An Exploratory Model of Shared Decision-Making in Women's Reproductive Health in Indiana: A Cross-Sectional Study

Abstract Ecological approaches to shared decision-making (SDM) are underexplored in women’s reproductive health. The purpose was to identify ecological factors important to women in contraceptive and prenatal care SDM. In this cross-sectional study, women (18-45 years) living in Indiana who had sought reproductive healthcare completed an online survey (N=432). Multiple linear regression was utilized to identify predictors of SDM. Furthermore, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were conducted to explore ecological factors associated with SDM in contraception and prenatal care. Healthcare professional type was associated with decreased contraceptive SDM scores, but not prenatal care SDM scores. Access, social support, and patient-healthcare professional relationship demonstrated good global fit in confirmatory factor analysis. Path coefficients suggested significant relationships between these ecological factors and contraceptive and prenatal care SDM scores. Additionally, the ecological factors demonstrated good global fit for contraceptive and prenatal care SDM. Social support had a significant, strong, and inverse relationship with both contraceptive and prenatal care SDM in the models. Findings further SDM work by moving beyond option discussion and toward increased attention to women’s contexts and relationships. Taking a holistic approach to SDM and the patient experience ensures that women’s multi-faceted needs, influences, and preferences are met across healthcare settings.