scholarly journals Understanding public health providers’ preferences for interventions against informal payment in Tanzania: a discrete choice experiment

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Binyaruka
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Private Practice ◽  
Choice Experiment ◽  
Multinomial Logit ◽  
Health Providers ◽  
Informal Payment ◽  
Survey Tool ◽  
Facility Level

Abstract Background Informal payments are regressive. They can limit the access to quality healthcare, particularly of the most vulnerable, and are potentially catastrophic. Little is known in terms of providers' preferences for interventions. Methods We conducted a cross-sectional discrete choice experiment (DCE) among 432 health providers from 42 public health facilities (hospitals and health centres) in seven districts from Pwani region and five districts from Dar es Salaam region. The DCE attributes were derived from a scoping literature review, qualitative interview from 27 key informants from three districts, and through workshop with health providers, managers and policy makers. The final DCE survey tool included 12 unlabeled choice sets, each describing two hypothetical jobs that varied across six attributes: mode of payment, supervision at facility, opportunity for private practice, awareness and monitoring, measures against informal payment, and incentive payment for lack informal payment in the past 6 months. Multinomial logit and mixed multinomial logit methods were used to estimate preferences for the attributes. Results All attribute-levels, apart from supervision at the facility level, were significantly influencing health providers' choice decisions for job type (p < 0.001). The most preferred attributes were measures for awareness creation and monitoring -i.e. preferences were significantly higher for facility with noticeboard (coefficient 0.39, 95% CI 0.29 -0.48 ), followed by provision of receipts (0.34, 0.24 -0.44) and presence of hotline number for reporting corrupt practices (0.26, 0.17 -0.35). Opportunity for private practice was significantly preferred (0.38, 0.31-045) and job preference increases as salary top-up increases (0.06, 0.05-0.7). The less preferred attributes were cash payment for healthcare (-0.27, -0.35- -0.19) and disciplinary measures at the district (-0.15, -0.23 - -0.07) or facility level (-0.10, -0.17- -0.03).

scholarly journals Public Preferences for Social Distancing Behaviors to Mitigate the Spread of COVID-19: A Discrete Choice Experiment

2020 ◽  
Author(s):  
Ingrid Eshun Wilson ◽  
Aaloke Mody ◽  
Ginger McKay ◽  
Mati Hlatshwayo ◽  
Cory Bradley ◽  
...  
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Latent Class Models ◽  
Second Phase ◽  
Sampling Weights ◽  
Social Distancing ◽  
The Public

AbstractPolicies to promote social distancing can minimize COVID-19 transmission, but come with substantial social and economic costs. Quantifying relative preferences of the public for such practices can inform policy prioritization and optimize uptake. We used a discrete choice experiment (DCE) to quantify relative “utilities” (preferences) for five COVID-19 pandemic social distances strategies (e.g., closure of restaurants, restriction of large gatherings) against the hypothetical risk of acquiring COVID-19 and anticipated income loss. The survey was distributed in Missouri in May-June, 2020. We applied inverse probability sampling weights to mixed logit and latent class models to generate mean preferences and identify preference classes. Overall (n=2,428), the strongest preference was for the prohibition of large gatherings, followed by preferences to keep outdoor venues, schools, and social and lifestyle venues open, 75% of the population showing probable support for a strategy that prohibited large gatherings and closed lifestyle and social venues. Latent class analysis, however revealed four preference sub-groups in the population - “risk eliminators”, “risk balancers”, “altruistic” and “risk takers”, with men twice as likely as women to belong to the risk-taking group. In this setting, public health policies which as a first phase prohibit large gatherings, as well as close social and lifestyle venues may be acceptable and adhered to by the public. In addition, policy messages that address preference heterogeneity, for example by targeting public health messages at men, could improve adherence to social distancing measures and prevent further COVID-19 transmission prior to vaccine distribution and in the event of future pandemics.Significance StatementPreferences drive behavior – DCE’s are a novel tool in public health that allow examination of preferences for a product, service or policy, identifying how the public prioritizes personal risks and cost in relation to health behaviors. Using this method to establish preferences for COVID-19 mitigation strategies, our results suggest that, firstly, a tiered approach to non-essential business closures where large gatherings are prohibited and social and lifestyle venues are closed as a first phase, would be well aligned with population preferences and may be supported by the public, while school and outdoor venue closures may require more consideration prior to a second phase of restrictions. And secondly, that important distinct preference phenotypes - that are not captured by sociodemographic (e.g., age, sex, race) characteristics - exist, and therefore that messaging should be target at such subgroups to enhance adherence to prevention efforts.

scholarly journals Do Canadians Support Tailored And Targeted Public Health Programs? A Discrete Choice Experiment

2021 ◽  
Author(s):  
Kiffer G. Card ◽  
Marina Adshade ◽  
Robert S. Hogg ◽  
Jody Jollimore ◽  
Nathan J. Lachowsky
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Public Support ◽  
Health Conditions ◽  
Health Programs ◽  
Public Health Programs ◽  
Marginalized Communities ◽  
Generalized Linear Mixed Effects

Abstract Background. We aimed to assess public support of tailored and targeted public health interventions for various marginalized communities. Methods. We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged >16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target group. Demographically-weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection.Results. 23,889 exercises were completed by 3,054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared with interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs of marginalized communities (e.g. HIV and men who have sex with men). Conclusions. Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.

scholarly journals Enhancing Public Participation in Public Health Offerings: Patient Preferences for Facilities in the Western Cape Province Using a Discrete Choice Experiment

2022 ◽  
Vol 19 (1) ◽  
pp. 590
Author(s):  
Plaxcedes Chiwire ◽  
Charlotte Beaudart ◽  
Silvia M. Evers ◽  
Hassan Mahomed ◽  
Mickaël Hiligsmann
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Waiting Times ◽  
Cape Town ◽  
Health Facilities ◽  
Western Cape ◽  
Western Cape Province ◽  
Public Health Facilities

Understanding patients’ preferences for health facilities could help decision makers in designing patient-centered services. Therefore, this study aims to understand how patients’ willingness to trade for certain attributes affects the choice of public health facilities in the Western Cape province of Cape Town, South Africa. A discrete choice experiment was conducted in two community day centers (CDCs). Patients repetitively chose between two hypothetical health facilities that differed in six attributes: distance to facility, treatment by doctors vs. nurses, confidentiality during treatment, availability of medication, first visit (drop-in) waiting times, and appointment waiting times. The sample consisted of 463 participants. The findings showed that availability of medication (50.5%), appointment waiting times (19.5%), and first visit waiting times (10.2%) were the most important factors for patients when choosing a health facility. In addition, respondents preferred shorter appointment and first visit waiting times (<2 h). These results identified important characteristics in choosing public health facilities in Cape Town. These public health facilities could be improved by including patient voices to inform operational and policy decisions in a low-income setting.

scholarly journals Enhancing Public Health Messaging: Discrete-Choice Experiment Evidence on the Design of HIV Testing Messages in China

2019 ◽  
Vol 39 (5) ◽  
pp. 568-582
Author(s):  
Maya Durvasula ◽  
Stephen W. Pan ◽  
Jason J. Ong ◽  
Weiming Tang ◽  
Bolin Cao ◽  
...  
Keyword(s):  
Public Health ◽  
Social Media ◽  
Hiv Testing ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Underserved Populations ◽  
Social Media Platforms ◽  
Choice Tasks ◽  
Health Messaging

Introduction. While a growing literature documents the effectiveness of public health messaging on social media, our understanding of the factors that encourage individuals to engage with and share messages is limited. In the context of human immunodeficiency virus (HIV) among men who have sex with men (MSM) in China, rising incidence and low testing rates despite decades of interventions suggest the need for effective, targeted messaging to reach underserved populations. Social media platforms and sex-seeking apps present a promising avenue, as web-based strategies can take advantage of existing trust within dense social networks. Methods. We conducted an online discrete-choice experiment in January 2017 with MSM from across China. Participants were presented with 6 choice tasks, each composed of 2 messages about HIV testing, and were asked in which scenario they were more likely to share the content. Participants were given information about the source of the HIV testing message, the social media sharing platform, and the recipients with whom they would share the message. They were given the option of sharing 1 message or neither. Multinomial and mixed logit models were used to model preferences within 4 subgroups. Results. In total, 885 MSM joined the survey, completing 4387 choice tasks. The most important attribute for 3 of the 4 subgroups was social media sharing platform. Men were more willing to share messages on sex-seeking mobile applications and less willing to share materials on generic (non-MSM) social media platforms. We found that men with more active online presences were less willing to share HIV testing messages on generic social media platforms. Conclusions. Our findings suggest that sex-seeking platforms represent a targeted, efficient method of actively engaging MSM in public health interventions.

scholarly journals Analysis of policy interventions to attract and retain nurse midwives in rural areas of Malawi: A discrete choice experiment

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253518
Author(s):  
Leslie Berman ◽  
Levison Nkhoma ◽  
Margaret Prust ◽  
Courtney McKay ◽  
Mihereteab Teshome ◽  
...  
Keyword(s):  
Health Worker ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Health Workers ◽  
Scale Up ◽  
Unequal Distribution ◽  
Recruitment And Retention ◽  
Facility Level

Background Inadequate and unequal distribution of health workers are significant barriers to provision of health services in Malawi, and challenges retaining health workers in rural areas have limited scale-up initiatives. This study therefore aims to estimate cost-effectiveness of monetary and non-monetary strategies in attracting and retaining nurse midwife technicians (NMTs) to rural areas of Malawi. Methods The study uses a discrete choice experiment (DCE) methodology to investigate importance of job characteristics, probability of uptake, and intervention costs. Interviews and focus groups were conducted with NMTs and students to identify recruitment and retention motivating factors. Through policymaker consultations, qualitative findings were used to identify job attributes for the DCE questionnaire, administered to 472 respondents. A conditional logit regression model was developed to produce probability of choosing a job with different attributes and an uptake rate was calculated to estimate the percentage of health workers that would prefer jobs with specific intervention packages. Attributes were costed per health worker year. Results Qualitative results highlighted housing, facility quality, management, and workload as important factors in job selection. Respondents were 2.04 times as likely to choose a rural job if superior housing was provided compared to no housing (CI 1.71–2.44, p<0.01), and 1.70 times as likely to choose a rural job with advanced facility quality (CI 1.47–1.96, p<0.01). At base level 43.9% of respondents would choose a rural job. This increased to 61.5% if superior housing was provided, and 72.5% if all facility-level improvements were provided, compared to an urban job without these improvements. Facility-level interventions had the lowest cost per health worker year. Conclusions Our results indicate housing and facility-level improvements have the greatest impact on rural job choice, while also creating longer-term improvements to health workers’ living and working environments. These results provide practical evidence for policymakers to support development of workforce recruitment and retention strategies.

scholarly journals Factors Affecting Pharmaceutical Care Implementation by Community Pharmacist: A Discrete Choice Experiment

2018 ◽  
Vol 8 (3) ◽  
pp. 136
Author(s):  
Nia Kurnia Sholihat ◽  
Masita Wulandari Suryoputri ◽  
Ade Martinus
Keyword(s):  
Pharmaceutical Care ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Multinomial Logit Model ◽  
Simple Random Sampling ◽  
Multinomial Logit ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Choice Sets

Even though pharmaceutical care has been proven increasing patients’ quality of life, pharmacists still have barriers to implement it. Our study aims to examine factors affecting pharmacists in the community to implement pharmaceutical care using a Discrete Choice Experiment (DCE). The study was a cross-sectional study. A structured DCE questionnaire was administered to 90 community pharmacists in Banyumas district, Indonesia. Respondents were chosen using a simple random sampling method. According to the literature review and expert opinions, the following six attributes were selected: pharmacists’ confidence; willingness to implement pharmaceutical care; communication skill; knowledge and professional skill; availability of time; and availability of space in pharmacy. Eighteen choice sets were developed. Each choice sets comprised of two scenarios. Respondents were asked to choose the scenario they preferred the most. Data were analyzed using multinomial logit model. Of 90 questionnaires distributed, 67 were analyzed. Based on multinomial logit, all attributes had a significant effect on pharmacists’ preferences to implement pharmaceutical care. The findings suggested that pharmacist association should train their member to increase professional skills, as well as the management of pharmacy should provide enough space to perform pharmaceutical care.

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