Providing information to parents of children with mental health problems: a discrete choice conjoint analysis of professional preferences

Preferences in the Design and Delivery of Neurodevelopmental Follow-Up Care for Children: A Systematic Review of Discrete Choice Experiments

Neurodevelopmental disorders are a significant cause of morbidity. Early detection of neurodevelopmental delay is essential for timely diagnosis and intervention, and it is therefore important to understand the preferences of parents and clinicians for engaging with neurodevelopmental surveillance and follow-up care. Discrete choice experiment (DCE) may be an appropriate method for quantifying these preferences. This review systematically examined how DCEs have been designed and delivered in studies examining neurodevelopmental care of children and identified the preferred attributes that have been reported. PubMed, Embase, CINAHL, and Scopus databases were systematically searched. Studies were included if they used DCE to elicit preferences for a neurodevelopmental follow-up program for children. Two independent reviewers conducted the title and abstract and full-text screening. Risk of bias was assessed using a DCE-specific checklist. Findings were presented using a narrative synthesis. A total of 6618 records were identified and 16 papers were included. Orthogonal (n=5) and efficient (n=5) experimental designs were common. There was inconsistent reporting of design-related features. Analysis was primarily completed using mixed logit (n=6) or multinomial logit (n=3) models. Several key attributes for neurodevelopmental follow-up care were identified including social, behavioral and emotional support, therapy, waiting time, and out-of-pocket costs. DCE has been successfully used as a preference elicitation method for neurodevelopmental-related care. There is scope for improvement in the design and analysis of DCE in this field. Nonetheless, attributes identified in these studies are likely to be important considerations in the design and implementation of programs for neurodevelopmental care.

The relationship between parent-child relationship and peer victimization: a multiple mediation model through peer relationship and depression

Introduction

Peer victimization is a highly prevalent worldwide issue with cross-cultural characteristics. Parent-child relationship and peer victimization is known to be interrelated, but how they influence each other remains unclear. This study explored the mechanisms of peer victimization related to parent-child relationship.

Methods

A total of 58,756 fourth grade students aged 10-12 years (10.83 ± 0.83, 54.4% males) from China completed four questionnaires. A multiple mediator model was tested, in which the two variables influenced each other through the mediating factors of peer relationship and depression.

Results

Peer victimization was indirectly negatively impacted by parent-child relationship through two chain mediating factors of peer relationship and depression: (1) the mediational path through peer relationship with an effect size of 44.66%; (2) the mediational path through depression with an effect size of 21.64%; and (3) the mediational path through peer relationship and depression with an effect size of 18.08%. The total mediational effect size was 84.11%.

Conclusion

The effect size through peer relationship is the strongest among the three mediation paths, suggesting that peer relationship is the key determinant in breaking the link between parent-child relationship and victimization. Poor parent-child and peer relationships may be risk factors eliciting peer victimization. Compared to internalizing behaviors (e.g., depression), low-quality interpersonal relationships maybe the root cause of the formation and maintenance of victimization. Thus, intervention programs against bullying should pay more attention on children's contextual factors, especially their relationships with their families and peers, among children at an early age.

Mental healthcare for children with chronic conditions: a qualitative study

OBJECTIVE

To explore parent perspectives on accessing mental healthcare for children with a chronic physical health condition.

DESIGN

Qualitative research using semistructured interviews and Framework Analysis. Rankings were used to select attributes for a Discrete Choice Experiment (DCE).

SETTING

Four specialty outpatient clinics (diabetes, epilepsy, bronchiectasis unrelated to cystic fibrosis and epidermolysis bullosa) at an Australian tertiary paediatric hospital.

PARTICIPANTS

Eighteen parents of children with a chronical physical health condition.

RESULTS

Most parents identified the child's general practitioner and/or hospital team as an initial pathway to seek help if they were worried about their child's mental health. Parents see mental healthcare as part of care for the whole child and want the outpatient clinics to proactively discuss child and family mental health, as well as refer to appropriate services as needed. The hospital being a familiar, child-friendly environment was identified as a key reason the hospital might be a desired place to access mental healthcare, as previous research has found. Six attributes of mental health services were identified as important and will be included in an upcoming DCE: travel time, cost, wait time, available hours, knowledge of physical health condition, and recommendation.

CONCLUSIONS

This study highlights the opportunity presented in specialist outpatient clinics to address the often unmet mental healthcare needs of children with chronic physical health conditions. Parents identified practical ways for outpatient clinics to better facilitate access to mental healthcare. These will be further explored through a quantitative study of parent preferences.

Evaluating the Impact of Incentives on Clinical Trial Participation: Protocol for a Mixed Methods, Community-Engaged Study

BACKGROUND

Monetary incentives in research are frequently used to support participant recruitment and retention. However, there are scant empirical data regarding how researchers decide upon the type and amount of incentives offered. Likewise, there is little guidance to assist study investigators and institutional review boards (IRBs) in their decision-making on incentives. Monetary incentives, in addition to other factors such as the risk of harm or other intangible benefits, guide individuals' decisions to enroll in research studies. These factors emphasize the need for evidence-informed guidance for study investigators and IRBs when determining the type and amount of incentives to provide to research participants.

OBJECTIVE

The specific aims of our research project are to (1) characterize key stakeholders' views on and assessments of incentives in biomedical HIV research; (2) reach consensus among stakeholders on the factors that are considered when choosing research incentives, including consensus on the relative importance of such factors; and (3) pilot-test the use of the guidance developed via aims 1 and 2 by presenting stakeholders with vignettes of hypothetical research studies for which they will choose corresponding incentive types.

METHODS

Our 2-year study will involve monthly, active engagement with a stakeholder advisory board of people living with HIV, researchers, and IRB members. For aim 1, we will conduct a nationwide survey (N=300) among people living with HIV to understand their views regarding the incentives used in HIV research. For aim 2, we will collect qualitative data by conducting focus groups with people living with HIV (n=60) and key informant interviews with stakeholders involved in HIV research (people living with HIV, IRB members, and biomedical HIV researchers: n=36) to extend and deepen our understanding of how incentives in HIV research are perceived. These participants will also complete a conjoint analysis experiment to gain an understanding of the relative importance of key HIV research study attributes and the impact that these attributes have on study participation. The data from the nationwide survey (aim 1) will be triangulated with the qualitative and conjoint analysis data (aim 2) to create 25 vignettes that describe hypothetical HIV research studies. Finally, individuals from each stakeholder group will select the most appropriate incentive that they feel should be used in each of the 25 vignettes (aim 3).

RESULTS

The stakeholder advisory board began monthly meetings in March 2021. All study aims are expected to be completed by December 2022.

CONCLUSIONS

By studying the role of incentives in HIV clinical trial participation, we will establish a decision-making paradigm to guide the choice of incentives for HIV research and, eventually, other types of similar research and facilitate the ethical recruitment of clinical research participants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04809636; https://clinicaltrials.gov/ct2/show/NCT04809636.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/33608.

Mental Health Information Seeking Online: A Google Trends Analysis of ADHD

Health information influences consumer decision making to seek, select, and utilize services. Online searching for mental health information is increasingly common, especially by adolescents and parents. We examined historical trends and factors that may influence population-level patterns in information seeking for attention-deficit/hyperactivity disorder (ADHD). We extracted Google Trends data from January 2004 to February 2020. Keywords included "ADHD," "ADHD treatment," "ADHD medication," and "ADHD therapy." We examined trends (systematic change over time) and seasonality (repeating pattern of change) via time-series analyses and graphics. We also used interrupted time-series analyses to examine the impact of celebrity and pharmaceutical events. Queries of "ADHD medication" increase, while queries for "ADHD therapy" remain relatively low despite a positive linear trend. Searches for "ADHD treatment" displayed a downward trend in more recent years. Analyses on seasonality revealed that holiday breaks coincided with a decrease in search interest, while post-break periods illustrated a rise, and the ADHD Awareness Month (October) coincided with a rise of public interest in all four search terms. Celebrity effects were more prominent in earlier years; the "Own It" pharmaceutical campaign may have increased ADHD awareness and the specificity of searches for "ADHD medication." The anonymous, accessible, and low-cost nature of seeking information online makes search engines like Google important sources of mental health information. Changing search patterns in response to seasonal, advocacy, and media events highlight internet-based opportunities for raising awareness and disseminating empirically supported information.

Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20 years (1999-2019)

BACKGROUND

In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients' needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers.

METHODS

We performed a scoping review from the past 20 years (2009-2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers.

RESULTS

Among the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%).

CONCLUSIONS

Overall, preference elicitation approaches have been increasingly applied to mental health services globally in the past 20 years. To date, these methods have been exclusively applied to populations within the field of mental health in high-income countries. Prioritizing patients' needs and preferences is a vital component of patient-centered care - one of the six domains of health care quality. Identifying patient preferences for mental health services may improve quality of care and, ultimately, increase acceptability and uptake of services among patients. Rigorous preference-elicitation approaches should be considered, especially in settings where mental health resources are scarce, to illuminate resource allocation toward preferred service characteristics especially within low-income settings.

People's preferences for self-management support

Objective

To identify and assess the preferences of people with long‐term health conditions toward generalizable characteristics of self‐management support interventions, with the objective to inform the design of more person‐centered support services.

Data Sources

Primary qualitative and quantitative data collected on a representative sample of individuals with at least one of the fifteen most prevalent long‐term conditions in the UK.

Study Design

Targeted literature review followed by a series of one‐to‐one qualitative semistructured interviews and a large‐scale discrete choice experiment.

Data Collection

Digital recording of one‐to‐one qualitative interviews, one‐to‐one cognitive interviews, and a series of online quantitative surveys, including two best‐worst scaling and one discrete choice experiment, with individuals with long‐term conditions.

Principal Findings

On average, patients preferred a self‐management support intervention that (a) discusses the options available to the patient and make her choose, (b) is individual‐based, (c) face to face (d) with doctor or nurse, (e) at the GP practice, (f) sessions shorter than 1 hour, and (g) occurring annually for two‐third of the sample and monthly for the rest. We found heterogeneity in preferences via three latent classes, with class sizes of 41% (C1), 30% (C2), and 29% (C3). The individuals’ gender [P < 0.05(C1), P < 0.01(C3)], age [P < 0.05(C1), P < 0.05(C2)], type of long‐term condition [P < 0.05(C1), P < 0.01(C3)], and presence of comorbidity [P < 0.01(C1), P < 0.01(C3), P < 0.01(C3)] were able to characterize differences between these latent classes and help understand the heterogeneity of preferences toward the above mentioned features of self‐management support interventions. These findings were then used to profile individuals into different preference groups, for each of whom the most desirable form of self‐management support, one that was more likely to be adopted by the recipient, could be designed.

Conclusions

We identified several factors that could be used to inform a more nuanced self‐management support service design and provision that take into account the recipient's characteristics and preferences.

Factors influencing dentists' willingness to treat Medicaid-enrolled adolescents

OBJECTIVES

To identify factors influencing dentists' willingness to treat Medicaid-enrolled adolescents with intellectual and developmental disabilities in Washington state.

DATA SOURCES

Primary data were collected by a survey instrument administered in 2017 to general and pediatric dentists who were Medicaid providers (N = 512).

METHODS

We administered a 40-item survey, which included 20 hypothetical scenarios involving a 12-year-old Medicaid-enrolled adolescent. Based on the characteristics of the potential patient, dentists were asked to rate their willingness to treat (1 = very likely; 5 = very unlikely). We used conjoint analytic techniques to examine the relative importance of six adolescent- and family-level factors (e.g., severity of intellectual and/or developmental disability [IDD], sugar intake, toothbrushing, caregiver beliefs about fluoride, restorative needs, appointment keeping) and state Medicaid reimbursement level (35 percent, 55 percent, 85 percent of usual, customary, and reasonable amount). Analyses focused on data from 178 dentists with complete and varied responses to the scenarios.

RESULTS

The mean age of participants was 53.8 ± 10.5 years and 10.7 percent were pediatric dentists. The holdouts correlation statistics indicated excellent fit for the conjoint model (Pearson's R = 0.99, P < 0.0001; Kendall's tau = 0.89, P < 0.0001). Reimbursement level and appointment keeping were the most important factors in dentists' willingness to treat Medicaid-enrolled adolescents (importance scores of 26.7 and 25.7, respectively). Restorative needs, caregiver beliefs about fluoride, and IDD severity were the next most important (importance scores of 15.4, 10.6, and 8.1, respectively). Sugar intake and toothbrushing behaviors were the least important.

CONCLUSIONS

Reimbursement and appointment keeping were the most important determinants of dentists' willingness to treat Medicaid-enrolled adolescents with IDD.

Care Management for Youth With Comorbid Developmental and Mental Health Conditions: A Discrete Choice Experiment Pilot Study

OBJECTIVE

Caregivers of a child with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability have difficult decisions regarding care management options for their child. This study aimed to pilot and refine an instrument to elicit caregivers' preferences in managing their child's care needs.

METHODS

Subjects were 38 caregivers of a child aged 21 and younger with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability. A mixed-methods design was used to develop and pilot a discrete choice experiment (DCE) to elicit care management preferences for their child. Six attributes of care management decisions were tested in the DCE: medication use, parental custody, time cost, social interactions, medication effects, and school placement. Subjects completed a paper-and-pencil survey after which a debriefing discussion was held to obtain feedback that would aid in refining the attribute descriptions. Conditional logistic regression generated mean scores for each attribute. Comments from the debriefing sessions were audio-recorded and used to modify the attribute descriptions.

RESULTS

The majority (84%) of subjects were aged 40 years or older and a female caregiver. Common diagnoses of the children were autism spectrum disorder (55%) and attention-deficit/hyperactivity disorder (76%). Subjects preferred using fewer medications and maintaining decision-making authority as opposed to delegating authority to a third party. Medication effects on the child's mood were more important than effects on personality or body weight.

CONCLUSIONS

The DCE was sensitive to caregivers' preferences for managing their child's coexisting cognitive/intellectual and emotional/behavior/developmental disability. Findings may help providers gauge treatment in a broader context of health outcomes.

Using Latent Class Analysis to Model Preference Heterogeneity in Health: A Systematic Review

BACKGROUND

Latent class analysis (LCA) has been increasingly used to explore preference heterogeneity, but the literature has not been systematically explored and hence best practices are not understood.

OBJECTIVE

We sought to document all applications of LCA in the stated-preference literature in health and to inform future studies by identifying current norms in published applications.

METHODS

We conducted a systematic review of the MEDLINE, EMBASE, EconLit, Web of Science, and PsycINFO databases. We included stated-preference studies that used LCA to explore preference heterogeneity in healthcare or public health. Two co-authors independently evaluated titles, abstracts, and full-text articles. Abstracted key outcomes included segmentation methods, preference elicitation methods, number of attributes and levels, sample size, model selection criteria, number of classes reported, and hypotheses tests. Study data quality and validity were assessed with the Purpose, Respondents, Explanation, Findings, and Significance (PREFS) quality checklist.

RESULTS

We identified 2560 titles, 99 of which met the inclusion criteria for the review. Two-thirds of the studies focused on the preferences of patients and the general population. In total, 80% of the studies used discrete choice experiments. Studies used between three and 20 attributes, most commonly four to six. Sample size in LCAs ranged from 47 to 2068, with one-third between 100 and 300. Over 90% of the studies used latent class logit models for segmentation. Bayesian information criterion (BIC), Akaike information criterion (AIC), and log-likelihood (LL) were commonly used for model selection, and class size and interpretability were also considered in some studies. About 80% of studies reported two to three classes. The number of classes reported was not correlated with any study characteristics or study population characteristics (p > 0.05). Only 30% of the studies reported using statistical tests to detect significant variations in preferences between classes. Less than half of the studies reported that individual characteristics were included in the segmentation models, and 30% reported that post-estimation analyses were conducted to examine class characteristics. While a higher percentage of studies discussed clinical implications of the segmentation results, an increasing number of studies proposed policy recommendations based on segmentation results since 2010.

CONCLUSIONS

LCA is increasingly used to study preference heterogeneity in health and support decision-making. However, there is little consensus on best practices as its application in health is relatively new. With an increasing demand to study preference heterogeneity, guidance is needed to improve the quality of applications of segmentation methods in health to support policy development and clinical practice.

Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care

We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite.

Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents' mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents' needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population.

Objective

The objective of this study was to describe where, what, and when people search online for topics related to ADHD.

Methods

Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods.

Results

Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis.

Conclusions

The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.

Using a Discrete Choice Conjoint Experiment to Engage Stakeholders in the Design of an Outpatient Children’s Health Center

Objectives:

To engage users in the design of a regional child and youth health center.

Background:

The perspective of users should be an integral component of a patient-centered, evidence-based approach to the design of health facilities.

Methods:

We conducted a discrete choice conjoint experiment (DCE), a method from marketing research and health economics, as a component of a strategy to engage users in the preconstruction planning process. A sample of 467 participants (290 staff and 177 clients or community stakeholders) completed the DCE.

Results:

Latent class analysis identified three segments with different design preferences. A group we termed an enhanced design (57%) segment preferred a fully featured facility with personal contacts at the start of visits (in-person check-in, personal waiting room notification, volunteer-assisted wayfinding, and visible security), a family resource center with a health librarian, and an outdoor playground equipped with covered heated pathways. The self-guided design segment (11%), in contrast, preferred a design allowing a more independent use of the facility (e.g., self-check-in at computer kiosks, color-coded wayfinding, and a self-guided family resource center). Designs affording privacy and personal contact with staff were important to the private design segment (32%). The theme and decor of the building was less important than interactive features and personal contacts.

Conclusion:

A DCE allowed us to engage users in the planning process by estimating the value of individual design elements, identifying segments with differing views, informing decisions regarding design trade-offs, and simulating user response to design options.

Understanding Pediatric Dentists' Dental Caries Management Treatment Decisions: A Conjoint Experiment

When traditional ranking and rating surveys are used to assess dentists' treatment decisions, the patient's source of payment appears to be of little importance. Therefore, this study used the marketing research tool conjoint analysis to investigate the relative impact of source of payment along with the child's age and cooperativeness on pediatric dentists' willingness to use Atraumatic Restorative Treatment (ART) to restore posterior primary teeth. A conjoint survey was completed by 707 pediatric dentists. Three factors (age of the child, cooperativeness, type of insurance) were varied across 3 levels to create 9 patient scenarios. The relative weights that dentists placed on these factors in the restorative treatment decision process were determined by conjoint analysis. "Cooperativeness" (52%) was the most important factor, "age of the child" (26%) the second-most important factor, followed by "insurance status of the child" (22%). For the third factor, insurance, pediatric dentists were least willing to use ART with publicly insured children (-0.082), and this was significantly different from their willingness to use ART with uninsured children (0.010) but not significantly different than their willingness to use ART for children with private insurance (0.073). Unlike traditional ranking and rating tools, conjoint analysis found that the insurance status of the patient appeared to be an important factor in dentists' decisions about different restorative treatment options. When pediatric dentists were forced to make tradeoffs among different patients' factors, they were most willing to use ART technique with young, uncooperative patients when they had no insurance. Knowledge Transfer Statement: The present study suggests the feasibility of using techniques borrowed from marketing research, such as conjoint analysis, to understand dentists' restorative treatment decisions. Results of this study demonstrate pediatric dentists' willingness to use a particular restorative treatment option (Atraumatic Restorative Treatment in this application) when forced to make tradeoffs in a "conjoined," or holistic, context among different factors presented in real-life patient scenarios. A deeper understanding of dentists' treatment decisions is vital to develop valid practice guidelines and interventions that encourage the use of appropriate restorative treatment modalities.

A randomized preference trial to inform personalization of a parent training program implemented in community mental health clinics

Incorporating participant preferences into intervention decision-making may optimize health outcomes by improving participant engagement. We describe the rationale for a preference-based approach to the personalization of community-based interventions. Compensating for the limitations of traditional randomized controlled trials (RCTs) and partially randomized preference trials (PRPTs), we employed a doubly randomized preference trial in the present study. Families (N = 129) presenting to community mental health clinics for child conduct problems were randomized to choice or no-choice conditions. Within each condition, parents were again randomized, or offered choices between home- and clinic-based, individual and group versions of a parent training program or services-as-usual. Participants were assessed at baseline, and treatment retention data were gathered. Families assigned to the choice condition were significantly less likely to drop out of treatment than those in the no-choice condition. In the choice condition, in-home treatment was the preferred modality, and across conditions, families were less likely to be retained in group and clinic modalities. Research on preferences may boost participant engagement and inform shared decision-making.

Examining Parents' Preferences for Group and Individual Parent Training for Children with ADHD Symptoms

Parent training (PT) programs have been found to reduce some behavioral impairment associated with children's attention deficit hyperactivity disorder (ADHD) as well as improve parenting competence, but poor uptake and participation by parents are formidable barriers that affect service effectiveness. We used a discrete-choice experiment (DCE) to examine how parent preferences for treatment format (i.e., group vs. individual) might influence their participation in PT. Participants were 445 parents seeking mental health services for children with elevated symptoms of ADHD in Ontario, Canada. Parents completed a DCE composed of 30 choice tasks used to gauge PT format preference. Results showed that 58.7% of parents preferred individual PT; these parents were most interested in interventions that would make them feel more informed about their child's problems and in understanding-as opposed to solving-their child's problems. A minority of parents (19.4%) preferred group PT; these parents were most interested in active, skill-building services that would help them solve their child's problems. About one fifth of parents (21.9%) preferred the Minimal Information alternative (i.e., receiving neither individual or group PT); these parents reported the highest levels of depression and the most severe mental health problems in their child. Results highlight the importance of considering parent preferences for format and suggest that alternative formats to standard PT should be considered for multiply stressed families.

A best-worst scaling experiment to prioritize caregiver concerns about ADHD medication for children

OBJECTIVE

The objective of this feasibility study was to develop and pilot an instrument to elicit caregivers' priorities when initiating attention-deficit hyperactivity disorder (ADHD) medication for their child.

METHODS

A best-worst scaling experiment was used to rank competing priorities when initiating ADHD medicine. Forty-six participants were recruited for a two-phase study involving survey development (phase 1, N=21) and the survey pilot (phase 2, N=25). Best-worst scores and 95% confidence intervals indicating the relative importance of 16 concerns were determined, and t tests were used to determine the scores' significance.

RESULTS

The significance of best-worst scores for most concerns indicated that the choices were purposeful. Concerns about helping the child become a successful adult, having a doctor who addresses caregivers' concerns, and improving school behavior were ranked highest.

CONCLUSIONS

The best-worst scaling method can elicit priorities for children's mental health treatment. Future work using this method will guide family-centered care.

Physician and patient willingness to pay for electronic cardiovascular disease management

OBJECTIVES

Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs.

METHODS

Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system.

RESULTS

144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below.

CONCLUSION

Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds.

Modeling Parenting Programs as an Interim Service for Families Waiting for Children's Mental Health Treatment

Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E-Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E-Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.

The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis

OBJECTIVES

The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis.

METHODS

A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios.

RESULTS

Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119).

CONCLUSIONS

Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

Probabilistic choice models in health-state valuation research: background, theories, assumptions and applications

Interest is rising in measuring subjective health outcomes, such as treatment outcomes that are not directly quantifiable (functional disability, symptoms, complaints, side effects and health-related quality of life). Health economists in particular have applied probabilistic choice models in the area of health evaluation. They increasingly use discrete choice models based on random utility theory to derive values for healthcare goods or services. Recent attempts have been made to use discrete choice models as an alternative method to derive values for health states. In this article, various probabilistic choice models are described according to their underlying theory. A historical overview traces their development and applications in diverse fields. The discussion highlights some theoretical and technical aspects of the choice models and their similarity and dissimilarity. The objective of the article is to elucidate the position of each model and their applications for health-state valuation.

The interim service preferences of parents waiting for children's mental health treatment: a discrete choice conjoint experiment

Parents seeking help for children with mental health problems are often assigned to a waiting list. We used a discrete choice conjoint experiment to model preferences for interim services that might be used while waiting for the formal assessment and treatment process to begin. A sample of 1,059 parents (92 % mothers) seeking mental health services for 4 to 16 year olds chose between hypothetical interim services composed by experimentally varying combinations of the levels of 13 interim service attributes. Latent Class analysis yielded a four-segment solution. All segments preferred interim options helping them understand how agencies work, enhancing their parenting knowledge and skill, and providing an opportunity to understand or begin dealing with their own difficulties. The Group Contact segment (35.1 %) preferred interim services in meetings with other parents, supported by phone contacts, frequent checkup calls, and wait-time updates. Virtual Contact parents (29.2 %) preferred to meet other parents in small internet chat groups supported by e-mail contact. Membership in this segment was linked to higher education and computer skills. Frequent Contact parents (24.4 %) preferred face-to-face interim services supported by weekly progress checks and wait time updates. Limited Contact parents (11.3 %) were less intent on using interim services. They preferred to pursue interim services alone, with contacts by phone, supported by fewer check-up calls and less frequent wait time updates. All segments were more likely to enroll in interim services involving their child.

Randomized trial of distance-based treatment for young children with discipline problems seen in primary health care

OBJECTIVE

Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds' discipline were recruited when they visited their family physician at 1 of 24 practices.

METHODS

After completing mailed baseline measures, parents were randomly assigned to receive usual care or the Parenting Matters intervention along with usual care. Parenting Matters combined a self-help booklet with two calls from a telephone coach during a 6-week treatment period. Follow-up assessments were completed at 7 weeks post-randomization, and 3 and 6 months later.

RESULTS

Behaviour problems (Eyberg Child Behaviour Inventory) decreased significantly more in the Parenting Matters condition compared with Usual Care alone, based on a significant time by treatment group effect in intent-to-treat, growth curve analyses (P = 0.033). The Parenting Matters group also demonstrated greater and more rapid improvement than in usual care alone in terms of overall psychopathology (Child Behaviour Checklist, P = 0.02), but there were no group differences in parenting. The overall magnitude of group differences was small (d = 0.15 or less).

CONCLUSION

A brief early intervention combining a self-help booklet and telephone coaching is an effective way to treat mild behaviour problems among young children. This minimal-contact approach addresses the need for interventions in primary health care settings and may be a useful component in step-care models of mental health.

Analysis of patients' preferences: direct assessment and discrete-choice experiment in therapy of adults with attention-deficit hyperactivity disorder

BACKGROUND

: Attention-deficit hyperactivity disorder (ADHD) is a complex neuropsychiatric disorder that affects children and young people, as well as adults. Since ADHD does not produce specific organic characteristics, behavior and preferences are crucial to diagnosis and treatment. Comprehensive therapy concepts should take full account of the needs of the patients.

OBJECTIVE

: To document therapy attributes that are important from the adults' perspective and to analyze findings from two different valuation approaches used in the same survey.

METHODS

: A self-administered survey measuring attitudes and preferences was conducted in Germany in 2009 (n = 329). Adult patients (aged ≥18 years) were recruited from all over Germany, with the help of patient advocacy organizations. Attitudes were measured and analyzed using a classic rating scale in 5-point Likert format. Discrete-choice experiment (DCE) scenarios were developed using a fractional factorial design and results were analyzed using random effects logit models.

RESULTS

: The aspect of highest importance for the respondents was that social function (job, studies, friendships) was not impaired (coefficient 2.115; standard error 0.111). The next most important in the view of the respondents was achievement of behavioral changes through treatment (coefficient 1.755; standard error 0.110). The 'drug intake' aspect was not important in the attitude component rating and not significant in the DCE.

CONCLUSIONS

: The primary goal of ADHD treatment is by no means the alleviation of core symptoms. Instead, therapy should help enable patients to set and achieve their own objectives. Treatment should enable patients to organize their social participation in everyday life.

Using conjoint analysis to measure the acceptability of rectal microbicides among men who have sex with men in four South American cities

Conjoint Analysis (CJA), a statistical market-based technique that assesses the value consumers place on product characteristics, may be used to predict acceptability of hypothetical products. Rectal Microbicides (RM)-substances that would prevent HIV infection during receptive anal intercourse-will require acceptability data from potential users in multiple settings to inform the development process by providing valuable information on desirable product characteristics and issues surrounding potential barriers to product use. This study applied CJA to explore the acceptability of eight different hypothetical RM among 128 MSM in Lima and Iquitos, Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil. Overall RM acceptability was highest in Guayaquil and lowest in Rio. Product effectiveness had the greatest impact on acceptability in all four cities, but the impact of other product characteristics varied by city. This study demonstrates that MSM from the same region but from different cities place different values on RM characteristics that could impact uptake of an actual RM. Understanding specific consumer preferences is crucial during RM product development, clinical trials and eventual product dissemination.

Preferences for evidence-based practice dissemination in addiction agencies serving women: a discrete-choice conjoint experiment

AIM

  To model variables influencing the dissemination of evidence-based practices to addiction service providers and administrators.

DESIGN

  A discrete-choice conjoint experiment. We systematically varied combinations of 16 dissemination variables that might influence the adoption of evidence-based practices. Participants chose between sets of variables.

SETTING

  Canadian agencies (n = 333) providing addiction services to women.

PARTICIPANTS

  Service providers and administrators (n = 1379).

MEASUREMENTS

  We estimated the relative importance and optimal level of each dissemination variable. We used latent class analysis to identify subsets of participants with different preferences and simulated the conditions under which participants would use more demanding professional development options.

FINDINGS

  Three subsets of participants were identified: outcome-sensitive (52%), process-sensitive (29.6%) and demand-sensitive (18.2%). Across all participants, the number of clients who were expected to benefit from an evidence-based practice exerted the most influence on dissemination choices. If a practice was seen as feasible, co-worker and administrative support influenced decisions. Client benefits were most important to outcome-sensitive participants; type of dissemination process (e.g. active versus passive learning) was more important to process-sensitive participants. Brief options with little follow-up were preferred by demand-sensitive participants. Simulations predicted that initiatives selected and endorsed by government funders would reduce participation.

CONCLUSIONS

  Clinicians and administrators are more likely to adopt evidence-based addiction practices if the practice is seen as helpful to clients, and if it is supported by co-workers and program administration.

A discrete choice conjoint experiment to evaluate parent preferences for treatment of young, medication naive children with ADHD

The current study examined treatment preferences of 183 parents of young (average age = 5.8 years, SD = 0.6), medication naive children with ADHD. Preferences were evaluated using a discrete choice experiment in which parents made choices between different combinations of treatment characteristics, outcomes, and costs. Latent class analysis yielded two segments of parents: (a) medication avoidant parents constituted 70.5% of the sample whose treatment decisions were strongly influenced by a desire to avoid medication, and (b) outcome oriented parents constituted 29.5% of the sample whose treatment decisions were most influenced by a desire for positive treatment outcomes. Parents in the outcome oriented segment were more stressed and depressed, had lower socioeconomic status and education, were more likely to be single parents, and had more disruptive and impaired children. Simulations predicted that parents would prefer treatments with behavior therapy over treatments with stimulant medication only.

Modeling the bullying prevention program design recommendations of students from grades five to eight: a discrete choice conjoint experiment

We used a discrete choice conjoint experiment to model the bullying prevention recommendations of 845 students from grades 5 to 8 (aged 9-14). Students made choices between experimentally varied combinations of 14 four-level prevention program attributes. Latent class analysis yielded three segments. The high impact segment (27.1%) recommended uniforms, mandatory recess activities, four playground supervisors, surveillance cameras, and 4-day suspensions when students bully. The moderate impact segment (49.5%) recommended discretionary uniforms and recess activities, four playground supervisors, and 3-day suspensions. Involvement as a bully or bully-victim was associated with membership in a low impact segment (23.4%) that rejected uniforms and surveillance cameras. They recommended fewer anti-bullying activities, discretionary recess activities, fewer playground supervisors, and the 2-day suspensions. Simulations predicted most students would recommend a program maximizing student involvement combining prevention with moderate consequences. The simulated introduction of mandatory uniforms, surveillance cameras, and long suspensions reduced overall support for a comprehensive program, particularly among students involved as bullies or bully-victims.

Adaptive choice-based conjoint analysis: a new patient-centered approach to the assessment of health service preferences

Conjoint analysis (CA) has emerged as an important approach to the assessment of health service preferences. This article examines Adaptive Choice-Based Conjoint Analysis (ACBC) and reviews available evidence comparing ACBC with conventional approaches to CA. ACBC surveys more closely approximate the decision-making processes that influence real-world choices. Informants begin ACBC surveys by completing a build-your-own (BYO) task identifying the level of each attribute that they prefer. The ACBC software composes a series of attribute combinations clustering around each participant's BYO choices. During the Screener section, informants decide whether each of these concepts is a possibility or not. Probe questions determine whether attribute levels consistently included in or excluded from each informant's Screener section choices reflect 'Unacceptable' or 'Must Have' simplifying heuristics. Finally, concepts identified as possibilities during the Screener section are carried forward to a Choice Tournament. The winning concept in each Choice Tournament set advances to the next choice set until a winner is determined.A review of randomized trials and cross-over studies suggests that, although ACBC surveys require more time than conventional approaches to CA, informants find ACBC surveys more engaging. In most studies, ACBC surveys yield lower standard errors, improved prediction of hold-out task choices, and better estimates of real-world product decisions than conventional choice-based CA surveys.