Prenatal aneuploidy screening assesses the likelihood that a fetus will have a chromosomal anomaly. If a screen reveals a high probability, the pregnant woman will be offered diagnostic testing and the possibility of pregnancy termination if a serious anomaly is confirmed. Evidence indicates that incomplete understanding of prenatal aneuploidy screens, unclear risk perception, and the rapid integration of prenatal aneuploidy screening early in the first trimester of pregnancy may compromise the educational and decisional processes needed for women to make informed choices about prenatal aneuploidy screening. As prenatal aneuploidy screening occurs in a complex social, ethical, and political reality, a women's health literacy likely influences her understanding of and decisions made for prenatal aneuploidy screening.

Therefore, the purpose of this study was to explore women's informed decision-making for prenatal aneuploidy screening by investigating the relationships between women's understanding of prenatal aneuploidy screening, their health literacy, and their subsequent satisfaction with decisions made for prenatal aneuploidy screening. The study was guided by Faden and Beauchamp's (1986) model of informed consent, Nutbeam's (2000) concept of health literacy, and Holmes-Rovner and colleague's (1996) concept of satisfaction with a decision. The five domains of health literacy examined in this study include Feeling understood and supported by health care providers, Appraisal of health information, Ability to actively engage with health care providers, Ability to find good health information, and Understand health information enough to know what to do (Osborne, Batterham, Elsworth, Hawkins, & Buchbinder, 2013).

A convenience sample of 95 adult women living in western North Carolina who were ≥ 18 weeks pregnant was recruited to participate in this descriptive, correlational study using cross-sectional methodology. Potential participants were invited to complete an online survey which was distributed via electronic mail to recipients of an electronic pregnancy and parenting newsletter. The survey was used to collect data on women's understanding of prenatal aneuploidy screening, their health literacy, and their satisfaction with decisions made for prenatal aneuploidy screening. Data analyses included descriptive statistics, bivariate correlational analysis, and multiple linear regression.

The majority of participants were Caucasian/White non-Hispanic and college-educated. Results indicate that 42.1% of participants did not report satisfaction with decisions made for prenatal aneuploidy screening. Higher levels of Ability to actively engage with health care providers was significantly associated with increased understanding of prenatal aneuploidy screening. Feeling understood and supported by health care providers, Appraisal of health information, Ability to find good health information, and Understand health information enough to know what to do were not significantly associated with understanding of prenatal aneuploidy screening. Feeling understood and supported by health care providers and Ability to find good health information were significantly associated with increased satisfaction with decisions made for prenatal aneuploidy screening. Appraisal of health information, Ability to actively engage with health care providers, Understand health information enough to know what to do, and understanding of prenatal aneuploidy screening were not significantly associated with satisfaction with decisions made for prenatal aneuploidy screening. This new knowledge has important implications for nursing practice, education, and policy. This study's findings can be used to guide the development of interventions to promote women's informed decision-making for prenatal aneuploidy screening.