Translation and adaptation of the multidimensional measure of informed choice and the decision regret scale for evaluating non-invasive prenatal test implementation in Norwegian public healthcare

Objective: Norway recently implemented publicly funded non-invasive prenatal testing (NIPT) for pregnant women aged 35 years or older. To evaluate informed decision-making and decision regret in this context, valid and reliable Norwegian instruments are needed. This study aimed to translate, culturally adapt, and psychometrically evaluate the Multidimensional Measure of Informed Choice (MMIC) and Decision Regret Scale (DRS) for use in Norwegian antenatal care. Methods: Following established cross-cultural adaptation guidelines, we conducted forward and backward translation, expert committee review, patient representative feedback, and cognitive interviews. Psychometric evaluation included 120 pregnant women participating in the DIANA study, a Norwegian evaluation of the NIPT screening program. Participants completed the MMIC three weeks after NIPT blood sampling and the DRS four weeks later. Internal consistency (Cronbach's alpha) and content validity were assessed. Results: The Norwegian MMIC and DRS demonstrated comparable performance to the original English instruments. Adaptation identified linguistic, cultural, and medical terminology differences particularly regarding the terms «baby," "chance," and "decision versus choice." Cronbach's alpha coefficients were 0.63 for knowledge, 0.98 for attitude, and 0.82 for deliberation indicating acceptable to excellent reliability. Conclusions: This study provides the first reliable and culturally adapted Norwegian versions of the MMIC and DRS, enabling evaluation of informed decision-making and decision regret in prenatal screening. Innovation: Patient perspectives were included early in the adaptation process, and procedures followed the COSMIN study checklist standards, supporting evaluation of NIPT and other health care decisions.