Pretesting Discrete-Choice Experiments: A Guide for Researchers

Tolerance for chemotherapy-induced peripheral neuropathy among women with metastatic breast cancer: a discrete-choice experiment

PURPOSE

To quantify preferences for chemotherapy-induced peripheral neuropathy (CIPN) risks and survival benefits of continuing neurotoxic chemotherapy and explore differences in preferences by race among women with metastatic breast cancer (mBC).

METHODS

Women with mBC and CIPN experience completed a discrete-choice experiment that included 12 choice tasks presenting paired profiles that varied four attributes across three levels each: progression-free survival (PFS) (6, 12, 24 months), neuropathy in hands (mild, moderate, severe), neuropathy in feet (mild, moderate, severe), and neuropathy persistence (short-term, long-term, permanent). Aggregate and exploratory stratified (White versus non-White) conditional logit models were estimated from which patients' minimum acceptable benefit was calculated using the willingness-to-pay approach.

RESULTS

Women (n = 189) were on average 52.5 years and 47.1% were non-White. Fewer women who were non-White held a bachelor's degree or higher (p < 0.01) and reported a household income of $85,000 or higher (p = 0.03). In both the aggregate and the stratified analyses, women preferred longer duration of PFS, less severe CIPN in hands and feet, and shorter CIPN duration. In aggregate, respondents were willing to tolerate a one-level increase in neuropathy severity (mild to moderate or moderate to severe) in their hands and feet in exchange for 6.7 and 2.9 months of PFS, respectively. In exchange for 9.3 months of PFS, respondents were willing to tolerate a one-level increase in neuropathy persistence (short-term to long-term or long-term to permanent). Exploratory stratified analysis showed that non-White women had different preferences from White women (p < 0.01), with non-White women requiring more months of PFS benefit to tolerate increases in neuropathy severity and duration compared to White women.

CONCLUSION

Women with mBC favored longer duration of progression-free survival, less severe CIPN in hands and feet, and shorter CIPN duration. Different preferences by race warrant additional future investigation.

Factors influencing the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy among patients with metastatic breast cancer: a best-worst scaling

PURPOSE

To measure the importance of factors that influence the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy (CIPN) among patients with metastatic breast cancer (mBC).

METHODS

An online survey incorporating a best-worst scaling (BWS) was conducted among women in the USA with mBC and experiencing CIPN. In the BWS, women chose the most and least important factors influencing their decision to discontinue treatment due to CIPN. Seven factors were included: relieving current neuropathy symptoms, reducing risk of long-term neuropathy, having another cancer treatment option, understanding the risk of treatment discontinuation, and receiving support for treatment discontinuation from the oncologist, loved ones, or patients with similar experiences. To measure the importance of each factor, a conditional logit model estimated coefficients, which were subsequently rescaled to importance scores that summed to 100. The dependent variable was the choice of a factor as most or least important across seven choice tasks.

RESULTS

The sample included 189 women with a mean age of 52.5 (SD = 12.65) years, 52.9% were White, 33.9% were Black, and 64.6% held a bachelor's degree or higher. When faced with the decision to discontinue treatment due to CIPN, the most important factors were having another cancer treatment option (score 23.5), followed by understanding the risk of treatment discontinuation (score 19.2), and reducing risk of long-term neuropathy (score 19.1). The least important factors in the decision to discontinue treatment due to CIPN were: support from loved ones (score 5.2) and support from other patients (score 3.3).

CONCLUSION

When faced with the decision to discontinue treatment due to CIPN, women with mBC attributed more importance to survival and reducing the risk of long-term CIPN. Knowledge of what matters most to patients may assist with shared decision-making to optimize therapeutic outcomes in patients receiving neurotoxic chemotherapy.

Co-designing Healthcare Interventions with Users: A Discrete Choice Experiment to Understand Young People's Preferences for Sexual and Reproductive Health Services in Lusaka, Zambia

INTRODUCTION

Like in many countries, coverage of sexual and reproductive health (SRH) services among adolescents and young people (AYP) aged 15-24 remains low in Zambia. Increasing coverage of SRH services requires interventions that are responsive to the needs and preferences of AYP. We conducted a discrete choice experiment (DCE) to elicit AYP's preferences for SRH service delivery in Lusaka, Zambia.

METHODS

A cross-sectional DCE was conducted with AYP aged 15-24 years. Consenting participants were presented with alternative SRH service delivery strategies represented by six attributes, namely: location, type of provider, type of services, service differentiation by sex, availability of edutainment, and opening hours. Multinomial logit and random parameters logit models were used to analyse the data. All variables were effect coded.

RESULTS

A total of 423 AYP aged 15-24 years (61% female) completed the DCE. Respondents preferred SRH services that were integrated with other healthcare services (b = 0.65, p < 0.001), delivered by medical staff and peer support workers (b = 0.44, p < 0.001), and provided at a hub within a health facility (b = 0.62, p < 0.001). AYP also preferred services to be available on weekends during the daytime (b = 0.37, p < 0.001). Participants also preferred alternatives which included edutainment (b = 0.22, p < 0.001). Service differentiation by sex had little effect on the preference for SRH service delivery (b = - 0.05, p = 0.08). The coefficient for the "neither" option was negative and statistically significant (b = - 5.31, p < 0.001), implying that AYP did not favor routine SRH service delivery in an outpatient department.

CONCLUSION

Efforts to increase SRH service utilization among AYP should focus on providing comprehensive SRH services that are integrated with other healthcare services. These services should be delivered by a combination of medical staff and peer supporter workers in youth-friendly spaces. Careful attention should be paid to opening times to ensure that these are convenient to AYP.

Discrete Choice Experiment Versus Best-Worst Scaling: An Empirical Comparison in Eliciting Young People's Preferences for Web-Based Mental Health Interventions

BACKGROUND

Discrete choice experiments (DCEs) and best-worst scaling (BWS) profile cases (BWS case 2, or BWS-2) have been increasingly used in eliciting preferences towards health care interventions. However, it remains unclear which method is more suitable for preference elicitation, particularly in the mental health context. This study aims to compare: (1) the preference results elicited from a DCE and BWS-2; and (2) the acceptability of the two methods in the context of web-based mental health interventions (W-MHIs) for managing anxiety and depression in young people.

METHODS

Participants were aged 18-25 years, lived in Australia, and self-reported experiencing anxiety and/or depression in the past 12 months. They also had either an intention to use W-MHIs or previous experience with W-MHIs for managing anxiety and/or depression. Recruitment was conducted online via social media and Deakin University notice boards. Eligible participants completed an online survey containing eight DCE and eight BWS-2 choice tasks. Both types of choice tasks comprised six attributes. A multinominal logit model was used to estimate the preference weights and relative importance of attributes. Acceptability was assessed on the basis of dropout rate, completion time, task difficulty, understanding, and participants' preferred type of choice task.

RESULTS

A total of 198 participants (mean age: 21.42 ± 2.3 years, 64.65% female) completed the survey. Both DCE and BWS-2 predicted that cost was the most important attribute in young people's decision to engage with W-MHIs. However, the two methods differed in the relative importance of attributes and the preference ranking of levels within attributes. The DCE was perceived as easier to understand and answer, with nearly 64% of the participants preferring it over the BWS-2.

CONCLUSIONS

While both methods found cost was the most important attribute associated with engagement with W-MHIs, differences in the ranking of other attributes suggest that DCE and BWS-2 are not necessarily interchangeable. Increased acceptability by study participants of the DCE format suggests that this technique may have more merit than BWS-2-at least in the current study's context. Further research is required to identify the optimal method for determining the relative importance of attributes.

Value of Innovative Multiple Myeloma Treatments from Patient and Healthcare Provider Perspectives: Evidence from a Discrete Choice Experiment

BACKGROUND

Although innovation generally provides measurable improvements in disease characteristics and patient survival, some benefits can remain unclear. This study aimed to investigate patient and healthcare provider (HCP) preferences for the innovative attributes of multiple myeloma (MM) treatments.

METHODS

A cross-sectional, web-based, discrete choice experiment (DCE) survey was conducted among 200 patients with MM and 30 HCPs of patients with MM in the USA. A literature review, followed by interviews with patients with MM and HCPs, was undertaken to select five attributes (progression-free survival [PFS], chance of severe side effects, how patients live with MM treatments, scientific innovation, and monthly out-of-pocket [OOP] cost) and their levels. A Bayesian efficient design was used to generate DCE choice sets. Each choice set comprised two hypothetical MM treatment alternatives described by the selected attributes and their levels. Each patient and HCP was asked to choose a preferred alternative from each of the 11 choice sets. Mixed logit and latent class models were developed to estimate patient and HCP preferences for the treatment attributes.

RESULTS

Overall, patients and HCPs preferred increased PFS, less chance of severe side effects, a treatment that offered life without treatment, scientific innovation, and lower OOP cost. From patients' perspectives, PFS had the highest conditional relative importance (44.7%), followed by how patients live with MM treatments (21.6%) and scientific innovation (16.0%).

CONCLUSIONS

In addition to PFS, patients and HCPs also valued innovative MM treatments that allowed them to live without treatments and/or offered scientific innovation. These attributes should be considered when evaluating MM treatments.

Young People's Preferences for Web-Based Mental Health Interventions for Managing Anxiety and Depression: A Discrete Choice Experiment

OBJECTIVE

Anxiety and depression are prevalent in young people. Web-based mental health interventions (W-MHIs) have the potential to reduce anxiety and depression, yet the level of engagement remains low. This study aims to elicit young people's preferences towards W-MHIs and the relative importance of intervention attributes in influencing choice.

METHODS

A discrete choice experiment (DCE) was conducted online among young people aged 18-25 years who lived in Australia, self-reported experiences of anxiety and/or depression in the past 12 months and had an intention to use W-MHIs and/or previous experience with W-MHIs for managing anxiety and/or depression. Participants were recruited via social media and Deakin University notice boards. The DCE design comprised six attributes, including out-of-pocket cost, access to trained instructors (e.g., therapists, coaches) to help users stay engaged with the intervention, total time required to complete the intervention, initial screening, quizzes within the W-MHIs to check user's understanding about the intervention content, and communication with other users. The DCE design consisted of three blocks, each with eight unlabelled choice tasks, each with two alternatives. Data were analysed using a mixed logit model.

RESULTS

One hundred ninety-nine participants completed the DCE (mean age: 21.43 ± 2.29 years, 64.32% female). Lower cost, access to instructors, and moderate time required to complete the intervention (5 h) were significant facilitators. The W-MHIs including audio- or video-call access to instructors were 23 percentage points more likely to be chosen than those without and W-MHI with a moderate completion time (5 h) was 18 percentage points more likely to be chosen than one with a shorter time (2 h).

CONCLUSION

Our results highlight that low-cost W-MHIs with access to trained instructors and moderate completion time could increase uptake. More research is required to confirm these findings and examine whether these preferences vary across different population characteristics.

What Do People Want from an AI-Assisted Screening App for Sexually Transmitted Infection-Related Anogenital Lesions: A Discrete Choice Experiment

BACKGROUND

One of the World Health Organization (WHO) recommendations to achieve its global targets for sexually transmitted infections (STIs) is the increased use of digital technologies. Melbourne Sexual Health Centre (MSHC) has developed an AI-assisted screening application (app) called AiSTi for the detection of common STI-related anogenital skin conditions. This study aims to understand the community's preference for using the AiSTi app.

METHODS

We used a discrete choice experiment (DCE) to understand community preferences regarding the attributes of the AiSTi app for checking anogenital skin lesions. The DCE design included the attributes: data type; AI accuracy; verification of result by clinician; details of result; speed; professional support; and cost. The anonymous DCE survey was distributed to clients attending MSHC and through social media channels in Australia between January and March 2024. Participant preferences on various app attributes were examined using random parameters logit (RPL) and latent class analysis (LCA) models.

RESULTS

The median age of 411 participants was 32 years (interquartile range 26-40 years), with 64% assigned male at birth. Of the participants, 177 (43.1%) identified as same-sex attracted and 137 (33.3%) as heterosexual. In the RPL model, the most influential attribute was the cost of using the app (24.1%), followed by the clinician's verification of results (20.4%), the AI accuracy (19.5%) and the speed of receiving the result (19.1%). The LCA identified two distinct groups: 'all-rounders' (88%), who considered every attribute as important, and a 'cost-focussed' group (12%), who mainly focussed on the price. On the basis of the currently available app attributes, the predicted uptake was 72%. In the short term, a more feasible scenario of improving AI accuracy to 80-89% with clinician verification at a $5 cost could increase uptake to 90%. A long-term optimistic scenario with AI accuracy over 95%, no clinician verification and no cost could increase it to 95%.

CONCLUSIONS

Preferences for an AI-assisted screening app targeting STI-related anogenital skin lesions are one that is low-cost, clinician-verified, highly accurate and provides results rapidly. An app with these key qualities would substantially improve user uptake.

Measuring Patient Preferences to Inform Clinical Trial Design: An Example in Rheumatoid Arthritis

BACKGROUND

Allogeneic bone marrow transplantation (BMT) may be a curative treatment for patients with rheumatoid arthritis (RA), but it has serious risks, including death. It is uncertain whether patients would accept the risks and benefits of BMT and participate in clinical trials. We conducted a discrete choice experiment (DCE) to quantify risk tolerance and benefit-risk trade-offs to inform the design of a clinical trial for BMT.

METHODS

We conducted a DCE with three attributes (three levels each): chance of stopping disease progression (50-90%), increased chance of death in year after transplant (3-15%), and chance of chronic graft-versus-host disease (cGVHD) (3-15%). An orthogonal main effects design of nine binary choice tasks were presented for two scenarios: one considering their current situation and a second scenario where the patient has failed seven anti-rheumatic drugs. Participants were recruited from the Rheum4U inflammatory arthritis registry. Choice data were analyzed using a logit model accounting for multiple responses per participant.

RESULTS

Sixty patients participated. Most (82%) had severe disease, and the median number of anti-rheumatic drugs previously taken was 6 (range 0-18). As expected, an increased chance of stopping disease progression increases the probability of choosing BMT, while increased chance of both risks decreases the probability. Patients were willing to accept a 3% increase in risk of death or 6% increase in chance of chronic GVHD for a 10% increase in the chance of stopping disease progression. For the most clinically likely BMT risk-benefit profiles, and the likely initial target population of patients who have failed multiple biologics, between 72% and 91% of patients would choose BMT.

CONCLUSIONS

Patients with RA are willing to accept substantial risks for a chance to stop disease progression with BMT, suggesting that a pilot trial of BMT for RA could successfully recruit patients. Preference studies have an important role in informing patient-centered clinical trial planning and design.

Acceptability of linking individual credit, financial, and public records data to healthcare records for suicide risk machine learning models

Objectives

Individual-level information about negative life events (NLE) such as bankruptcy, foreclosure, divorce, and criminal arrest might improve the accuracy of machine learning models for suicide risk prediction. Individual-level NLE data is routinely collected by vendors such as Equifax. However, little is known about the acceptability of linking this NLE data to healthcare data. Our objective was to assess preferences for linking external NLE data to healthcare records for suicide prevention.

Materials and Methods

We conducted a discrete choice experiment (DCE) among Kaiser Permanente Washington (KPWA) members. Patient partners assisted in the design and pretesting of the DCE survey. The DCE included 12 choice tasks involving 4 data linking program attributes and 3 levels within each attribute. We estimated latent class conditional logit models to derive preference weights.

Results

There were 743 participants. Willingness to link data varied by type of information to be linked, demographic characteristics, and experience with NLE. Overall, 65.1% of people were willing to link data and 34.9% were more private. Trust in KPWA to safeguard data was the strongest predictor of willingness to link data.

Discussion

Most respondents supported linking NLE data for suicide prevention. Contrary to expectations, People of Color and people who reported experience with NLEs were more likely to be willing to link their data.

Conclusions

A majority of participants were willing to have their credit and public records data linked to healthcare records provided that conditions are in place to protect privacy and autonomy.

Identifying pragmatic solutions to reduce cigarette smoking prevalence in Indigenous North Americans: A sequential exploratory mixed-methods study protocol

BACKGROUND

American Indians and Alaska Natives (AI/AN) have the highest prevalence of cigarette smoking of any race or ethnicity in the United States. Efforts to address smoking prevalence in this population have not historically targeted maintenance of smoking cessation, or behaviors associated with pregnancy. Recent longitudinal cohort studies have identified maintenance of cessation and pregnancy as potential opportunities to address smoking in AI/AN people.

METHODS

To promote success in achieving sustained smoking cessation in AI/AN people, we propose a community engaged sequential exploratory mixed-methods study focused on identifying pragmatic elements of cessation interventions. A discovery sample of 45 AI/AN people will be included in the qualitative study in one of two arms consisting of small groups or one-on-one interviews to develop elements of cessation interventions for evaluation in a discrete choice experiment survey. These one-on-one interviews will characterize the key drivers of smoking relapse and unique experiences of smoking during pregnancy. An additional, independent small group will consist of counselors who engage in smoking cessation counseling. A larger-scale survey will be administered to an AI/AN cohort from Olmsted County, Minnesota (n = 898). Elements of successful interventions will be used to inform a smoking cessation intervention pilot study. Community stakeholders have informed the methods outlined in this protocol, and there is a longitudinal engagement plan for the duration of study.

DISCUSSION

We outline the methods to understand optimal strategies to promote sustained cigarette smoking cessation and cessation during pregnancy in AI/AN people. This study is critical to inform a pilot intervention aimed at reducing smoking prevalence in AI/AN people.

Preferences for Neurodevelopmental Follow-Up Care for Children: A Discrete Choice Experiment

INTRODUCTION

Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services and early interventions are common. The design and delivery of these services, and associated outcomes for children, may be improved if service provision aligns with families' needs and preferences for receiving care. The aim of this study is to identify families' preferences for neurodevelopmental follow-up care for children using an established methodology.

METHODS

We used a discrete choice experiment (DCE) to elicit families' preferences. We collected data from families and caregivers of children with neurodevelopmental needs. The DCE process included four stages. In stage 1, we identified attributes and levels to be included in the DCE using literature review, interviews, and expert advice. The finalised attributes were location, mode of follow-up, out-of-pocket cost per visit, mental health counselling for parents, receiving educational information, managing appointments, and waiting time. In stage 2, we generated choice tasks that contained two alternatives and a 'neither' option for respondents to choose from, using a Bayesian d-efficient design. These choice tasks were compiled in a survey that also included demographic questions. We conducted pre- and pilot tests to ensure the functionality of the survey and obtain priors. In stage 3, the DCE survey was administered online. We received 301 responses. In stage 4, the analysis was conducted using a latent class model. Additionally, we estimated the relative importance of attributes and performed a scenario analysis.

RESULTS

Two latent classes were observed. More families with full-time employees, higher incomes, postgraduate degrees, and those living in metropolitan areas were in class 1 compared with class 2. Class 1 families preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting < 3 months. Class 2 families disliked city hospitals when compared with private, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. However, no significant differences were noted in follow-up modality, receiving educational information, and appointment management. The relative importance estimation suggested that location was most important for class 1 (28%), whereas for class 2, cost accounted for nearly half of the importance when selecting an alternative. The expected uptake of follow-up care, estimated under three different hypothetical scenarios, may increase by approximately 24% for class 2 if an 'ideal' scenario taking into account preferences was implemented.

CONCLUSION

This study offers insights into aspects that may be prioritised by health services and policymakers to improve the design and delivery of neurodevelopmental follow-up care for children. The findings may enhance the organisation and functioning of existing care programmes; and therefore, improve the long-term outcomes of children with neurodevelopmental needs and their families.

Patients' Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical Management Considerations: A Choice Experiment

BACKGROUND

Several sphingosine-1-phosphate receptor (S1PR) modulators are available in the US for treating relapsing forms of multiple sclerosis (RMS). Given that these S1PR modulators have similar efficacy and safety, patients may consider the clinical management characteristics of the S1PR modulators when deciding among treatments. However, none of the S1PR modulators is clearly superior in every aspect of clinical management, and for some treatments, clinical management varies based on a patient's comorbid health conditions (e.g., heart conditions [HC]).

OBJECTIVES

This study aimed to determine which S1PR modulator patients with relapsing-remitting multiple sclerosis (RRMS) would prefer based on clinical management considerations, and to estimate how different clinical management considerations might drive these preferences. Preferences were explored separately for patients with and without comorbid HC.

METHODS

A multicriteria decision analysis was conducted on S1PR modulators approved to treat RMS: fingolimod, ozanimod, siponimod, and ponesimod. Clinical management preferences of patients with RRMS were elicited in a discrete choice experiment (DCE) in which participants repeatedly chose between hypothetical S1PR modulator profiles based on their clinical management attributes. Attributes included first-dose observations, genotyping, liver function tests, eye examinations, drug-drug interactions, interactions with antidepressants, interactions with foods high in tyramine, and immune system recovery time. Preferences were estimated separately for patients with HC and without HC (noHC). Marginal utilities were calculated from the DCE data for each attribute and level using a mixed logit model. In the multicriteria decision analysis, partial value scores were created by applying the marginal utilities for each attribute and level to the real-world profiles of S1PR modulators. Partial value scores were summed to determine an overall clinical management value score for each S1PR modulator.

RESULTS

Four hundred patients with RRMS completed the DCE. Ponesimod had the highest overall value score for patients both without (n = 341) and with (n = 59) HC (noHC: 5.1; HC: 4.0), followed by siponimod (noHC: 4.9; HC: 3.3), fingolimod (noHC: 3.4; HC: 2.8), and ozanimod (noHC: 0.9; HC: 0.8). Overall, immune system recovery time contributed the highest partial value scores (noHC: up to 1.9 points; HC: up to 1.2 points), followed by the number of drug-drug interactions (noHC: up to 1.2 points; HC: up to 1.7 points).

CONCLUSIONS

When considering the clinical management of S1PR modulators, the average patient with RRMS is expected to choose a treatment with shorter immune system recovery time and fewer interactions with other drugs. Patients both with and without heart conditions are likely to prefer the clinical management profile of ponesimod over those of siponimod, fingolimod, and ozanimod. This information can help inform recommendations for treating RRMS and facilitate shared decision making between patients and their doctors.

Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England

BACKGROUND

Health systems are moving towards value-based care, implementing new care models that allegedly aim beyond patient outcomes. Therefore, a policy and academic debate is underway regarding the definition of value in healthcare, the inclusion of costs in value metrics, and the importance of each value element. This study aimed to define healthcare value elements and assess their relative importance (RI) to the public in England.

METHOD

Using data from 26 semi-structured interviews and a literature review, and applying decision-theory axioms, we selected a comprehensive and applicable set of value-based elements. Their RI was determined using two discrete choice experiments (DCEs) based on Bayesian D-efficient DCE designs, with one DCE incorporating healthcare costs expressed as income tax rise. Respondent preferences were analysed using mixed logit models.

RESULTS

Six value elements were identified: additional life-years, health-related quality of life, patient experience, target population size, equity, and cost. The DCE surveys were completed by 402 participants. All utility coefficients had the expected signs and were statistically significant (p < 0.05). Additional life-years (25.3%; 95% confidence interval [CI] 22.5-28.6%) and patient experience (25.2%; 95% CI 21.6-28.9%) received the highest RI, followed by target population size (22.4%; 95% CI 19.1-25.6%) and quality of life (17.6%; 95% CI 15.0-20.3%). Equity had the lowest RI (9.6%; 95% CI 6.4-12.1%), decreasing by 8.8 percentage points with cost inclusion. A similar reduction was observed in the RI of quality of life when cost was included.

CONCLUSION

The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.

Midwives' compliance with post-exposure prophylaxis guidelines in Tshwane District, South Africa

BACKGROUND

 Human immunodeficiency virus (HIV) remains a major public health concern. Midwifery practitioners as frontline healthcare workers (HCWs) remain susceptible to occupational exposure to infections while performing their routine duties. It is estimated that 90% of occupational exposures occur because of a lack of awareness and training regarding prevention and measures to be taken in case of accidental exposure.

OBJECTIVES

 The study aimed to assess the knowledge, attitudes and compliance of midwifery practitioners regarding post-exposure prophylaxis (PEP) guidelines.

METHOD

 Concurrent mixed-methods research approach with qualitative nested in quantitative design was followed. A random simple sampling technique was used to collect quantitative data from 71 midwifery practitioners. Simultaneously, a purposive non-probability sampling technique was used for the qualitative approach with two occupational health and safety (OHS) practitioners and 13 midwifery practitioners. Data were collected through questionnaires and semi-structured interviews. Quantitative data were analysed with SPSS version 24 and presented in tables and figures, and thematic analysis was employed for the qualitative strand.

RESULTS

 The midwifery practitioners have good knowledge about PEP for HIV. However, the study revealed the underreporting of accidental exposures to blood and body fluids (BBFs) and the underutilisation of available PEP services.

CONCLUSION

 Maternity units are high-risk clinical environments. Underreporting of incidents of exposure remains prevalent among midwifery practitioners.Contribution: The findings will inform policy development structures and hospital management regarding knowledge and implementation gaps related to PEP guidelines in the specific hospitals. Strategies to improve compliance with PEP among midwifery practitioners were developed as a derivative from study findings.

Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment

AIMS

This study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care.

METHOD

We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents' T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model.

RESULTS

The value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (-$10.88 (95% CI: -$12.60, -9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)).

CONCLUSIONS

Stated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.

Consumer Preferences for a Healthcare Appointment Reminder in Australia: A Discrete Choice Experiment

BACKGROUND

It is essential to consider the evidence of consumer preferences and their specific needs when determining which strategies to use to improve patient attendance at scheduled healthcare appointments.

OBJECTIVES

This study aimed to identify key attributes and elicit healthcare consumer preferences for a healthcare appointment reminder system.

METHODS

A discrete choice experiment was conducted in a general Australian population sample. The respondents were asked to choose between three options: their preferred reminder (A or B) or a 'neither' option. Attributes were developed through a literature review and an expert panel discussion. Reminder options were defined by four attributes: modality, timing, content and interactivity. Multinomial logit and mixed multinomial logit models were estimated to approximate individual preferences for these attributes. A scenario analysis was performed to estimate the likelihood of choosing different reminder systems.

RESULTS

Respondents (n = 361) indicated a significant preference for an appointment reminder to be delivered via a text message (β = 2.42, p < 0.001) less than 3 days before the appointment (β = 0.99, p < 0.001), with basic details including the appointment cost (β = 0.13, p < 0.10), and where there is the ability to cancel or modify the appointment (β = 1.36, p < 0.001). A scenario analysis showed that the likelihood of choosing an appointment reminder system with these characteristics would be 97%.

CONCLUSIONS

Our findings provide evidence on how healthcare consumers trade-off between different characteristics of reminder systems, which may be valuable to inform current or future systems. Future studies may focus on exploring the effectiveness of using patient-preferred reminders alongside other mitigation strategies used by providers.

Examining the Effect of Depicting a Patient Affected by a Negative Reimbursement Decision in Healthcare on Public Disagreement with the Decision

BACKGROUND

The availability of increasingly advanced and expensive new health technologies puts considerable pressure on publicly financed healthcare systems. Decisions to not-or no longer-reimburse a health technology from public funding may become inevitable. Nonetheless, policymakers are often pressured to amend or revoke negative reimbursement decisions due to the public disagreement that typically follows such decisions. Public disagreement may be reinforced by the publication of pictures of individual patients in the media. Our aim was to assess the effect of depicting a patient affected by a negative reimbursement decision on public disagreement with the decision.

METHODS

We conducted a discrete choice experiment in a representative sample of the public (n = 1008) in the Netherlands and assessed the likelihood of respondents' disagreement with policymakers' decision to not reimburse a new pharmaceutical for one of two patient groups. We presented a picture of one of the patients affected by the decision for one patient group and "no picture available" for the other group. The groups were described on the basis of patients' age, health-related quality of life (HRQOL) and life expectancy (LE) before treatment, and HRQOL and LE gains from treatment. We applied random-intercept logit regression models to analyze the data.

RESULTS

Our results indicate that respondents were more likely to disagree with the negative reimbursement decision when a picture of an affected patient was presented. Consistent with findings from other empirical studies, respondents were also more likely to disagree with the decision when patients were relatively young, had high levels of HRQOL and LE before treatment, and large LE gains from treatment.

CONCLUSIONS

This study provides evidence for the effect of depicting individual, affected patients on public disagreement with negative reimbursement decisions in healthcare. Policymakers would do well to be aware of this effect so that they can anticipate it and implement policies to mitigate associated risks.

Developing a person-centered stated preference survey for dementia with Lewy bodies: value of a personal and public involvement process

Introduction

The development of high-quality stated preference (SP) surveys requires a rigorous design process involving engagement with representatives from the target population. However, while transparency in the reporting of the development of SP surveys is encouraged, few studies report on this process and the outcomes. Recommended stages of instrument development includes both steps for stakeholder/end-user engagement and pretesting. Pretesting typically involves interviews, often across multiple waves, with improvements made at each wave; pretesting is therefore resource intensive. The aims of this paper are to report on the outcomes of collaboration with a Lewy body dementia research advisory group during the design phase of a SP survey. We also evaluate an alternative approach to instrument development, necessitated by a resource constrained context.

Method

The approach involved conducting the stages of end-user engagement and pretesting together during a public involvement event. A hybrid approach involving a focus group with breakout interviews was employed. Feedback from contributors informed the evolution of the survey instrument.

Results

Changes to the survey instrument were organized into four categories: attribute modifications; choice task presentation and understanding; information presentation, clarity and content; and best-best scaling presentation. The hybrid approach facilitated group brainstorming while still allowing the researcher to assess the feasibility of choice tasks in an interview setting. However, greater individual exploration and the opportunity to trial iterative improvements across waves was not feasible with this approach.

Discussion

Involvement of the research advisory group resulted in a more person-centered survey design. In a context constrained by time and budget, and with consideration of the capacity and vulnerability of the target population, the approach taken was a feasible and pragmatic mechanism for improving the design of a SP survey.

Putting the Choice in Choice Tasks: Incorporating Preference Elicitation Tasks in Health Preference Research

Choice-based preference elicitation methods such as the discrete choice experiment (DCE) present hypothetical choices to respondents, with an expectation that these hypothetical choices accurately reflect a 'real world' health-related decision context and that consequently the choice data can be held to be a true representation of the respondent's health or treatment preferences. For this to be the case, careful consideration needs to be given to the format of the choice task in a choice experiment. The overarching aim of this paper is to highlight important aspects to consider when designing and 'setting up' the choice tasks to be presented to respondents in a DCE. This includes the importance of considering the potential impact of format (e.g. choice context, choice set presentation and size) as well as choice set content (e.g. labelled and unlabelled choice sets and inclusion of reference alternatives) and choice questions (stated choice versus additional questions designed to explore complete preference orders) on the preference estimates that are elicited from studies. We endeavoure to instil a holistic approach to choice task design that considers format alongside content, experimental design and analysis.