PROJECT SUMMARY Advancements in prenatal genetic screening have significantly improved the identification of chromosomal abnormalities and heritable conditions during pregnancy, yet current standards for patient education in this domain are largely ineffective. Further, the American College of Obstetricians and Gynecologists recommends prenatal care providers offer all women prenatal genetic screening in the first trimester of pregnancy, regardless of age or genetic risk status. This has moved the focus of prenatal screening from a subset of higher risk couples to all pregnant couples. Classically, information in the clinic has been transferred by written materials and discussions with providers. This approach has a number of weaknesses, including limited time, biases presented by provider perceptions of risk level, and limited genetic knowledge of clinicians. These factors may also contribute to disparities in screening uptake among under-represented populations during pregnancy. The most effective approach to education about prenatal screening, is one-on-one genetic counseling, but due to the limited number of counselors this is not feasible, especially in rural and frontier areas. New innovative education games offer promise to more effectively address gaps in healthcare decision- making. About 59% of all Americans play video games and most of them play for at least three hours per week. In fact, women age 18 or older represent a significantly greater portion of the game-playing population (44%) than boys 18 or younger (17%). Game technology can display complex information in a culturally and linguistically appropriate format to individuals of diverse educational backgrounds that make them ideal for clinical settings especially among low health literacy populations. Aim 1: To compare the effectiveness of a prenatal screening education game to improve knowledge and reduce decisional conflict among underrepresented women with a diverse range of health literacy levels of pregnant women. Aim 2: To assess the effectiveness of the prenatal screening education game to promote shared decision making with providers compared to enhanced usual care (an interactive pdf of the clinic's brochure) or one-on-one genetic counseling (in-person or tele-health). Aim 3: To compare the effectiveness of a prenatal screening education game to improve knowledge and reduce decisional conflict among partners of pregnant women.

PROJECT NARRATIVE Advancements in prenatal genetic screening have significantly improved the identification of chromosomal abnormalities and heritable conditions during pregnancy, yet current standards for patient education in this domain are largely ineffective. The most effective approach to education about prenatal screening, is one-on- one genetic counseling, but due to the limited number of counselors this is not feasible, especially in rural and frontier areas. We will address this national problem using a novel education game that can more effectively address this gap in healthcare decision-making.