O-223 Can the theory of planned behavior predict parents’ disclosure of donor conception to their children within 5-9 years?
Authors: Paulin J , Sorjonen K , Sydsjö G , Lampic C 
Published: July 2024

Abstract

Study question
Does application of the theory of planned behavior (TPB) help predict heterosexual-couple parents’ disclosure of donor conception (DC) to their children?

Summary answer
According to TPB, parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process.

What is known already
In contrast to same-sex couples and single mothers by choice, heterosexual couples need to make an active decision to disclose, or not disclose, their use of DC to their child. While disclosure at an early age is encouraged by international and national guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents’ de facto disclosure behavior.

Study design, size, duration
The present study is based on the fourth (2014-2017) and fifth (2022-2023) waves of data collection in the prospective, longitudinal Swedish Study on Gamete Donation (SSGD). The project collects survey data at five timepoints from acceptance to be donor-recipient, to the children were adolescents. Participating parents had conceived through identity-release oocyte donation (OD; n = 68, response rate 65%) and sperm donation (SD; n = 62, response rate 56%) as part of a heterosexual couple.

Participants/materials, setting, methods
The SSGD includes all parents seeking gamete donation treatment at Swedish university hospitals between 2005-2008, the present study including parents’ data when the children were 7-8 years (T4), and 13-17 years (T5). Parents completed the TPB Disclosure Questionnaire (TPB-DQ) at T4, and disclosure behavior was assessed at both T4 and T5. Data from the participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions.

Main results and the role of chance
Forty participants (31%) had not disclosed the DC to their children at T4 and out of these, 13 had still not disclosed at T5. The TPB-DQ consists of four factors affecting intent to disclose; Attitudes, Subjective norms, Perceived behavioral control and Behavioral intent. The use of Cox regression enabled us to estimate how the parents disclosing to their children related to TPB-DQ, as well as the effect of adjusting for possible confounders. We found a significant association between scores on the TPB-DQ factor Subjective norms at T4 and the subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36 to 3.01). None of the other factors were significantly associated with disclosure behavior. Adjusting for potential confounders did not affect the outcomes. Our results show that parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years. In particular, the co-parent’s opinion about disclosure was found to be an important motivating factor in disclosure behavior.

Limitations, reasons for caution
The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants.

Wider implications of the findings
Our findings highlight the importance of perceived subjective norms for parents’ disclosure behavior and indicate that the co-parent’s opinion about disclosure is particularly relevant. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around family building with DC.

Trial registration number
Not applicable