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Mulligan K, Baid D, Doctor JN, Phelps CE, Lakdawalla DN. Risk preferences over health: Empirical estimates and implications for medical decision-making. J Health Econ 2024; 94:102857. [PMID: 38232447 DOI: 10.1016/j.jhealeco.2024.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Mainstream health economic theory implies that an expected gain in health-related quality of life (HRQoL) produces the same value for consumers, regardless of baseline health. Several strands of recent research call this implication into question. Generalized Risk-Adjusted Cost-Effectiveness (GRACE) demonstrates theoretically that baseline health status influences value, so long as consumers are not risk-neutral over health. Prior empirical literature casts doubt on risk-neutral expected utility-maximization in the health domain. We estimate utility over HRQoL in a nationally representative U.S. population and use our estimates to measure risk preferences over health. We find that individuals are risk-seeking at low levels of health, become risk-averse at health equal to 0.485 (measured on a 0-1 scale), and are most risk-averse at perfect health (coefficient of relative risk aversion = 4.51). We develop the resulting implications for medical decision making, cost-effectiveness analyses, and the proper theory of health-related decision making under uncertainty.
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Affiliation(s)
- Karen Mulligan
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA
| | - Drishti Baid
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA
| | - Charles E Phelps
- Department of Economics, University of Rochester, 238 Harkness Hall, 280 Hutchison Road, Box 270156, Rochester, NY, 14627, USA
| | - Darius N Lakdawalla
- Sol Price School of Public Policy, University of Southern California, Ralph and Goldy Lewis Hall 312, Los Angeles, CA, 90089, USA; Schaffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA, 90089, USA; School of Pharmacy, University of Southern California, 1985 Zonal Ave, Los Angeles, CA, 90089, USA.
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Tang J, Yang Z, Kee F, Congdon N. Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes. Front Psychol 2023; 14:1101909. [PMID: 37138986 PMCID: PMC10149913 DOI: 10.3389/fpsyg.2023.1101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.
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Affiliation(s)
- Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ziwei Yang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, China
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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3
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Jiang N, Ao C, Xu L, Wei Y, Long Y. Will information interventions affect public preferences and willingness to pay for air quality improvement? An empirical study based on deliberative choice experiment. Sci Total Environ 2023; 868:161436. [PMID: 36623658 DOI: 10.1016/j.scitotenv.2023.161436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Environmental information is a prerequisite for public participation in air quality improvement, and the choice of such participation behavior is influenced by the intervention of environmental information. Nonetheless, there has been insufficient analysis of how information interventions affect public preferences and willingness to pay for air quality improvement. The combination of deliberative and choice experiment is used to explore the importance of information interventions for public participation in air quality improvement, and the changes in public preferences and willingness to pay for air quality improvement before and after information interventions are compared to analyze the impact of information interventions on evaluation results of air quality value. The results suggest that information interventions do alter the preferences and willingness of the public to pay for air quality improvement, significantly increasing the choice certainty of respondents and decreasing the protest response. In addition, women and high-income groups showed a stronger willingness to improve air quality after the information interventions, with 35.15 CNY, 44.07 CNY and 46.75 CNY increases in willingness to pay for improved urban green coverage rate, fewer haze days and reduced morbidity. The combination of deliberative information interventions and choice experiment will help improve the effectiveness of air quality value evaluation, stimulate public environmental awareness and willingness to participate, and the results will aid government environmental management.
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Affiliation(s)
- Nan Jiang
- College of Engineering, Northeast Agricultural University, Harbin 150030, Heilongjiang, China
| | - Changlin Ao
- College of Engineering, Northeast Agricultural University, Harbin 150030, Heilongjiang, China.
| | - Lishan Xu
- Faculty of Economic and Management, Mudanjiang Normal University, Mudanjiang 157011, China.
| | - Yuehua Wei
- College of Engineering, Northeast Agricultural University, Harbin 150030, Heilongjiang, China
| | - Yulin Long
- College of Engineering, Northeast Agricultural University, Harbin 150030, Heilongjiang, China
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Attema AE, Brouwer WBF, Pinto‐Prades JL. Reference-dependent age weighting of quality-adjusted life years. Health Econ 2022; 31:2515-2536. [PMID: 36057854 PMCID: PMC9826257 DOI: 10.1002/hec.4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
People do not only care about maximizing health gains but also about their distribution. For example, they give more weight to younger patients than older patients. This pilot study aims to investigate if age weighting is reinforced by loss aversion if young people are falling behind one's perceived 'normal' quality of life (QoL), while older people do not. We apply a person trade-off method in a large representative sample (n = 990) to estimate age weighting factors. We also measure QoL levels that individuals regard as 'normal' for different ages, serving as reference points. We observe a considerable amount of age weighting, with 20-year-old patients on average receiving 1.7 times as much weight as 80-year-old patients. Perceived 'normal' QoL rapidly decreases with age of a patient. Older people are more optimistic about what constitutes 'normal QoL' than younger people, but they express a faster decline in normal QoL due to aging. Respondents who view all improvements to be gain enlarging show the least age weighting, but loss aversion cannot explain the results. Still, one's age-related reference level is an important predictor of age weights. Given the explorative nature of this study, further studies are called for to generate more robust evidence.
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Affiliation(s)
- Arthur E. Attema
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
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Rouyard T, Leal J, Salvi D, Baskerville R, Velardo C, Gray A. An Intuitive Risk Communication Tool to Enhance Patient-Provider Partnership in Diabetes Consultation. J Diabetes Sci Technol 2022; 16:988-994. [PMID: 33655766 PMCID: PMC9264433 DOI: 10.1177/1932296821995800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM). METHODS The development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires. RESULTS The tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks. Clinicians reported high scores for the usability and usefulness of the tool, making its adoption in routine care promising. CONCLUSIONS Despite increased use of risk calculators in clinical care, this is the first time that such a tool has been developed in the diabetes area. Further studies are needed to confirm the benefits of using this tool on behavioral and health outcomes in T2DM populations.
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Affiliation(s)
- Thomas Rouyard
- Nuffield Department of Population
Health, Health Economics Research Centre, University of Oxford, Oxford, UK
- Research Center for Health Policy and
Economics, Hitotsubashi University, Tokyo, Japan
- Thomas Rouyard, DPhil, Adjunct Assistant
Professor, Research Center for Health Policy and Economics, Hitotsubashi
University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan.
| | - José Leal
- Nuffield Department of Population
Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Dario Salvi
- Department of Engineering Science,
Institute of Biomedical Engineering, University of Oxford, Oxford, UK
- School of Arts, Culture and
Communication, Malmö University, Malmö, Sweden
| | - Richard Baskerville
- Nuffield Department of Primary Care
Health Sciences, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- Department of Engineering Science,
Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population
Health, Health Economics Research Centre, University of Oxford, Oxford, UK
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Herbas-Torrico BC, Frank B. Explaining interpersonal differences in COVID-19 disease prevention behavior based on the health belief model and collective resilience theory: a cross-sectional study from Bolivia. BMC Public Health 2022; 22:1077. [PMID: 35641948 PMCID: PMC9153240 DOI: 10.1186/s12889-022-13068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens’ adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen’s disease prevention behavior. These hypotheses deal with how citizens’ vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors. Methods From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling. Results Regarding a citizen’s vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior. Conclusions In the COVID-19 pandemic, a citizen’s low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13068-1.
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Affiliation(s)
- Boris Christian Herbas-Torrico
- Exact Sciences and Engineering Research Center (CICEI), Bolivian Catholic University San Pablo, M. Marquez Street and Jorge Trigo Andia Park - Tupuraya, Cochabamba, Bolivia.
| | - Björn Frank
- Faculty of Commerce, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku-ku, Tokyo, 169-8050, Japan
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Yang M, Roope LSJ, Buchanan J, Attema AE, Clarke PM, Walker AS, Wordsworth S. Eliciting risk preferences that predict risky health behavior: A comparison of two approaches. Health Econ 2022; 31:836-858. [PMID: 35194876 PMCID: PMC9305924 DOI: 10.1002/hec.4486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/29/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
Information on attitudes to risk could increase understanding of and explain risky health behaviors. We investigate two approaches to eliciting risk preferences in the health domain, a novel "indirect" lottery elicitation approach with health states as outcomes and a "direct" approach where respondents are asked directly about their willingness to take risks. We compare the ability of the two approaches to predict health-related risky behaviors in a general adult population. We also investigate a potential framing effect in the indirect lottery elicitation approach. We find that risk preferences elicited using the direct approach can better predict health-related risky behavior than those elicited using the indirect approach. Moreover, a seemingly innocuous change to the framing of the lottery question results in significantly different risk preference estimates, and conflicting conclusions about the ability of the indicators to predict risky health behaviors.
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Affiliation(s)
- Murong Yang
- Nuffield Department of Population HealthHealth Economics Research CentreUniversity of OxfordOxfordUK
| | - Laurence S. J. Roope
- Nuffield Department of Population HealthHealth Economics Research CentreUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreJohn Radcliffe HospitalUniversity of OxfordOxfordUK
- NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial ResistanceUniversity of OxfordPublic Health England (PHE)OxfordUK
| | - James Buchanan
- Nuffield Department of Population HealthHealth Economics Research CentreUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreJohn Radcliffe HospitalUniversity of OxfordOxfordUK
- NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial ResistanceUniversity of OxfordPublic Health England (PHE)OxfordUK
| | - Arthur E. Attema
- Erasmus School of Health Policy & ManagementRotterdamThe Netherlands
| | - Philip M. Clarke
- Nuffield Department of Population HealthHealth Economics Research CentreUniversity of OxfordOxfordUK
| | - A. Sarah Walker
- NIHR Oxford Biomedical Research CentreJohn Radcliffe HospitalUniversity of OxfordOxfordUK
- NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial ResistanceUniversity of OxfordPublic Health England (PHE)OxfordUK
- Nuffield Department of MedicineJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Sarah Wordsworth
- Nuffield Department of Population HealthHealth Economics Research CentreUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreJohn Radcliffe HospitalUniversity of OxfordOxfordUK
- NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial ResistanceUniversity of OxfordPublic Health England (PHE)OxfordUK
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8
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Attema AE, Frasch JJ, L’Haridon O. Multivariate risk preferences in the quality-adjusted life year model. Health Econ 2022; 31:382-398. [PMID: 34796588 PMCID: PMC9299505 DOI: 10.1002/hec.4456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 08/20/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
The interest in multivariate and higher-order risk preferences has increased. A growing body of literature has demonstrated the relevance and impact of these preferences, but for health the evidence is lacking. We measure multivariate and higher-order risk preferences for quality of life (QoL) and longevity, the two attributes of the Quality-Adjusted Life Year (QALY) model. We observe preferences for a positive correlation between these attributes and for pooling together a fixed loss in one of the attributes and a mean-zero risk in the other, and for pooling together mean-zero risks in QoL and longevity. The findings indicate that higher-order risk preferences are stronger for health than for money. Furthermore, we test if preferences for a risky treatment for a disease affecting only QoL, depend on life expectancy. We find no such a relation, but there is a positive relation between riskiness of a comorbidity affecting life expectancy and risk aversion for a QoL treatment. We therefore observe no definitive deviation from the QALY model, although the model is more robust when expected longevity is high. Our findings suggest that the current practice of cost-effectiveness analysis should be generalized to account for risk aversion in QoL and longevity, and higher-order preferences.
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Affiliation(s)
- Arthur E. Attema
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Jona J. Frasch
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
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9
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Stolk-Vos AC, Attema AE, Manzulli M, van de Klundert JJ. Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care. Soc Sci Med 2022; 294:114730. [DOI: 10.1016/j.socscimed.2022.114730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
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10
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Gandjour A. Financial Incentives in the Path to Recovery from the COVID-19 Pandemic. Appl Health Econ Health Policy 2022; 20:5-8. [PMID: 34719753 PMCID: PMC8557961 DOI: 10.1007/s40258-021-00689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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11
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Edwards DJ. Ensuring Effective Public Health Communication: Insights and Modeling Efforts From Theories of Behavioral Economics, Heuristics, and Behavioral Analysis for Decision Making Under Risk. Front Psychol 2021; 12:715159. [PMID: 34721162 PMCID: PMC8548420 DOI: 10.3389/fpsyg.2021.715159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023] Open
Abstract
Public health (PH) messaging can have an enormous impact on shaping how individuals within society behave, and can ensure it is in a safe and responsible way, consistent with up-to-date evidence-based PH guidelines. If done effectively, messaging can save lives and improve the health of those within society. However, unfortunately, those within Government PH bodies typically have little training about how to effectively represent PH messages in a way that is consistent with psychological theories of cognitive bias, in order to avoid cognitively biasing the public through their messages. As a result of this, inadequate representation of PH messages can result, which can often lead to cognitive bias in those from the public who read or listen to the message information. This can lead to poor decision making of the pubic as a whole, which can then further lead to harm and even death of public members as a result of these poor decisions. One way to minimize the problem of bias in decision making is to explore psychology theories that model how bias can occur from PH messaging, and identify ways in which PH agencies can utilize such approaches to improve the effectiveness of their messages. Previous focus has been largely on behavioral economic theories, however, here, other accounts are offered in addition to these. These include theories of heuristics and theories from the behavior analysis domain, which may increase the predictive power of modeling bias, and have applications for how best to represent PH message information which minimize bias.
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Affiliation(s)
- Darren J. Edwards
- Department of Public Health, Policy, and Social Sciences, Swansea University, Swansea, United Kingdom
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12
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Neil JM, Chang Y, Goshe B, Rigotti N, Gonzalez I, Hawari S, Ballini L, Haas JS, Marotta C, Wint A, Harris K, Crute S, Flores E, Park ER. A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial. JMIR Form Res 2021; 5:e28952. [PMID: 34255651 PMCID: PMC8280830 DOI: 10.2196/28952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.
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Affiliation(s)
- Jordan M Neil
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yuchiao Chang
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Brett Goshe
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nancy Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Irina Gonzalez
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Saif Hawari
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sydney Crute
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Efren Flores
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elyse R Park
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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13
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Hallan SI, Øvrehus MA, Bjørneklett R, Aasarød KI, Fogo AB, Ix JH. Hypertensive nephrosclerosis: wider kidney biopsy indications may be needed to improve diagnostics. J Intern Med 2021; 289:69-83. [PMID: 32613703 DOI: 10.1111/joim.13146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypertensive nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE To evaluate and improve the diagnostic process for nephrosclerosis patients. METHODS We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical nephrosclerosis criteria. RESULTS Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterionephrosclerosis. A new optimized diagnostic algorithm based on proteinuria (<0.75 g d-1 ), systolic blood pressure (>155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio < 1:4) should consider kidney biopsy. CONCLUSION Further improvements of the current clinical criteria seem difficult, so risks and benefits of kidney biopsy could be more actively discussed with selected patients to reduce misclassification and direct treatment.
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Affiliation(s)
- S I Hallan
- From the, Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Nephrology, St Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M A Øvrehus
- From the, Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Nephrology, St Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - R Bjørneklett
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - K I Aasarød
- From the, Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Nephrology, St Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A B Fogo
- Division of Renal Pathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA.,Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA
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Kim KM, Max W, White JS, Chapman SA, Muench U. Do penalty-based pay-for-performance programs improve surgical care more effectively than other payment strategies? A systematic review. Ann Med Surg (Lond) 2020; 60:623-630. [PMID: 33304576 PMCID: PMC7711081 DOI: 10.1016/j.amsu.2020.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this systematic review is to assess if penalty-based pay-for-performance (P4P) programs are more effective in improving quality and cost outcomes compared to two other payment strategies (i.e., rewards and a combination of rewards and penalties) for surgical care in the United States. Penalty-based programs have gained in popularity because of their potential to motivate behavioral change more effectively than reward-based programs to improve quality of care. However, little is known about whether penalties are more effective than other strategies. Materials and methods A systematic literature review was conducted according to the PRISMA guideline to identify studies that evaluated the effects of P4P programs on quality and cost outcomes for surgical care. Five databases were used to search studies published from 2003 to March 1, 2020. Studies were selected based on the PRISMA guidelines. Methodological quality of individual studies was assessed based on ROBINS-I with GRADE approach. Results This review included 22 studies. Fifteen cross-sectional, 1 prospective cohort, 4 retrospective cohort, and 2 case-control studies were found. We identified 11 unique P4P programs: 5 used rewards, 3 used penalties, and 3 used a combination of rewards and penalties as a payment strategy. Five out of 10 studies reported positive effects of penalty-based programs, whereas evidence from studies evaluating P4P programs with a reward design or combination of rewards and penalties was little or null. Conclusions This review highlights that P4P programs with a penalty design could be more effective than programs using rewards or a combination of rewards and penalties to improve quality of surgical care. Evidence on the effectiveness of pay-for-performance programs in quality improvement is mixed. Five out of 10 studies reported positive effects of penalty-based programs. Evidence from studies evaluating P4P programs with a reward design or combination of rewards and penalties was little or null. The increasing use of penalty-based pay-for-performance programs has the potential to improve surgical care quality. Penalties may induce stronger provider and hospital behavioral change than other payment strategies.
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Affiliation(s)
- Kyung Mi Kim
- Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen St Stanford, CA, 94305, United States
| | - Wendy Max
- Institute for Health & Aging, University of California, 3333 California Street, Suite 340, San Francisco, CA, 94118, United States
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies & Department of Epidemiology & Biostatistics, School of Medicine, University of California, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 3333 California Street, Room 455Q UCSF Box 0612, San Francisco, CA, 94118, United States
| | - Ulrike Muench
- Department of Social and Behavioral Sciences & Philip R. Lee Institute for Health Policy Studies, School of Nursing, University of California, San Francisco, 3333 California Street, Room 455H UCSF Box 0612, San Francisco, CA, 94118, United States
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Kim HJ, Jeon B. Decision under risk: Argument against early deep brain stimulation in Parkinson's disease. Parkinsonism Relat Disord 2019; 69:7-10. [DOI: 10.1016/j.parkreldis.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 08/31/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
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