scholarly journals What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India

2019 ◽  
Vol 4 (3) ◽  
pp. e001509 ◽  
Author(s):  
Marwa Abdel-All ◽  
Blake Angell ◽  
Stephen Jan ◽  
Martin Howell ◽  
Kirsten Howard ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Health Workers ◽  
Family Health ◽  
Health Check ◽  
Social Health ◽  
Significant Heterogeneity ◽  
Group 3

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.

scholarly journals Improving the demand for birth registration: a discrete choice experiment in Ethiopia

2020 ◽  
Vol 5 (5) ◽  
pp. e002209 ◽  
Author(s):  
Mahari Yihdego ◽  
Ayanaw Amogne ◽  
Selamawit Desta ◽  
Yoonjoung Choi ◽  
Solomon Shiferaw ◽  
...  
Keyword(s):  
Willingness To Pay ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Urban Areas ◽  
Choice Experiment ◽  
Addis Ababa ◽  
Discrete Choice Experiments ◽  
Birth Certificates ◽  
Significant Heterogeneity ◽  
Birth Registration

IntroductionBirth registration remains limited in most low and middle-income countries. We investigated which characteristics of birth registration facilities might determine caregivers’ decisions to register children in Ethiopia.MethodsWe conducted a discrete choice experiment in randomly selected households in Addis Ababa and the Southern Nations, Nationalities, and People’s Region. We interviewed caregivers of children 0–5 years old. We asked participants to make eight choices between pairs of hypothetical registration facilities. These facilities were characterised by six attributes selected through a literature review and consultations with local stakeholders. Levels of these attributes were assigned at random using a fractional design. We analysed the choice data using mixed logit models that account for heterogeneity in preferences across respondents. We calculated respondents’ willingness to pay to access registration facilities with specific attributes. We analysed all data separately by place of residence (urban vs rural).ResultsSeven hundred and five respondents made 5614 choices. They exhibited preferences for registration facilities that charged lower fees for birth certificates, that required shorter waiting time to complete procedures and that were located closer to their residence. Respondents preferred registration facilities that were open on weekends, and where they could complete procedures in a single visit. In urban areas, respondents also favoured registration facilities that remained open for extended hours on weekdays, and where the presence of only one of the parents was required for registration. There was significant heterogeneity between respondents in the utility derived from several attributes of registration facilities. Willingness to pay for access to registration facilities with particular attributes was larger in urban than rural areas.ConclusionIn these regions of Ethiopia, changes to the operating schedule of registration facilities and to application procedures might help improve registration rates. Discrete choice experiments can help orient initiatives aimed at improving birth registration.

Is “Localness” about Distance or Relationships? Evidence from Hard Cider

2019 ◽  
Vol 14 (3) ◽  
pp. 252-273 ◽  
Author(s):  
Jarrad Farris ◽  
Trey Malone ◽  
Lindon J. Robison ◽  
Nikki L. Rothwell
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Consumer Preferences ◽  
Geographic Distance ◽  
Social Capital Theory ◽  
The State ◽  
Travel Distance ◽  
Local Foods

AbstractWhile many studies have evaluated consumer demand for local foods, fewer studies have focused on the mechanism that has created the positive willingness-to-pay for local foods. This article compares the role of geographic distance and attachment value in consumer preferences for locally produced hard cider. Consumer valuations are estimated via a “branded” discrete choice experiment where the respondents chose between an in-state hard cider, an out-of-state hard cider, and a no buy option. Our measure of travel distance is based on the optimal driving route between each consumer's GPS location and the locations of the cideries while our attachment value measure is based on social capital theory. This allows us to analyze individual-specific travel distance heterogeneity in consumer choice as it relates to attachment value. Based on a latent class logit model estimated from a discrete choice experiment with 441 participants, we show that attachment value is higher for a cider produced within the state than for a cider produced outside the state. Furthermore, we show that increases in attachment value increase demand for locally produced hard cider more than an equal increase in attachment value for non-locally produced hard cider. Our findings are consistent with “local” preferences based on geopolitical boundaries (e.g., the state of Michigan) and not distance. (JEL Classifications: B55, M3, Q13, C83)

scholarly journals Understanding Health Workers’ Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0165940 ◽  
Author(s):  
Marc-Francois Smitz ◽  
Sophie Witter ◽  
Christophe Lemiere ◽  
Patrick Hoang-Vu Eozenou ◽  
Tomas Lievens ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Health Workers ◽  
Job Preferences ◽  
Timor Leste ◽  
Rural Retention

scholarly journals Incentivising doctor attendance in rural Bangladesh: a latent class analysis of a discrete choice experiment

2021 ◽  
Vol 6 (7) ◽  
pp. e006001
Author(s):  
Blake Angell ◽  
Mushtaq Khan ◽  
Raihanul Islam ◽  
Kate Mandeville ◽  
Nahitun Naher ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Latent Class Models ◽  
Class Analysis ◽  
Sustainable Solutions ◽  
Rural Bangladesh ◽  
Incentive Payments

ObjectiveDoctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at their posts.MethodsWe conducted a discrete choice experiment with 308 doctors across four hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included based on a literature review, qualitative research and a consensus-building workshop with policymakers and key health-system stakeholders: relationship with the community, security measures, attendance-based policies and incentive payments. Respondents’ choices were analysed with mixed multinomial logistic and latent class models and were used to simulate the likely uptake of jobs under different policy packages.ResultsAll attributes significantly impacted doctor choices (p<0.01). Doctors strongly preferred jobs at rural facilities where there was a supportive relationship with the community (β=0.93), considered good attendance in education and training (0.77) or promotion decisions (0.67), with functional security (0.67) and higher incentive payments (0.5 per 10% increase of base salary). Jobs with disciplinary action for poor attendance were disliked by respondents (−0.63). Latent class analysis identified three groups of doctors who differed in their uptake of jobs. Scenario modelling identified intervention packages that differentially impacted doctor behaviour and combinations that could feasibly improve doctors’ attendance.ConclusionBangladeshi doctors have strong but varied preferences over interventions to overcome absenteeism. We generated evidence suggesting that interventions considering the perspective of the doctors themselves could result in substantial reductions in absenteeism. Designing policy packages that take account of the different situations facing doctors could begin to improve their ability and motivation to be present at their job and generate sustainable solutions to absenteeism in rural Bangladesh.

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 Should I Stay or Should I Go Home? A Latent Class Analysis of a Discrete Choice Experiment on Hospital-At-Home

2014 ◽  
Vol 17 (5) ◽  
pp. 588-596 ◽  
Author(s):  
Lucas M.A. Goossens ◽  
Cecile M.A. Utens ◽  
Frank W.J.M. Smeenk ◽  
Bas Donkers ◽  
Onno C.P. van Schayck ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Class Analysis ◽  
Hospital At Home ◽  
At Home

scholarly journals Use of Lotteries for the Promotion of Voluntary Medical Male Circumcision Service: A Discrete-Choice Experiment among Adult Men in Tanzania

2019 ◽  
Vol 39 (4) ◽  
pp. 474-485 ◽  
Author(s):  
Jason J. Ong ◽  
Nyasule Neke ◽  
Mwita Wambura ◽  
Evodius Kuringe ◽  
Jonathan M. Grund ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Male Circumcision ◽  
Choice Experiment ◽  
Latent Class ◽  
Individual Preference ◽  
Preference Heterogeneity ◽  
Voluntary Medical Male Circumcision ◽  
Lottery Ticket ◽  
Medical Male Circumcision

Voluntary medical male circumcision (VMMC) is effective in reducing the risk of human immunodeficiency virus (HIV). However, countries like Tanzania have high HIV prevalence but low uptake of VMMC. We conducted a discrete-choice experiment to evaluate the preferences for VMMC service attributes in a random sample of 325 men aged 18 years or older from the general population in 2 Tanzanian districts, Njombe and Tabora. We examined the preference for financial incentives in the form of a lottery ticket or receiving a guaranteed transport voucher for attendance at a VMMC service. We created a random-parameters logit model to account for individual preference heterogeneity and a latent class analysis model for identifying groups of men with similar preferences to test the hypothesis that men who reported sexually risky behaviors (i.e., multiple partners and any condomless sex in the past 12 months) may have a preference for participation in a lottery-based incentive. Most men preferred a transport voucher (84%) over a lottery ticket. We also found that offering a lottery-based financial incentive may not differentially attract those with greater sexual risk. Our study highlights the importance of gathering local data to understand preference heterogeneity, particularly regarding assumptions around risk behaviors.

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