * qn7. The Doctor/ Doctors wanted to know exactly how I want to be involved in making the decision on mode of delivery. * qn8. The Doctor/ Doctors told me there are different options for delivery following one prior cesarean. * qn9. The doctor precisely explained the advantages and disadvantages of each mode of delivery following one prior cesarean. * qn10. The Doctor/ Doctors helped me to understand all the information. * qn11. The Doctor/ Doctors asked me which mode of delivery I prefer * qn12. The Doctor/ Doctors and I thoroughly weighed the different options of mode of delivery. * qn13. The Doctor/ Doctors and I selected the mode of delivery together. * qn14. The Doctor/ Doctors and I reached an agreement on how to proceed. * SDM (shared decision making) was obtained from addition of scores from responses to qn6-qn 14, i.e. if the response to all 9 questions was 5, the total score would be 45. * (trans)- the scores obtained from the SDM column were transformed by multiplying the score to 20/9 as recommended by original SDMQ9 tool, to obtain scores ranging 0-100 * (outcome\_SDM) represents women who were involved in shared decision-making by scoring equal or >80=1, not involved( score <80) =0. This column was used to obtain the proportion of women involved in SDM * qn15. At the clinic, did you enquire about your mode of delivery, benefits and harm? 1-Yes, 2-No   qn16. Do you usually visit doctor’s room with your companion? 1-Yes, 2-No –skip question 17   17\. When you attended clinic with your companion\, did he/she enquire about your mode of delivery\, benefits and harm? 1\-Yes\, 2\-No   18\. How well do you know your clinician? 1\-Very Well\, Well\, Rather well\, 2\-Not well\, Not well at all ## Sharing/Access information none * ## Code/Software no codes