Communicating Test Results from a General Health Check: Preferences from a Discrete Choice Experiment Survey

IntroductionA number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.MethodsA discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes.ResultWe invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families.ConclusionASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers.Trial registration numberCTRI/2018/03/012425.

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The essential ingredients of research supervision: A discrete-choice experiment.

Journal of Educational Psychology ◽

10.1037/edu0000322 ◽

2019 ◽

Vol 111 (7) ◽

pp. 1243-1260 ◽

Cited By ~ 3

Author(s):

Alex Roach ◽

Bruce K. Christensen ◽

Elizabeth Rieger

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Research Supervision

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INDIVIDUALS' PREFERENCES FOR ESOPHAGEAL CANCER SCREENING STRATEGIES: A DISCRETE CHOICE EXPERIMENT

10.1055/s-0039-1681488 ◽

2019 ◽

Author(s):

Y Peters ◽

E van Grinsven ◽

M van de Haterd ◽

D van Lankveld ◽

J Verbakel ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Screening ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Screening Strategies

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A Note on Segmented Multinomial Logit Models for the Analysis of Discrete Choice Experiment Data

SSRN Electronic Journal ◽

10.2139/ssrn.3578105 ◽

2020 ◽

Author(s):

Henning Schaak

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Multinomial Logit ◽

Logit Models ◽

Experiment Data ◽

Multinomial Logit Models

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Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment

The European Journal of Health Economics ◽

10.1007/s10198-016-0763-8 ◽

2016 ◽

Vol 18 (2) ◽

pp. 155-165 ◽

Cited By ~ 27

Author(s):

Axel C. Mühlbacher ◽

John F. P. Bridges ◽

Susanne Bethge ◽

Ch.-Markos Dintsios ◽

Anja Schwalm ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Antiviral Therapy ◽

Chronic Hepatitis C ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment

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Patient preferences for specialist outpatient video consultations: A discrete choice experiment

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211022898 ◽

2021 ◽

pp. 1357633X2110228

Author(s):

Centaine L Snoswell ◽

Anthony C Smith ◽

Matthew Page ◽

Liam J Caffery

Keyword(s):

General Practitioner ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Healthcare Delivery ◽

General Practitioner Practice ◽

Specialist Care ◽

Time Away ◽

Out Of Pocket Costs

Introduction Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. Methods We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. Results Patients ( n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities ( p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient’s local general practitioner practice or hospital ( p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). Conclusion Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.

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Understanding what women want: eliciting preference for delivery health facility in a rural subcounty in Kenya, a discrete choice experiment

BMJ Open ◽

10.1136/bmjopen-2020-038865 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038865

Author(s):

Jackline Oluoch-Aridi ◽

Mary B Adam ◽

Francis Wafula ◽

Gilbert Kokwaro

Keyword(s):

Quality Of Care ◽

Health Facility ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Home Delivery ◽

Process Indicator ◽

Opt Out ◽

Women’S Preferences

ObjectiveTo identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery.DesignA discrete choice experiment (DCE) was conducted to elicit rural women’s preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes.SettingSix health facilities in a rural subcounty.ParticipantsWomen aged 18–49 years who had delivered within 6 weeks.Primary outcomeThe DCE required women to select from hypothetical health facility A or B or opt-out alternative.ResultsA total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare worker (β=1.184, p<0.001), second availability of medical equipment and drug supplies (β=1.073, p<0.001) and third quality of clinical services (β=0.826, p<0.001). Distance, availability of referral services and costs were ranked fourth, fifth and sixth, respectively (β=0.457, p<0.001; β=0.266, p<0.001; and β=0.000018, p<0.001). The opt-out alternative ranked last suggesting a disutility for home delivery (β=−0.849, p<0.001).ConclusionThe most highly valued attribute was a process indicator of quality of care followed by technical indicators. Policymakers need to consider women’s preferences to inform strategies that are person centred and lead to improvements in quality of care during delivery.

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