Sonographer-Identified Barriers and Facilitators to Prenatal Screening for Congenital Heart Disease: A Mixed Methods Study

Nelangi Pinto, Xiaoming Sheng, Heather T. Keenan, Janice L.B. Byrne, Belva Stanton, Anita Y. Kinney

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Fetal ultrasound screening for congenital heart disease has high detection rates in efficacy studies but not in practice. We investigated sonographers' perspectives on barriers to screening and their association with intermediate measures of cardiac imaging. Methods: Barriers to fetal heart screening were identified in focus groups with obstetric sonographers. A web-based survey measured reported barriers and sonographers' ability to interpret fetal heart screening images. Generalized linear random effect models assessed associations between barriers and image interpretation. Results: Four themes were identified: intrinsic barriers (self-efficacy), external barriers (time), informational needs, and provider and patient expectations. Among 224 sonographers surveyed, an average of 77.6% of fetal heart images were interpreted correctly. Perceptions about self-efficacy (P =.03) and ease of performing imaging (P =.01) were associated with accuracy of image interpretation. Conclusions: Several sonographer-identified barriers associated with image interpretation may be novel targets for improving prenatal detection of congenital heart disease.

Original languageEnglish (US)
Pages (from-to)3-12
Number of pages10
JournalJournal of Diagnostic Medical Sonography
Issue number1
StatePublished - Jan 2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


  • congenital heart defects
  • fetal ultrasonography
  • prenatal diagnosis


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