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Rivara AC, Galárraga O, Selu M, Arorae M, Wang R, Faasalele-Savusa K, Rosen R, Hawley NL, Viali S. Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa. PLoS One 2023; 18:e0295845. [PMID: 38134044 PMCID: PMC10745180 DOI: 10.1371/journal.pone.0295845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
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Affiliation(s)
- Anna C. Rivara
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Omar Galárraga
- Department of Health Services Policy and Practice, and International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Melania Selu
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Maria Arorae
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Ruiyan Wang
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rochelle Rosen
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, United States of America
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Satupaitea Viali
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
- School of Medicine, National University of Samoa, Apia, Samoa
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Leslie HH, Babu GR, Dolcy Saldanha N, Turcotte-Tremblay AM, Ravi D, Kapoor NR, Shapeti SS, Prabhakaran D, Kruk ME. Population Preferences for Primary Care Models for Hypertension in Karnataka, India. JAMA Netw Open 2023; 6:e232937. [PMID: 36917109 PMCID: PMC10015308 DOI: 10.1001/jamanetworkopen.2023.2937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/29/2023] [Indexed: 03/15/2023] Open
Abstract
Importance Hypertension contributes to more than 1.6 million deaths annually in India, with many individuals being unaware they have the condition or receiving inadequate treatment. Policy initiatives to strengthen disease detection and management through primary care services in India are not currently informed by population preferences. Objective To quantify population preferences for attributes of public primary care services for hypertension. Design, Setting, and Participants This cross-sectional study involved administration of a household survey to a population-based sample of adults with hypertension in the Bengaluru Nagara district (Bengaluru City; urban setting) and the Kolar district (rural setting) in the state of Karnataka, India, from June 22 to July 27, 2021. A discrete choice experiment was designed in which participants selected preferred primary care clinic attributes from hypothetical alternatives. Eligible participants were 30 years or older with a previous diagnosis of hypertension or with measured diastolic blood pressure of 90 mm Hg or higher or systolic blood pressure of 140 mm Hg or higher. A total of 1422 of 1927 individuals (73.8%) consented to receive initial screening, and 1150 (80.9%) were eligible for participation, with 1085 (94.3%) of those eligible completing the survey. Main Outcomes and Measures Relative preference for health care service attributes and preference class derived from respondents selecting a preferred clinic scenario from 8 sets of hypothetical comparisons based on wait time, staff courtesy, clinician type, carefulness of clinical assessment, and availability of free medication. Results Among 1085 adult respondents with hypertension, the mean (SD) age was 54.4 (11.2) years; 573 participants (52.8%) identified as female, and 918 (84.6%) had a previous diagnosis of hypertension. Overall preferences were for careful clinical assessment and consistent availability of free medication; 3 of 5 latent classes prioritized 1 or both of these attributes, accounting for 85.1% of all respondents. However, the largest class (52.4% of respondents) had weak preferences distributed across all attributes (largest relative utility for careful clinical assessment: β = 0.13; 95% CI, 0.06-0.20; 36.4% preference share). Two small classes had strong preferences; 1 class (5.4% of respondents) prioritized shorter wait time (85.1% preference share; utility, β = -3.04; 95% CI, -4.94 to -1.14); the posterior probability of membership in this class was higher among urban vs rural respondents (mean [SD], 0.09 [0.26] vs 0.02 [0.13]). The other class (9.5% of respondents) prioritized seeing a physician (the term doctor was used in the survey) rather than a nurse (66.2% preference share; utility, β = 4.01; 95% CI, 2.76-5.25); the posterior probability of membership in this class was greater among rural vs urban respondents (mean [SD], 0.17 [0.35] vs 0.02 [0.10]). Conclusions and Relevance In this study, stated population preferences suggested that consistent medication availability and quality of clinical assessment should be prioritized in primary care services in Karnataka, India. The heterogeneity observed in population preferences supports considering additional models of care, such as fast-track medication dispensing to reduce wait times in urban settings and physician-led services in rural areas.
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Affiliation(s)
- Hannah H. Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Giridhara R. Babu
- Indian Institute of Public Health–Bangalore, Public Health Foundation of India, Bengaluru, Karnataka
| | - Nolita Dolcy Saldanha
- Indian Institute of Public Health–Bangalore, Public Health Foundation of India, Bengaluru, Karnataka
| | - Anne-Marie Turcotte-Tremblay
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- VITAM–Laval University Sustainable Health Research Center, Quebec City, Quebec, Canada
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada
| | - Deepa Ravi
- Indian Institute of Public Health–Bangalore, Public Health Foundation of India, Bengaluru, Karnataka
| | - Neena R. Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Suresh S. Shapeti
- Indian Institute of Public Health–Bangalore, Public Health Foundation of India, Bengaluru, Karnataka
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Kocher E, Wood D, Lim SC, Jackson-Morris A, Kataria I, Ngongo C, Sham Z, Chandran A, Nugent R, Mustapha FI. Community priorities for obesity prevention among low-income adults in Kuala Lumpur: a discrete choice experiment. Health Promot Int 2022; 37:6823575. [PMID: 36367424 PMCID: PMC9651037 DOI: 10.1093/heapro/daac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases and associated risk factors, such as obesity, are prevalent and increasing in Malaysia. To address this burden and the heightened vulnerability of low-income communities to these risk factors, the Better Health Programme Malaysia conducted a partial-profile discrete choice experiment (DCE) to inform the design of a community-based obesity-prevention programme. The DCE survey was conducted with community members (n = 1453) from three publicly supported low-cost, high-rise flat complexes in urban Kuala Lumpur. In the survey, community members were asked to choose between different sets of potential evidence-based interventions for obesity prevention. Their responses to these choice tasks were analysed to quantify preferences for these different health interventions using a random utility maximization model. Based on these results, we determined participants’ relative prioritization of the different options. The most preferred interventions were those that reduced the price of fruit and vegetables; altered cooking practices at restaurants and food vendors to reduce salt, sugar and oil; and offered reward incentives for completing online educational activities. Community members did not prioritize several evidence-based interventions, including changes to product placement or product labelling, suggesting that these effective approaches may be less familiar or simply not preferred by respondents. The DCE enabled the clear articulation of these community priorities for evidence-based interventions that focus on the supply and promotion of affordable healthy foods within the local food environment, as well as community demand for healthier food options.
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Affiliation(s)
- Erica Kocher
- Global Health Division, Center for Global Noncommunicable Diseases, RTI International , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Dallas Wood
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Shiang-Cheng Lim
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Angie Jackson-Morris
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Ishu Kataria
- Global Health Division, RTI International, 6th Floor, Commercial Tower, Pullman Hotel, Aerocity New Delhi 100037 , India
| | - Carrie Ngongo
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Zhi Sham
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Arunah Chandran
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
| | - Rachel Nugent
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Feisul Idzwan Mustapha
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
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Mahumud RA, Sultana M, Kundu S, Rahman MA, Mistry SK, Kamara JK, Kamal M, Ali MA, Hossain MG, Brooks C, Khan A, Alam K, Renzaho AMN. The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh. Health Expect 2022; 25:3259-3273. [PMID: 36263949 DOI: 10.1111/hex.13634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. METHODS The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. RESULTS The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. CONCLUSIONS Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. PATIENT OR PUBLIC CONTRIBUTION Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.
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Affiliation(s)
- Rashidul A Mahumud
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.,NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Marufa Sultana
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Satyajit Kundu
- Department of Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md A Rahman
- Development Studies Discipline, Khulna University, Khulna, Bangladesh
| | - Sabuj K Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.,ARCED Foundation, Mirpur, Dhaka, Bangladesh.,Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Joseph K Kamara
- Regional Director, Humanitarian & Emergency Affairs, World Vision International, East Africa Regional Office, Karen, Nairobi, Kenya
| | - Mostafa Kamal
- BL Deakin Business School, Faculty of Business and Law, Deakin University, Geelong, Victoria, Australia
| | - Mohammad A Ali
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia.,Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Md G Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Cristy Brooks
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Khorshed Alam
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Andre M N Renzaho
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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Bansal P, Raj A, Mani Shukla D, Sunder N. COVID-19 vaccine preferences in India. Vaccine 2022; 40:2242-2246. [PMID: 35282928 PMCID: PMC8898737 DOI: 10.1016/j.vaccine.2022.02.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/15/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
India’s mass vaccination efforts have been slow due to high levels of vaccine hesitancy. This study uses data from an online discrete choice experiment with 1371 respondents to rigorously examine the factors shaping vaccine preference in the country. We find that vaccine efficacy, presence of side effects, protection duration, distance to vaccination centre and vaccination rates within social network play a critical role in determining vaccine demand. We apply a non-parametric model to uncover heterogeneity in the effects of these factors. We derive two novel insights from this analysis. First, even though, on average, domestically developed vaccines are preferred, around 30% of the sample favours foreign-developed vaccines. Second, vaccine preference of around 15% of the sample is highly sensitive to the presence of side effects and vaccination uptake among their peer group. These results provide insights for the ongoing policy debate around vaccine adoption in India.
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Larsen A, Tele A, Kumar M. Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20 years (1999-2019). BMC Health Serv Res 2021; 21:589. [PMID: 34144685 PMCID: PMC8214295 DOI: 10.1186/s12913-021-06499-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients' needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers. METHODS We performed a scoping review from the past 20 years (2009-2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers. RESULTS Among the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%). CONCLUSIONS Overall, preference elicitation approaches have been increasingly applied to mental health services globally in the past 20 years. To date, these methods have been exclusively applied to populations within the field of mental health in high-income countries. Prioritizing patients' needs and preferences is a vital component of patient-centered care - one of the six domains of health care quality. Identifying patient preferences for mental health services may improve quality of care and, ultimately, increase acceptability and uptake of services among patients. Rigorous preference-elicitation approaches should be considered, especially in settings where mental health resources are scarce, to illuminate resource allocation toward preferred service characteristics especially within low-income settings.
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Affiliation(s)
- Anna Larsen
- Department of Global Health, University of Washington, Seattle, WA 98195 USA
| | | | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, (47074), Nairobi, 00100 Kenya
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