STUDY QUESTION Can the application of the theory of planned behavior (TPB) help predict heterosexual parents’ disclosure of donor conception to their children? SUMMARY ANSWER 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. WHAT IS KNOWN ALREADY In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international 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’ disclosure behavior. STUDY DESIGN, SIZE, DURATION The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple. PARTICIPANTS/MATERIALS, SETTING, METHODS The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005–2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7–8 years old (T4), and 13–17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those 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 had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36–3.01). None of the other factors were significantly associated with 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 of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Swedish Research Council. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.

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使用计划行为理论预测父母向孩子透露捐赠者受孕的情况：一项纵向研究

研究问题 计划行为理论 (TPB) 的应用能否帮助预测异性恋父母向孩子透露捐赠者受孕的情况？摘要答案 如果父母有更强的意愿按照有利于披露的社会规范行事，则更有可能在未来 5-9 年内启动披露程序。已知的情况与选择的单亲母亲和同性伴侣相比，异性伴侣需要做出积极的决定，向孩子披露他们使用捐赠者受孕的情况。尽管国际准则鼓励在很小的时候就披露信息，但许多异性恋夫妇的父母却对此感到困扰。此前的一项研究发现，父母的TPB因素得分与披露意愿之间存在关联，但迄今为止，还没有研究应用TPB来预测父母的披露行为。研究设计、规模、持续时间 本研究基于全国纵向研究中的第四波和第五波数据收集（T4 和 T5）。参与的父母是通过身份公开卵母细胞捐赠（n = 68，反应率 65%）和精子捐赠（n = 62，反应率 56%）作为异性夫妇的一部分受孕的。参与者/材料、背景、方法 本研究是瑞典配子捐赠前瞻性纵向研究 (SSGD) 的一部分。在 3 年期间（2005 年至 2008 年），瑞典所有七家提供配子捐赠的生育诊所连续招募开始卵母细胞或精子捐赠治疗的夫妇。参与者被要求在五个时间点完成邮政调查。本研究包括捐献卵母细胞或精子的异性夫妇父母，他们在孩子 7-8 岁 (T4) 和 13-17 岁 (T5) 的两个最近时间点参与研究。在 T4，参与者完成了研究特定的 TPB 披露问卷 (TPB-DQ)，测量向孩子披露捐赠者受孕的态度和意图，并在 T4 和 T5 评估披露行为。使用 Cox 回归的生存分析对 T4 时尚未披露的参与者的数据进行了分析。主要结果和机会的作用 40 名参与者在 T4 时没有向他们的孩子透露捐赠者的受孕情况，其中 13 人在 T5 时仍未透露。我们发现 T4 时的 TPB 因素主观规范得分与 T5 时的后续披露行为之间存在显着关联（HR = 2.019；95% CI：1.36–3.01）。其他因素均与披露行为没有显着相关。局限性和谨慎的理由本研究涉及异性夫妇父母，他们的孩子是在接受开放身份捐赠者的配子治疗后怀孕的，这限制了我们的研究结果对其他群体和环境的普遍适用性。其他限制包括由于纵向研究设计而导致系统流失的风险以及由于参与者较少而导致统计功效下降。研究结果的更广泛影响 我们的研究结果强调了感知主观规范对父母披露行为的重要性，并表明共同父母对披露的看法在这方面特别相关。咨询师应重点支持准父母发起并保持健康、开放的对话，讨论有关通过捐赠者受孕建立家庭的担忧。研究资助/竞争利益 该研究由瑞典研究委员会资助。作者没有需要声明的竞争利益。试用注册号 不适用。