Preferences of Medical Students for Rural Medical Internships in South Africa: A Discrete Choice Experiment

Abstract Background: Globally the proportion of medical doctors to population in rural areas in low- and middle-income countries remains insufficient to address their health care needs. Therefore, it is imperative to design strategies that attract medical doctors to rural areas to reduce health inequalities and achieve universal health coverage. Methods: This study assessed preferences of medical students for rural internships using a discrete choice experiment. Attributes of rural job were identified through literature and focus group discussions. A D-efficient design was generated with 15 choice sets, each with forced binary, unlabelled, rural hospital alternatives. An online survey was conducted, and data analysed using mixed logit models of main effects only and main effects plus interaction terms. Results: Majority of the respondents were females (130/66.33%) and had urban origin (176/89.80%). The main effects only model showed advanced practical experience, hospital safety, correctly fitting personal protective equipment, and availability of basic resources as the most important attributes influencing take up of rural internship, respectively. Respondents were willing to pay ZAR 2645.92 monthly (95%CI: 1345.90; 3945.94) to gain advanced practical experience (equivalent to 66.15% of current rural allowance). In contrast, increases in rural allowance and the provision of housing were the least important attributes. Based on the interaction model, female respondents and those intending general practise associated higher weight for hospital safety over advanced practical experience. Conclusion: In the context of limited budgets and resource constraints, policy makers and rural health facility managers are advised to prioritise meaningful internship practise environments that offer supervised learning environment, safety from physical and occupational hazards and the provision of basic resources for healthcare system-wide benefits to both staff and rural health facility users alike.

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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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Job preferences of undergraduate pharmacy students in China: a discrete choice experiment

Human Resources for Health ◽

10.1186/s12960-021-00626-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ping Liu ◽

Shimeng Liu ◽

Tiantian Gong ◽

Quan Li ◽

Gang Chen ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Rural Areas ◽

Choice Experiment ◽

Job Characteristics ◽

Pharmacy Students ◽

Preference Heterogeneity ◽

Short Supply ◽

Job Preferences ◽

Open Management

Abstract Background Pharmacists are a crucial part of the health workforce and play an important role in achieving universal health coverage. In China, pharmaceutical human resources are in short supply, and the distribution is unequal. This study aimed to identify the key job characteristics that influence the job preferences of undergraduate pharmacy students and to elicit the relative importance of different job characteristics to shed light on future policy interventions. Methods A discrete choice experiment was conducted to assess the job preferences of undergraduate pharmacy students from 6 provinces in mainland China. A face-to-face interview was used to collect data. Conditional logit and mixed logit models were used to analyse data, and the final model was chosen according to the model fit statistics. A series of policy simulations was also conducted. Results In total, 581 respondents completed the questionnaire, and 500 respondents who passed the internal consistency test were analysed. All attributes were statistically significant except for open management. Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was preference heterogeneity among respondents, e.g., male students preferred open management, and female students preferred jobs in public institutions. Furthermore, students with an urban background or from a single-child family placed higher value on a job in the city compared to their counterparts. Conclusion The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of pharmacy students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of pharmacy school graduates.

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9. Understanding Rural Health Service in Cambodia: Results of a Discrete Choice Experiment

Improving Health Sector Performance ◽

10.1355/9789814311854-013 ◽

2011 ◽

pp. 202-247 ◽

Cited By ~ 1

Keyword(s):

Health Service ◽

Rural Health ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Rural Health Service

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Factors influencing the imposition of a charge on the entrance to the interpretive trails in the large protected areas

Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis ◽

10.11118/actaun201361041041 ◽

2013 ◽

Vol 61 (4) ◽

pp. 1041-1049

Author(s):

Josef Navrátil ◽

Kamil Pícha

Keyword(s):

Discrete Choice ◽

Choice Experiment ◽

Fractional Factorial Design ◽

Multinomial Logit Model ◽

Fractional Factorial ◽

Large Protected Areas ◽

A Charge ◽

Main Effects ◽

The Impact ◽

The Way

The aim of this paper is to assess the relation between the character of the interpretive trail and the imposition of a charge on the entrance. This was done using the discrete choice experiment that involves eight attributes, seven of which are with three levels: the overall character of the trail, the way that the route signs are used in the terrain, the ways of providing information, the length of the trail, the way of the routing, the focus of the trail, and the price of the entrance. There is also one with two levels that involves the existence of the places for rest. The fractional factorial design was used (the orthogonal main effects plan) and the Multinomial Logit Model was used in analyzing the data. The 2,830 choices were done by random sampled visitors from eight tourist locations in the Tourist Regions of the Šumava Mts. and South Bohemia during the summer season 2012. The impact of the character of the trail was especially detected in the model. Except for that, the equipment of the trail and its length have had the fundamental impact on the choice of the trail as well. Those longer and worse equipped trails have a significantly lower degree of utility for the respondents. What is quite surprising is that the respondents refused the ecotourism elements of the interpretive trails, such as the possibility of going through the trail on horseback or the accompaniment of an expert who would provide some comments, as it is common to do this at historical attractions within those sightseeing paths.

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Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment

Health Policy and Planning ◽

10.1093/heapol/czaa016 ◽

2020 ◽

Vol 35 (7) ◽

pp. 842-854

Author(s):

Melvin Obadha ◽

Jane Chuma ◽

Jacob Kazungu ◽

Gilbert Abotisem Abiiro ◽

Matthew J Beck ◽

...

Keyword(s):

Health Services ◽

Health Facility ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Latent Class Models ◽

Capitation Payment ◽

Capitation Rate ◽

Provider Payment ◽

Senior Health

Abstract Provider payment mechanisms (PPMs) are important to the universal health coverage (UHC) agenda as they can influence healthcare provider behaviour and create incentives for health service delivery, quality and efficiency. Therefore, when designing PPMs, it is important to consider providers’ preferences for PPM characteristics. We set out to uncover senior health facility managers’ preferences for the attributes of a capitation payment mechanism in Kenya. We use a discrete choice experiment and focus on four capitation attributes, namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate. Using a Bayesian efficient experimental design, choice data were collected from 233 senior health facility managers across 98 health facilities in seven Kenyan counties. Panel mixed multinomial logit and latent class models were used in the analysis. We found that capitation arrangements with frequent payment schedules, timelier disbursements, higher payment rates per individual per year and those that paid for a limited set of health services were preferred. The capitation rate per individual per year was the most important attribute. Respondents were willing to accept an increase in the capitation rate to compensate for bundling a broader set of health services under the capitation payment. In addition, we found preference heterogeneity across respondents and latent classes. In conclusion, these attributes can be used as potential targets for interventions aimed at configuring capitation to achieve UHC.

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Job preferences for medical and nursing students to work in rural Guizhou Province, China: a discrete choice experiment

10.21203/rs.3.rs-31721/v1 ◽

2020 ◽

Author(s):

Meiling Bao ◽

Cunrui Huang

Keyword(s):

Nursing Students ◽

Discrete Choice ◽

Rural Areas ◽

Choice Experiment ◽

Health Workers ◽

Mixed Logit ◽

Guizhou Province ◽

Medical Order ◽

Medical University ◽

Education Opportunity

Abstract Background Maldistribution of health workers between urban and rural areas has been a critical difficulty in China. The shortage of health workers in disadvantaged areas reduces access to essential health services delivery, and adversely affects the population health. Policies on attracting health workers to locate in rural areas are needed to be explored. In order to identify the appropriate incentives, we conducted a discrete choice experiment to determine how specific job attributes might be valued by final year students in medical university in Guizhou Province, China. Methods Attributes of potential job were developed through literature review, in-depth semi-structured interviews and pretest. Salary, education opportunity, transportation, job location, workload, essential equipment, medical order, and identification ('bianzhi') were included. The questionnaire was formulated through a fractional factorial experiment design using %MktRuns macros of SAS 9.4. All medical and nursing students in the final year at Guizhou Medical University were invited to participate in the study. Mixed logit model was used to estimate stated preferences of attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 respondents, including 388 medical students and 399 nursing students. Attributes were statistically significant (with the exception of once every two years for education opportunity) and had expected signs. The results indicate that physical conflict between doctors and patients and identification ('bianzhi') were two of the most important non-monetary job characteristics for both medical and nursing students. And nursing students placed more value on identification ('bianzhi'). Policy simulation suggests that as for the individual incentive respondents were most sensitive to salary increasing. Incentive packages effects were stronger for students from rural background. Conclusions Strategies on medical order, identification ('bianzhi') and salary should be considered to attract final year medical and nursing students to work in rural areas. In addition, specific recruitment policy design tailored for subgroups should be taken into account.

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