Optimizing the Design of a Contraceptive Microarray Patch: A Discrete Choice Experiment on Women’s Preferences in India and Nigeria

Abstract Background: Efforts are underway to develop an easy-to-use contraceptive microarray patch (MAP) that could expand the range of self-administrable methods. This paper presents results from a discrete choice experiment (DCE) designed to support optimal product design.Methods: We conducted a DCE survey of users and non-users of contraception in New Delhi, India (496 women) and Ibadan, Nigeria (two versions with 530 and 416 women, respectively) to assess stated preferences for up to six potential product attributes: effect on menstruation, duration of effectiveness, application pain, location, rash after application, and patch size. We estimated Hierarchical Bayes coefficients (utilities) for each attribute level and ran simulations comparing women’s preferences for hypothetical MAPs with varying attribute combinations.Results: The most important attributes of the MAP were potential for menstrual side effects (55% of preferences in India and 42% in Nigeria) and duration (13% of preferences in India and 24% in Nigeria). Women preferred a regular period over an irregular or no period, and a six-month duration to three or one month. Simulations show that the most ideal design would be a small patch, providing 6 months of protection, that would involve no pain on administration, result in a one-day rash, and be applied to the foot. Conclusions: To the extent possible, MAP developers should consider method designs and formulations that limit menstrual side effects and provide more than one month of protection.

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Optimizing the design of a contraceptive microarray patch: a discrete choice experiment on women’s preferences in India and Nigeria

Reproductive Health ◽

10.1186/s12978-021-01113-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rebecca L. Callahan ◽

Aurélie Brunie ◽

Victoria Lebrun ◽

Mario Chen ◽

Christine L. Godwin ◽

...

Keyword(s):

Side Effects ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Hierarchical Bayes ◽

New Delhi ◽

Pain Location ◽

Optimal Product Design ◽

Women’S Preferences ◽

Ibadan Nigeria

Abstract Background Efforts are underway to develop an easy-to-use contraceptive microarray patch (MAP) that could expand the range of self-administrable methods. This paper presents results from a discrete choice experiment (DCE) designed to support optimal product design. Methods We conducted a DCE survey of users and non-users of contraception in New Delhi, India (496 women) and Ibadan, Nigeria (two versions with 530 and 416 women, respectively) to assess stated preferences for up to six potential product attributes: effect on menstruation, duration of effectiveness, application pain, location, rash after application, and patch size. We estimated Hierarchical Bayes coefficients (utilities) for each attribute level and ran simulations comparing women’s preferences for hypothetical MAPs with varying attribute combinations. Results The most important attributes of the MAP were potential for menstrual side effects (55% of preferences in India and 42% in Nigeria) and duration (13% of preferences in India and 24% in Nigeria). Women preferred a regular period over an irregular or no period, and a six-month duration to three or one month. Simulations show that the most ideal design would be a small patch, providing 6 months of protection, that would involve no pain on administration, result in a one-day rash, and be applied to the foot. Conclusions To the extent possible, MAP developers should consider method designs and formulations that limit menstrual side effects and provide more than one month of protection.

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Women’s Preferences for Maternal Healthcare Services in Bangladesh: Evidence from a Discrete Choice Experiment

Journal of Clinical Medicine ◽

10.3390/jcm8020132 ◽

2019 ◽

Vol 8 (2) ◽

pp. 132 ◽

Cited By ~ 8

Author(s):

Rashidul Alam Mahumud ◽

Nadia Ishrat Alamgir ◽

Md. Tarek Hossain ◽

Elaine Baruwa ◽

Marufa Sultana ◽

...

Keyword(s):

Maternal Health ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Hierarchical Bayes ◽

Maternal Health Service ◽

Maternal Healthcare ◽

Provider Attitudes ◽

Healthcare Facilities ◽

Women’S Preferences

Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women’s decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women’s preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.

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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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What do women want? Valuing women’s preferences and estimating demand for alternative models of maternity care using a discrete choice experiment

Health Policy ◽

10.1016/j.healthpol.2017.09.013 ◽

2017 ◽

Vol 121 (11) ◽

pp. 1154-1160 ◽

Cited By ~ 5

Author(s):

Christopher G. Fawsitt ◽

Jane Bourke ◽

Richard A. Greene ◽

Brendan McElroy ◽

Nicolas Krucien ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Maternity Care ◽

Choice Experiment ◽

Alternative Models ◽

Women’S Preferences

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Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment

American Journal of Public Health ◽

10.2105/ajph.2008.146209 ◽

2009 ◽

Vol 99 (9) ◽

pp. 1666-1672 ◽

Cited By ~ 148

Author(s):

Margaret E. Kruk ◽

Magdalena Paczkowski ◽

Godfrey Mbaruku ◽

Helen de Pinho ◽

Sandro Galea

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Population Based ◽

Place Of Delivery ◽

Rural Tanzania ◽

Women’S Preferences

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A Discrete Choice Experiment on Women’s Preferences for Water Immersion During Labor and Birth: Identification, Refinement and Selection of Attributes and Levels

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061936 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1936

Author(s):

Thomas G. Poder ◽

Nathalie Carrier ◽

Mathieu Roy ◽

Chantal Camden

Keyword(s):

Focus Groups ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Water Immersion ◽

Risk Of Death ◽

Labor Duration ◽

Literature Reviews ◽

Women’S Preferences ◽

Selection Of

Objectives: To identify attributes (i.e., characteristics describing a scenario) and levels (i.e., each characteristic may be defined by a different level) that would be included in a discrete choice experiment (DCE) questionnaire to evaluate women’s preferences for water immersion during labor and birth. Methods: A mixed-method approach, combining systematic reviews of the literature and patient focus groups to identify attributes and levels explaining women’s preferences. After the focus groups, preference exercises were conducted and led to the creation of the questionnaire, including the DCE. A qualitative validation of the questionnaire was conducted with women from the focus groups and with medical experts. Results: The literature reviews provided 26 attributes to be considered for childbirth in water, and focus groups identified 14 additional attributes. From these 40 attributes, preference exercises allowed us to select four for the DCE, in addition to the birth mode. Labor duration was also included, even if it was not well ranked, as it is the main clinical outcome in the literature. Validation with experts and women did not change the choice of attributes but slightly changed the levels selected. The final six attributes were: birth mode, duration of the labor phase, pain sensation, risk of severe tears in the perineum during the expulsion of the newborn, risk of death of the newborn, and general condition of the newborn (Apgar) score at 5 minutes. Conclusion: This study allowed us to detail all the stages for the design of a DCE questionnaire. To date, this is the first study of this kind in the context of women’s preferences for water immersion during labor and birth.

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Women's preferences for cervical cancer screening: A study using a discrete choice experiment

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462306051245 ◽

2006 ◽

Vol 22 (3) ◽

pp. 344-350 ◽

Cited By ~ 26

Author(s):

Sarah Wordsworth ◽

Mandy Ryan ◽

Diane Skåtun ◽

Norman Waugh

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Waiting Time ◽

Choice Experiment ◽

Pap Smear ◽

Health Board ◽

Screening Programs ◽

Study Results ◽

Liquid Based Cytology ◽

Women’S Preferences

Objectives: Recent policy recommendations for cervical screening include liquid-based cytology. This new approach could improve laboratory throughput, reducing the waiting time for test results. New guidelines also standardize the interval for screening, with women aged 25–50 offered screening every 3 years and women aged 50–64 every 5 years. Quantitative evidence on the preferences of women for alternative screening programs is limited; this study, therefore, elicits such preferences.Methods: A postal questionnaire using a discrete choice experiment was mailed to 2,000 women in the Tayside Health Board region of Scotland.Results: A response rate of 44 percent from those women who had previously had a smear was achieved. Women had a significant positive preference for reductions in recall rates and waiting time for results. Women preferred more frequent screening, particularly those aged 50+. Expected reductions in the chance of recall from the conventional Pap smear to the new liquid-based cytology were associated with a willingness to pay of £41. Women aged 50+ would be willing to pay £42 to increase the frequency of screening from every 5 to every 3 years. Service characteristics did not influence screening participation.Conclusions: Guidance to move to liquid-based cytology will meet women's preferences for fewer repeat cervical smears and should reduce waiting time for results. However, proposals to increase screening intervals for those aged 50+ are inconsistent with the preferences for this age group. From a policy perspective, our study results suggest that the changes in attributes of the service such as unsatisfactory smear rates and frequency of screening, will improve service efficiency without affecting participation rates.

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