Location, Location, Location: A Discrete Choice Experiment to Inform Vaccination Programme Delivery in the UK

Abstract BackgroundLarge-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK’s vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18-29-year-olds with respect to key delivery characteristics.MethodsFrom 25 March - 2 April 2021, an online sample of 2,021 UK adults aged 18-29 years participated in a Discrete Choice Experiment. Participants made six choices, each between two SMS invitations to get vaccinated; each choice also had an opt-out. Each invitation had four attributes (1 x 5 levels, 3 x 3 levels): delivery mode, appointment timing, proximity, and SMS sender. These were systematically varied according to a d-optimal fractional factorial design. Order of presentation was randomised for each participant. Responses were analysed using a mixed logit model.ResultsThe logit model revealed a large alternative-specific constant (β = 1.385, SE = 0.067, p <0.001), indicating a strong preference for ‘opting in’ to appointment invitations. Pharmacies were dispreferred to the local vaccination centre (β = -0.256, SE = 0.072, p <0.001), appointments in locations that were 30-45 minutes travel time from one’s premises were dispreferred to locations that were less than 15 minutes away (β = -0.408, SE = 0.054, p <0.001), and, compared to invitations sent by the NHS, SMSs forwarded by ‘a friend’ were dispreferred (β = -0.615, SE = 0.056, p <0.001) but invitations from the General Practitioner were preferred (β = 0.105, SE = 0.048, p = 0.028).ConclusionsThe results indicated that the existing configuration of the UK’s mass vaccination programme was well-placed to deliver vaccines to 18-29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0-15 minutes from one’s premises) was not necessary; and either the ‘NHS’ or ‘Your GP’ would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens’ preferences, requirements and predicted behaviours regarding COVID-19.

Download Full-text

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

BMJ Open ◽

10.1136/bmjopen-2019-030274 ◽

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.

Download Full-text

Eliciting gastric cancer survivors’ preferences for follow-up services: a discrete choice experiment protocol

BMJ Open ◽

10.1136/bmjopen-2021-049742 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049742

Author(s):

Hui-qin Li ◽

Jin-hua Han ◽

Hua Yuan ◽

Guang-ying Wan ◽

Hui Xue ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Survivors ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Logit Model ◽

Choice Experiment ◽

Fractional Factorial ◽

Discrete Choice Experiments ◽

Follow Up Care

IntroductionFollow-up care is important for gastric cancer survivors, but follow-up strategies for gastric cancer survivors remain inconsistent, and compliance of gastric cancer survivors with follow-up care is very low. Understanding the needs and preferences of gastric cancer survivors is conducive to developing appropriate and acceptable follow-up strategies, thereby improving patient compliance. Discrete choice experiments can quantify individual needs and preferences. However, to date, there is no discrete choice experiment on the preferences of gastric cancer survivors, and no studies have examined how gastric cancer survivors make choices based on different characteristics of follow-up. This paper outlines an ongoing discrete choice experiment that aims to (1) explore follow-up service-related characteristics that may affect gastric cancer survivors’ choices about their follow-up, (2) elicit how gastric cancer survivors consider the trade-offs among different follow-up service options using discrete choice experiment, (3) determine whether gastric cancer survivors’ needs and preferences for follow-up vary due to the economy, politics, technology and culture in different regions.Methods and analysisSix attributes were developed through a literature review, semistructured interviews and experts and focus group discussions. A fractional factorial design was used to evaluate the interaction between attributes. A multiple logit model will be used to understand the trade-off between the follow-up characteristics of gastric cancer survivors. A mixed logit model will be used to explore the willingness to pay and uptake rate of gastric cancer survivors for follow-up attributes and further explore the preferences of different groups.Ethics and disseminationThis study was approved by the ethics committee of the School of Nursing, Jilin University. The results of this study will be shared through online blogs, policy briefs, seminars and peer-reviewed journal articles and will be used to modify the current strategy of gastric cancer survivors’ follow-up services according to economic development and regional culture.

Download Full-text

Patient Preferences For Specialty Pharmacy Services: A Stated Preference Discrete-Choice Experiment in China

Frontiers in Public Health ◽

10.3389/fpubh.2020.597389 ◽

2020 ◽

Vol 8 ◽

Author(s):

Qinyuan Hu ◽

Haiyao Hu ◽

Ming Hu ◽

Yumei Yang ◽

Zhiang Wu ◽

...

Keyword(s):

Drug Delivery ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Stated Preference ◽

Mixed Logit ◽

Fractional Factorial ◽

Pharmacy Services ◽

Specialty Pharmacy

Objectives: To survey, analyze, and ascertain the preferences for specialty pharmacy services among patients requiring complex care and to provide evidence to support specialty pharmacy service decision-making in China.Methods: To identify essential service attributes and levels, a review of the literature, discussions with specialty pharmacy managers and a pilot questionnaire were conducted. A D-efficient fractional factorial design was used to generate the discrete-choice experiment (DCE) questionnaire. A face-to-face survey of patients with chronic illness and their families or friends was conducted at three specialty pharmacies in Chengdu and Qingdao, China. A mixed logit model was used for estimation.Results: Six relevant attributes were identified and incorporated into the DCE questionnaire. A total of 417 participants completed the survey (mean age 43 years, 45.1% males), and 32.1% had lung cancer. The conditional relative importance showed that the most critical attribute was “frequency of telephone follow-up to monitor adverse drug reactions (ADRs), “followed by “mode of drug delivery,” “provider of medication guidance services,” and “availability of medical insurance consultation”; the least important attribute was “business hours.” A 1 min increase in time spent led to a 0.73% decrease in the probability that a service profile would be chosen. Negative preferences were noted for ADR monitoring by telephone follow-up once a year (β = −0.23, p < 0.001) and business hours [8:30–20:00 (Monday to Friday), 8:30–17:30 (weekend)] (β = −0.12, p < 0.001). Compared with women, men had a higher preference for service monitoring ADRs once every 3 months.Conclusions: Preference measurements showed that “frequency of telephone follow-up to monitor ADRs” had the most critical impact on decisions, followed by “mode of drug delivery.” Specialty pharmacies in China need to take these findings into account to improve their design to increase uptake and patient loyalty.

Download Full-text

Scale heterogeneity in discrete choice experiment: An application of generalized mixed logit model in air travel choice

Economics Letters ◽

10.1016/j.econlet.2018.08.037 ◽

2018 ◽

Vol 172 ◽

pp. 85-88 ◽

Cited By ~ 4

Author(s):

Ishrat Hossain ◽

Najam U. Saqib ◽

Munshi Masudul Haq

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Logit Model ◽

Choice Experiment ◽

Mixed Logit ◽

Air Travel ◽

Mixed Logit Model ◽

Travel Choice ◽

Scale Heterogeneity

Download Full-text

Parental Vaccine Preferences for Their Children in China: A Discrete Choice Experiment

Vaccines ◽

10.3390/vaccines8040687 ◽

2020 ◽

Vol 8 (4) ◽

pp. 687

Author(s):

Tiantian Gong ◽

Gang Chen ◽

Ping Liu ◽

Xiaozhen Lai ◽

Hongguo Rong ◽

...

Keyword(s):

Side Effects ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Logit Model ◽

Choice Experiment ◽

Stated Preference ◽

Mixed Logit ◽

National Sample ◽

Preference Heterogeneity ◽

Mixed Logit Model

Background: Vaccination is one of the most cost-effective health investments to prevent and control communicable diseases. Improving the vaccination rate of children is important for all nations, and for China in particular since the advent of the two-child policy. This study aims to elicit the stated preference of parents for vaccination following recent vaccine-related incidents in China. Potential preference heterogeneity was also explored among respondents. Methods: A discrete choice experiment was developed to elicit parental preferences regarding the key features of vaccines in 2019. The study recruited a national sample of parents from 10 provinces who had at least one child aged between 6 months and 5 years old. A conditional logit model and a mixed logit model were used to estimate parental preference. Results: A total of 598 parents completed the questionnaire; among them, 428 respondents who passed the rational tests were analyzed. All attributes except for the severity of diseases prevented by vaccines were statistically significant. The risk of severe side effects and protection rates were the two most important factors explaining parents’ decisions about vaccination. The results of the mixed logit model with interactions indicate that fathers or rural parents were more likely to vaccinate their children, and children whose health was not good were also more likely to be vaccinated. In addition, parents who were not more than 30 years old had a stronger preference for efficiency, and well-educated parents preferred imported vaccines with the lowest risk of severe side effects. Conclusion: When deciding about vaccinations for their children, parents in China are mostly driven by vaccination safety and vaccine effectiveness and were not affected by the severity of diseases. These findings will be useful for increasing the acceptability of vaccination in China.

Download Full-text

Job preferences of medical and nursing students seeking employment in rural China: a discrete choice experiment

BMC Medical Education ◽

10.1186/s12909-021-02573-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Meiling Bao ◽

Cunrui Huang

Keyword(s):

Nursing Students ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Rural Areas ◽

Choice Experiment ◽

Health Workers ◽

Rural China ◽

Mixed Logit ◽

Fractional Factorial ◽

Guizhou Province

Abstract Background China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final–year students in a medical university in Guizhou Province, China. Methods Attributes of potential jobs were developed through the literature review, semi–structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the 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 medical and nursing students. The statistically significant results indicated “Bianzhi” (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. Conclusions Strategies for patient–doctor relationships, Bianzhi and salary should be considered to attract final–year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.

Download Full-text

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Journal of Health Services Research & Policy ◽

10.1177/13558196211035427 ◽

2021 ◽

pp. 135581962110354

Author(s):

Anthony W Gilbert ◽

Emmanouil Mentzakis ◽

Carl R May ◽

Maria Stokes ◽

Jeremy Jones

Keyword(s):

Conceptual Model ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Best Practice ◽

Time Of Day ◽

Problem Area ◽

Fractional Factorial ◽

The Impact

Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

Download Full-text

Experts’ preferences for sarcopenia outcomes: a discrete-choice experiment from a working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) in collaboration with the European Union of Geriatric Medicine Society (EUGMS)

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01794-2 ◽

2021 ◽

Author(s):

Charlotte Beaudart ◽

◽

Jürgen M. Bauer ◽

Francesco Landi ◽

Olivier Bruyère ◽

...

Keyword(s):

Quality Of Life ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Musculoskeletal Diseases ◽

Geriatric Medicine ◽

Mixed Logit ◽

The European Union ◽

Domestic Activities

Abstract Background and aims To assess experts’ preference for sarcopenia outcomes. Methods A discrete-choice experiment was conducted among 37 experts (medical doctors and researchers) from different countries around the world. In the survey, they were repetitively asked to choose which one of two hypothetical patients suffering from sarcopenia deserves the most a treatment. The two hypothetical patients differed in five pre-selected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue and falls. A mixed logit panel model was used to estimate the relative importance of each attribute. Results All sarcopenia outcomes were shown to be significant, and thus, important for experts. Overall, the most important sarcopenia outcome was falls (27%) followed by domestic activities and mobility (24%), quality of life (15%) and fatigue (10%). Discussion and conclusion Compared to patient’s preferences, experts considered falls as a more important outcome of sarcopenia, while the outcomes fatigue and difficulties in domestic activities were considered as less important.

Download Full-text

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

BMJ Open ◽

10.1136/bmjopen-2020-043477 ◽

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.

Download Full-text