Your money, your life, or your freedom? A discrete choice experiment on trade‐offs during a public health crisis

2021 ◽  
Author(s):  
Nicola Belle ◽  
Paola Cantarelli
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Trade Offs

scholarly journals Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katy Tobin ◽  
Sinead Maguire ◽  
Bernie Corr ◽  
Charles Normand ◽  
Orla Hardiman ◽  
...  
Keyword(s):  
Health Services ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Strong Preference ◽  
Multidisciplinary Teams ◽  
Relative Importance ◽  
Trade Offs ◽  
Als Patients ◽  
The Impact

Abstract Background Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. Methods A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant’s choice. Results Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. Conclusions The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.

scholarly journals Understanding public preferences and trade-offs for government responses during a pandemic: a protocol for a discrete choice experiment in the UK

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e043477
Author(s):  
Mesfin G Genie ◽  
Luis Enrique Loría-Rebolledo ◽  
Shantini Paranjothy ◽  
Daniel Powell ◽  
Mandy Ryan ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Online Survey ◽  
Research Unit ◽  
Media Analysis ◽  
Moral Foundation ◽  
Trade Offs ◽  
Ethics Research ◽  
The Uk

IntroductionSocial distancing and lockdown measures are among the main government responses to the COVID-19 pandemic. These measures aim to limit the COVID-19 infection rate and reduce the mortality rate of COVID-19. Given we are likely to see local lockdowns until a treatment or vaccine for COVID-19 is available, and their effectiveness depends on public acceptability, it is important to understand public preference for government responses.Methods and analysisUsing a discrete choice experiment (DCE), this study will investigate the public’s preferences for pandemic responses in the UK. Attributes (and levels) are based on: (1) lockdown measures described in policy documents; (2) literature on preferences for lockdown measures and (3) a social media analysis. Attributes include: lockdown type; lockdown length; postponement of usual non-urgent medical care; number of excess deaths; number of infections; impact on household spending and job losses. We will prepilot the DCE using virtual think aloud interviews with respondents recruited via Facebook. We will collect preference data using an online survey of 4000 individuals from across the four UK countries (1000 per country). We will estimate the relative importance of the attributes, and the trade-offs individuals are willing to make between attributes. We will test if respondents’ preferences differ based on moral attitudes (using the Moral Foundation Questionnaire), socioeconomic circumstances (age, education, economic insecurity, health status), country of residence and experience of COVID-19.Ethics and disseminationThe University of Aberdeen’s College Ethics Research Board (CERB) has approved the study (reference: CERB/2020/6/1974). We will seek CERB approval for major changes from the developmental and pilot work. Peer-reviewed papers will be submitted, and results will be presented at public health and health economic conferences nationally and internationally. A lay summary will be published on the Health Economics Research Unit blog.

scholarly journals Understanding uptake of digital health products: Methodology tutorial for a Discrete Choice Experiment using a Bayesian efficient design (Preprint)

2021 ◽  
Author(s):  
Dorothy Szinay ◽  
Rory Cameron ◽  
Felix Naughton ◽  
Jennifer A. Whitty ◽  
Jamie Brown ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Stated Preference ◽  
Digital Health ◽  
Revealed Preferences ◽  
Quantitative Methodology ◽  
Efficient Design ◽  
Trade Offs ◽  
Health Products

UNSTRUCTURED Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals’ preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method; a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations where revealed preferences are difficult to collect but is much less used in the field of digital health. This article outlines the stages involved in developing a discrete choice experiment. As a case study, it uses the application of a DCE for revealing preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of two or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique.

scholarly journals An assessment of students’ job preference using a discrete choice experiment: a postgraduate case study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Henry Gyarteng-Mensah ◽  
De-Graft Owusu-Manu ◽  
David Edwards ◽  
Isaac Baidoo ◽  
Hatem El-Gohary
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Negative Impact ◽  
Employment Decisions ◽  
Content Type ◽  
Postgraduate Students ◽  
Trade Offs ◽  
Job Preference

Purpose Using a discrete choice experiment (DCE), this study aims to better understand the job preference of postgraduate students studying at the Kwame Nkrumah University of Science and Technology-Institute of Distance Learning, Ghana and also rank the attributes of a job they deem important. Design/methodology/approach The research adopted a positivist epistemological design contextualised within a deductive approach and case study strategy. Primary survey data was collected from a stratified random sample of 128 postgraduate students with multi-sectorial career prospects. Sample students were subjected to a DCE in which their stated preferences were collected using closed-ended questionnaires with 28 pairs of hypothetical job profiles. Respondents’ preferences from the DCE data were then modelled using the conditional logit. Findings The research reveals that: salary in the range GHC 2,800.00 to GHC 3,400.00 ($1 = GHS 5.3); supportive management; very challenging jobs; and jobs located in the city were the top attributes that were significant and had the most impact in increasing the utility of selecting a particular job. Interestingly, jobs with no extra hours workload were not significant hence, had a negative impact upon student preferences. Originality/value This novel research is the first to use a DCE to better elicit preference and trade-offs of postgraduate students in a developing country towards varying job characteristics that have an impact on their future employment decisions. Knowledge advancements made provide invaluable insight to employers and policymakers on the key criteria that should be implemented to retain the best candidate.

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 Finding the best fit: examining the decision-making of augmentative and alternative communication professionals in the UK using a discrete choice experiment

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030274
Author(s):  
Edward J D Webb ◽  
Yvonne Lynch ◽  
David Meads ◽  
Simon Judge ◽  
Nicola Randall ◽  
...  
Keyword(s):  
Decision Making ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Augmentative And Alternative Communication ◽  
Mixed Logit ◽  
Information Criterion ◽  
Alternative Communication ◽  
Trade Offs ◽  
The Uk

ObjectivesMany children with varied disabilities, for example, cerebral palsy, autism, can benefit from augmentative and alternative communication (AAC) systems. However, little is known about professionals’ decision-making when recommending symbol based AAC systems for children. This study examines AAC professionals’ preferences for attributes of AAC systems and how they interact with child characteristics.DesignAAC professionals answered a discrete choice experiment survey with AAC system and child-related attributes, where participants chose an AAC system for a child vignette.SettingThe survey was administered online in the UK.Participants155 UK-based AAC professionals were recruited between 20 October 2017 and 4 March 2018.OutcomesThe study outcomes were the preferences of AAC professionals’ as quantified using a mixed logit model, with model selection performed using a step-wise procedure and the Bayesian Information Criterion.ResultsSignificant differences were observed in preferences for AAC system attributes, and large interactions were seen between child attributes included in the child vignettes, for example, participants made more ambitious choices for children who were motivated to communicate using AAC, and predicted to progress in skills and abilities. These characteristics were perceived as relatively more important than language ability and previous AAC experience.ConclusionsAAC professionals make trade-offs between attributes of AAC systems, and these trade-offs change depending on the characteristics of the child for whom the system is being provided.

scholarly journals How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029406 ◽  
Author(s):  
Sandie Szawlowski ◽  
Peter F M Choong ◽  
Jinhu Li ◽  
Elizabeth Nelson ◽  
Mandana Nikpour ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Night Time ◽  
Trade Off ◽  
Orthopaedic Surgeons ◽  
Trade Offs ◽  
Total Knee ◽  
And Function

ObjectiveTo measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons’ decisions about whether to undertake total knee arthroplasty (TKA).MethodsA discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined.ResultsThe experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient’s pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA.ConclusionThis is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons.

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).

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