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Maculaitis MC, Hauber B, Beusterien KM, Will O, Kopenhafer L, Law AW, Vietri JT, Cappelleri JC, Coulter JR, Pugh S, Shea KM. A latent class analysis of factors influencing preferences for infant respiratory syncytial virus (RSV) preventives among pregnant people in the United States. Hum Vaccin Immunother 2024; 20:2358566. [PMID: 38847198 PMCID: PMC11164215 DOI: 10.1080/21645515.2024.2358566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/19/2024] [Indexed: 06/12/2024] Open
Abstract
A maternal vaccine and long-acting monoclonal antibody (mAb) were recently approved to protect infants against respiratory syncytial virus (RSV). We identified subgroups of pregnant people with different preferences for RSV preventives and respondent characteristics associated with subgroup membership. An online survey, including a discrete choice experiment (DCE), was conducted among US pregnant people. RSV preventive attributes included effectiveness, duration of protection during RSV season, injection recipient/timing, preventive type (vaccine or mAb), and type of visit required to receive injection. In DCE choice tasks, pregnant people selected between two hypothetical preventive profiles with varying attribute-levels and a no-preventive option. Logistic regression, including latent class analysis (LCA), was used to analyze the data. Of 992 pregnant people (mean age: 30.0 years), 60.3% were expecting their second/later birth. LCA identified three preference subgroups: 'Effectiveness' (preventive choice mostly driven by increases in effectiveness; 51.4% class membership probability), 'Season' (preventive choice mostly driven by improvement in duration of protection during the RSV season; 39.2% class membership probability), and 'No Preventive' (frequently chose no-preventive option; 9.4% class membership probability). 'Effectiveness' and 'Season' preferred maternal vaccine over mAb; mAb was preferred by 'No Preventive.' Perceiving RSV as serious for infants, higher health literacy, and lower household income were associated with 'Effectiveness.' Perceiving RSV as serious for pregnant people was associated with 'Season.' Perceiving RSV to not be serious for pregnant people and not being employed were associated with 'No Preventive.' Subgroups of pregnant people vary in preferences for RSV preventives. Most pregnant people preferred a maternal vaccine, although some may be more willing to accept alternative preventive options.
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Affiliation(s)
| | - Brett Hauber
- Worldwide Medical and Safety, Pfizer Inc, New York, NY, USA
| | | | - Oliver Will
- Real World Data & Analytics, Oracle Life Sciences, Austin, TX, USA
| | - Lewis Kopenhafer
- Real World Data & Analytics, Oracle Life Sciences, Austin, TX, USA
| | - Amy W. Law
- Global Access & Value Pfizer Inc, New York, NY, USA
| | | | | | | | - Sarah Pugh
- US Vaccines Medical & Scientific Affairs, Pfizer Inc, New York, NY, USA
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Johnson FR, Adamowicz W, Groothuis-Oudshoorn C. What Can Discrete-Choice Experiments Tell Us about Patient Preferences? An Introduction to Quantitative Analysis of Choice Data. THE PATIENT 2024:10.1007/s40271-024-00705-7. [PMID: 39048912 DOI: 10.1007/s40271-024-00705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/27/2024]
Abstract
This paper provides an introduction to statistical analysis of choice data using example data from a simple discrete-choice experiment (DCE). It describes the layout of the analysis dataset, types of variables contained in the dataset, and how to identify response patterns in the data indicating data quality. Model-specification options include linear models with continuous attribute levels and non-linear continuous and categorical attribute levels. Advantages and disadvantages of conditional logit, mixed logit, and latent-class analysis are discussed and illustrated using the example DCE data. Readers are provided with links to various software programs for analyzing choice data. References are provided on topics for which there currently is limited consensus and on more advanced techniques to guide readers interested in exploring choice-modeling challenges in greater depth. Supplementary materials include the simulated example data used to illustrate modeling approaches, together with R and Matlab code to reproduce the estimates shown.
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Affiliation(s)
- F Reed Johnson
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA.
| | - Wiktor Adamowicz
- Department of Resource Economics and Environmental Sociology, University of Alberta, Edmonton, Alberta, Canada
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Goswami S, Bentley JP, Kang M, Bhattacharya K, Barnard M. Preferences for a community pharmacy-based pre-exposure prophylaxis (PrEP) delivery program: A discrete choice experiment. J Am Pharm Assoc (2003) 2024; 64:102091. [PMID: 38604477 DOI: 10.1016/j.japh.2024.102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Community pharmacies are ideal venues for pre-exposure prophylaxis (PrEP) delivery. Pharmacists and pharmacy-based PrEP delivery programs have the potential to improve access. OBJECTIVES This study elicited preferences for attributes of a hypothetical community pharmacy-based PrEP delivery program among US men who have sex with men (MSM) and assessed predictors of their preferences. METHODS Data were collected via a cross-sectional anonymous survey of US MSM, who were aged 18-65 years, not transgender, reported HIV status negative/unknown, and PrEP eligible. A discrete choice experiment was conducted with seven attributes of a pharmacy-based PrEP program: initial PrEP eligibility screening mode, location for human immunodeficiency virus (HIV) tests, timing for HIV test results, PrEP decision-making style, location of PrEP consultations, PrEP medication fill method, and mode for ongoing monitoring. Latent class analysis was performed to analyze preference heterogeneity. Multinomial logistic regression assessed predictors of latent class membership. RESULTS This study included 390 MSM. Time to receive HIV test results was the most important attribute; receiving results on the same day had the highest preference. The next most important attribute was PrEP screening mode; online questionnaires were the most preferred. Respondents' preferences clustered into four classes: 1) "Same day results and online monitoring" (SDROM) group (63.1%), 2) "Consumerist decision-making" (CDM) group (16.2%), 3) "Self-screening (online questionnaire)" (SOQ) group (11.3%), and 4) "Same day results preferring" (SDRP) group (9.5%). Hispanic MSM (adjusted odds ratio [aOR] =0.31, 95% confidence interval [CI] [0.12-0.84], P = 0.020), MSM of other races (aOR=0.38, 95% CI [0.15-0.97], P = 0.044) vs. White MSM; and those having a sexually transmitted disease recently (aOR=0.37, 95% CI [0.16-0.85], P = 0.018), had lower odds of being in the CDM group vs. the SDROM group. CONCLUSIONS MSM's preferences for a pharmacy-based PrEP program are heterogeneous. Same day results for HIV tests and online PrEP screening are key components when designing a community pharmacy-based PrEP program.
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Sun Y, Zhang H, Qi G, Tian W. Nutrient deficiency patterns and all-cause and cardiovascular mortality in older adults with hypertension: a latent class analysis. BMC Public Health 2024; 24:1551. [PMID: 38853236 PMCID: PMC11163810 DOI: 10.1186/s12889-024-19003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Previous researches examining the impact of dietary nutrition on mortality risk have mainly focused on individual nutrients, however the interaction of these nutrients has not been considered. The purpose of this study was to identify of nutrient deficiencies patterns and analyze their potential impact on mortality risk in older adults with hypertension. METHODS We included participants from the National Health and Nutrition Examination Survey (NHANES) study. The latent class analysis (LCA) was applied to uncover specific malnutrition profiles within the sample. Risk of the end points across the phenogroups was compared using Kaplan-Meier analysis and Cox proportional hazard regression model. Multinomial logistic regression was used to determine the influencing factors of specific malnutrition profiles. RESULTS A total of 6924 participants aged 60 years or older with hypertension from NHANES 2003-2014 was followed until December 31, 2019 with a median follow-up of 8.7 years. Various nutrients included vitamin A, vitamin B1, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, fiber, folate, calcium, magnesium, zinc, copper, iron, and selenium, and LCA revealed 4 classes of malnutrition. Regarding all-cause mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.42 from 1.19 to 1.70) compared with "Adequate Nutrient" group, followed by "Inadequate Nutrient" group (1.29 from 1.10 to 1.50), and "Low Fiber, Magnesium, and Vit E" group (1.17 from 1.02 to 1.35). For cardiovascular mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.61 from 1.19 to 2.16) compared with "Adequate Nutrient" group, followed by "Low Fiber, Magnesium, and Vit E" group (1.51 from 1.04 to 2.20), and "Inadequate Nutrient" group (1.37 from 1.03 to 1.83). CONCLUSIONS The study revealed a significant association between nutrients deficiency patterns and the risk of all-cause and cardiovascular mortality in older adults with hypertension. The findings suggested that nutrients deficiency pattern may be an important risk factor for mortality in older adults with hypertension.
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Affiliation(s)
- YuJiao Sun
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - HuanRui Zhang
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - GuoXian Qi
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - Wen Tian
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China.
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Schuster ALR, Bollinger J, Geller G, Little SJ, Mehta SR, Sanchez T, Sugarman J, Bridges JFP. Prioritization of ethical concerns regarding HIV molecular epidemiology by public health practitioners and researchers. BMC Public Health 2024; 24:1436. [PMID: 38811963 PMCID: PMC11137925 DOI: 10.1186/s12889-024-18881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND HIV molecular epidemiology (HIV ME) can support the early detection of emerging clusters of new HIV infections by combining HIV sequence data routinely obtained during the clinical treatment of people living with HIV with behavioral, geographic, and sociodemographic information. While information about emerging clusters promises to facilitate HIV prevention and treatment efforts, the use of this data also raises several ethical concerns. We sought to assess how those working on the frontlines of HIV ME, specifically public health practitioners (PHPs) and researchers, prioritized these issues. METHODS Ethical issues were identified through literature review, qualitative in-depth interviews, and stakeholder engagement. PHPs and researchers using HIV ME prioritized the issues using best-worst scaling (BWS). A balanced incomplete block design was used to generate 11 choice tasks each consisting of a sub-set of 5 ethical concerns. In each task, respondents were asked to assess the most and least concerning issue. Data were analyzed using conditional logit, with a Swait-Louviere test of poolability. Latent class analysis was then used to explore preference heterogeneity. RESULTS In total, 57 respondents completed the BWS experiment May-June 2023 with the Swait-Louviere test indicating that researchers and PHPs could be pooled (p = 0.512). Latent class analysis identified two classes, those highlighting "Harms" (n = 29) (prioritizing concerns about potential risk of legal prosecution, individual harm, and group stigma) and those highlighting "Utility" (n = 28) (prioritizing concerns about limited evidence, resource allocation, non-disclosure of data use for HIV ME, and the potential to infer the directionality of HIV transmission). There were no differences in the characteristics of members across classes. CONCLUSIONS The ethical issues of HIV ME vary in importance among stakeholders, reflecting different perspectives on the potential impact and usefulness of the data. Knowing these differences exist can directly inform the focus of future deliberations about the policies and practices of HIV ME in the United States.
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Affiliation(s)
- Anne L R Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43016, USA.
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan J Little
- Division of Infectious Disease, University of California San Diego, San Diego, CA, USA
| | - Sanjay R Mehta
- Division of Infectious Disease, University of California San Diego, San Diego, CA, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43016, USA
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Kremer IEH, Beaudart C, Simons J, Plieger H, Schroeder M, Hiligsmann M. Preferences of people living with HIV for injectable and oral antiretroviral treatment in the Netherlands: a discrete choice experiment. AIDS Care 2024; 36:536-545. [PMID: 37526109 DOI: 10.1080/09540121.2023.2240067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACTInjectable antiretroviral treatment (ART) represents a new effective and potentially more convenient alternative to oral ART for people living with HIV (PLWH). This study assessed preferences of PLWH for long-acting injectable compared with oral ART in the Netherlands. A labelled discrete choice experiment presented 12 choice sets of long-acting injectable and oral ART. PLWH were asked to select their preferred ART, described by six attributes: location of administration, dosing frequency, risk of short-term side effects, drug-drug interaction, forgivability, and food and mealtime restrictions. Random parameters logit and latent class models were used to estimate preferences of PLWH. 98.6% of 76 respondents were experienced oral ART users that had taken ART for a median of 12 years (Q1-Q3: 7.0-20.0). 30 (39.5%) respondents chose long-acting injectable ART in all choice tasks and 22 (28.9%) always chose oral ART. The random parameter model showed that, on average, respondents significantly favoured long-acting injectable ART over oral ART, preferred administration of the long-acting injectable ART at home, and a less frequent regimen. The latent class model confirmed one class strongly preferring long-acting injectable ART and one class slightly preferring oral ART. This study highlights the value for both long-acting injectable and oral ART.
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Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Joost Simons
- GSK, Amersfoort, Netherlands
- University of Groningen, University Medical Centre, Groningen, Netherlands
| | | | | | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Mühlbacher A, Beaudet A, Brand M, Janssen EM, Gunz H, Li W, Preiss M, Sadler A, DiSantostefano RL. Patient Preferences in Pulmonary Arterial Hypertension, a Latent Class Analysis to Identify Preference Heterogeneity. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:206-215. [PMID: 37949354 DOI: 10.1016/j.jval.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is a chronic, progressive disease of the pulmonary circulation characterized by vascular remodeling that, if untreated, can lead to right heart dysfunction and death. This analysis measured heterogeneity in patient preferences for PAH-specific treatment regimens. METHOD Adult patients with PAH with slight to marked limitations during physical activity were recruited through a patient organization in Germany. Participants completed an online best-worst scaling case 3 survey. Patients chose among 3 hypothetical treatment profiles defined by 6 benefits and risks at varying levels. Participants completed 12 choice tasks. Preference heterogeneity was assessed using latent class analysis. RESULTS A total of 83 participants (76% female) completed the survey. Best-fit model revealed 4 classes. Class 1 (19% of participants) assigned importance to multiple attributes particularly side effects, class 2 (34%) to physical activity limitations, class 3 (30%) to survival and physical activity limitations, and class 4 (17%) to survival. No differences in sociodemographic characteristics were observed across classes. Compared with other classes, class 4 was most likely to report having marked physical activity limitations (79%) and needing daily help (100%), while considering higher daily activity levels to be ordinary (walking >1 km [71%] or climbing several flights of stairs [50%]). CONCLUSION This first patient preference study in a PAH population suggests that physical activity limitations in addition to survival matter most to patients; however, preference heterogeneity between groups of patients was observed. Patient preferences should be considered in treatment decision making to better balance patient's expectations regarding the known risk-benefit ratio of treatment.
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Affiliation(s)
- Axel Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany; Gesellschaft für empirische Beratung GmbH, Berlin, Germany.
| | - Amélie Beaudet
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Monika Brand
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Ellen M Janssen
- Janssen-Cilag Germany, Johnson & Johnson Platz, Neuss North Rhine-Westphalia, Germany
| | - Holger Gunz
- Janssen-Cilag Germany, Johnson & Johnson Platz, Neuss North Rhine-Westphalia, Germany
| | - Wenjing Li
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Michael Preiss
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Andrew Sadler
- Gesellschaft für empirische Beratung GmbH, Berlin, Germany
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Yang R, Chen J, Wang R, Li D, Hu J, Wan Y, Fang J, Zhang S. The effect of bullying victimization on sleep quality among Chinese medical students: Timing, duration, and patterns. J Affect Disord 2024; 344:25-32. [PMID: 37802327 DOI: 10.1016/j.jad.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Bullying victimization (BV) is a potential factor to sleep quality, but the role of BV characteristics in this association remains unclear. This study aimed to investigate correlation between the timing, duration, and patterns of BV and sleep quality among Chinese medical students. METHODS 4035 participants (mean age of 19.2 ± 1.0) were recruited. BV patterns from pre-school to college were estimated using latent class analysis. Multinomial logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (CI) between sleep quality and BV. E values were used to assess unmeasured confounding. RESULTS Three patterns of BV were identified as follows: persistent BV (6.2 %), moderate BV (10.5 %), and low BV (83.3 %). BV during pre-school, elementary school, junior high school, senior high school, and college were all positively associated with poor sleep quality. The ORs were 2.30 (1.43-3.70), 3.00 (2.28-3.95), 2.71 (2.14-3.43), 3.34 (2.57-4.33) and 4.13 (3.19-5.36), respectively. The E value were 4.03 (2.21-NA), 5.45 (3.99-NA), 4.86 (3.70-NA), 6.14 (4.58-NA), 7.73 (5.83-NA), respectively. Those who experienced more periods of BV were more strongly associated with poor sleep quality, presenting a dose-response relationship [OR = 1.78, 95 % CI: 1.63-1.95, E value: 2.96 (2.64-NA)]. Those who experienced moderate BV [OR = 2.58, 95 % CI: 1.99-3.35; E value: 4.60 (3.39-NA)] and persistent BV [OR = 4.01, 95 % CI: 2.95-5.46; E value: 7.48(5.35-NA)] had higher odds of poor sleep quality. LIMITATIONS Retrospective design may introduce recall bias. CONCLUSION BV was positively related to poor sleep quality and chronic exposure to BV had a cumulative effect on poor sleep quality.
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Affiliation(s)
- Rong Yang
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jin Chen
- School of Medical Technology, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China
| | - Rong Wang
- Community Health Service Center of Xiyuan Street, 77th Hezuohua South Road, Hefei 230031, Anhui Province, PR China
| | - Danlin Li
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jie Hu
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Yuhui Wan
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jun Fang
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China; Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan; Department of Preventive Medicine, School of Public Health and Health Management, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China.
| | - Shichen Zhang
- Department of Preventive Medicine, School of Public Health and Health Management, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China; MOE Key Laboratory of Population Health Across Life Cycle, 81th Meishan Road, Hefei 230032, Anhui Province, PR China.
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Kerkhoff AD, West NS, Del Mar Castro M, Branigan D, Christopher DJ, Denkinger CM, Nhung NV, Theron G, Worodria W, Yu C, Muyoyeta M, Cattamanchi A. Placing the values and preferences of people most affected by TB at the center of screening and testing: an approach for reaching the unreached. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:27. [PMID: 39239641 PMCID: PMC11376596 DOI: 10.1186/s44263-023-00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/04/2023] [Indexed: 09/07/2024]
Abstract
To reach the millions of people with tuberculosis (TB) undiagnosed each year, there is an important need to provide people-centered screening and testing services. Despite people-centered care being a key pillar of the WHO END-TB Strategy, there have been few attempts to formally characterize and integrate the preferences of people most affected by TB - including those who have increased exposure to TB, limited access to services, and/or are at increased risk for TB - into new tools and strategies to improve screening and diagnosis. This perspective emphasizes the importance of preference research among people most affected by TB, provides an overview of qualitative preference exploration and quantitative preference elicitation research methods, and outlines how preferences can be applied to improve the acceptability, accessibility, and appropriateness of TB screening and testing services via four key opportunities. These include the following: (1) Defining the most preferred features of novel screening, triage, and diagnostic tools, (2) exploring and prioritizing setting-specific barriers and facilitators to screening and testing, (3) understanding what features of community- and facility-based strategies for improving TB detection and treatment are most valued, and (4) identifying the most relevant and resonant communication strategies to increase individual- and community-level awareness and demand. Preference research studies and translation of their findings into policy/guidance and operationalization have enormous potential to close the existing gaps in detection in high burden settings by enhancing the people-centeredness and reach of screening and diagnostic services to people most affected by TB who are currently being missed and left behind.
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Affiliation(s)
- Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Nora S West
- Pulmonary, Critical Care Allergy and Sleep Medicine, University of California San Francisco, San Francisco, USA
| | - Maria Del Mar Castro
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Claudia M Denkinger
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Nguyen Viet Nhung
- University of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi, Vietnam
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - William Worodria
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- World Alliance for Lung and Intensive Care in Uganda, Kampala, Uganda
| | - Charles Yu
- Center for Tuberculosis Research, De La Salle Medical and Health Sciences Institute, City of Dasmarinas, The Philippines
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
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Yan H, Han Z, Nie H, Yang W, Nicholas S, Maitland E, Zhao W, Yang Y, Shi X. Continuing medical education in China: evidence from primary health workers' preferences for continuing traditional Chinese medicine education. BMC Health Serv Res 2023; 23:1200. [PMID: 37924090 PMCID: PMC10623727 DOI: 10.1186/s12913-023-10153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Continuing Medical Education (CME) is an important part of the training process for health workers worldwide. In China, training in Traditional Chinese Medicine (TCM) not only improves the expertise of medical workers, but also supports the Chinese Government's policy of promoting TCM as an equal treatment to western medicine. CME, including learning Traditional Chinese Medicine Technologies (TCMTs), perform poorly and research into the motivation of health workers to engage in CME is urgently required. Using a discrete choice experiment, this study assessed the CME learning preferences of primary health workers, using TCMT as a case study of CME programs. METHODS We conducted a discrete choice experiment among health workers in Shandong Province, Guizhou Province, and Henan provinces from July 1, 2021 to October 1, 2022 on the TCMT learning preferences of primary health workers. The mixed logit model and latent class analysis model were used to analyze primary health workers' TCMT learning preferences. RESULTS A total of 1,063 respondents participated in this study, of which 1,001 (94.2%) passed the consistency test and formed the final sample. Our key finding was that there were three distinct classes of TCMT learners. Overall, the relative importance of the seven attributes impacting the learning of TCMTs were: learning expenses, expected TCMT efficacy, TCMT learning difficulty, TCMT mode of learning, TCMT type, time required to learn, and expected frequency of TCMT use. However, these attributes differed significantly across the three distinct classes of TCMT learners. Infrequent users (class 1) were concerned with learning expenses and learning difficulty; workaholics (class 2) focused on the mode of learning; and pragmatists (class 3) paid more attention to the expected TCMT efficacy and the expected frequency of TCMT use. We recommend targeted strategies to motivate TCMT learning suited to the requirements of each class of TCMT learners. CONCLUSION Rather than a single TCMT medical education program for primary health workers, CME programs should be targeted at different classes of TCMT learners.
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Affiliation(s)
- Hao Yan
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Zhaoran Han
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Hanlin Nie
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Wanjin Yang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool, UK
| | - Weihan Zhao
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Yang
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China.
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China.
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11
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Bywall KS, Drevin J, Groothuis-Oudshoorn C, Veldwijk J, Nyholm D, Widner H, van Vliet T, Jiltsova E, Hansson M, Johansson JV. Patients accept therapy using embryonic stem cells for Parkinson's disease: a discrete choice experiment. BMC Med Ethics 2023; 24:83. [PMID: 37828462 PMCID: PMC10571417 DOI: 10.1186/s12910-023-00966-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND New disease-modifying ways to treat Parkinson's disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future. METHODS Patients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents' preferences. RESULTS A substantial difference in respondents' preferences was observed in three latent preference patterns (classes). "Effect on symptoms" was the most important attribute in class 1, closely followed by "type of treatment," with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on "type of treatment" in the decision-making. Respondents' class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs. CONCLUSIONS Most of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells.
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Affiliation(s)
- Karin Schölin Bywall
- School of Health, Care and Social Welfare, Division of Health and Welfare Technology, Mälardalen University, Västerås, Sweden.
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Jennifer Drevin
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - Catharina Groothuis-Oudshoorn
- Health Technology and Services Research (HTSR), Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Jorien Veldwijk
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dag Nyholm
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Hakan Widner
- Department of Neurology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Trinette van Vliet
- Department of Neurology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Elena Jiltsova
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - Jennifer Viberg Johansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- The Institute for Future Studies, Holländargatan 13, 111 36, Stockholm, Sweden
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12
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Beckham SW, Sanchez T, Fowler R, Zlotorzynska M, Rai M, Sullivan P, Vannappagari V, Sarkar S, Glick JL, Rinehart AR, Rawlings K, Bridges JF. Variation in Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among US Men Who Have Sex with Men: A Latent Class Analysis. AIDS Patient Care STDS 2023; 37:495-503. [PMID: 37862078 PMCID: PMC10771870 DOI: 10.1089/apc.2023.0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) is efficacious, with a good safety profile, and was approved by the US Food and Drug Administration in December 2021. Understanding variations in potential user preferences for LA PrEP may inform implementation and subsequently improve uptake and community-level effectiveness. HIV-negative, sexually active men who have sex with men (MSM) aged ≥15 years were recruited online for the 2019 American Men's Internet Survey, before LA PrEP approval. Respondents completed a discrete-choice experiment (DCE) with hypothetical LA PrEP attributes (out-of-pocket cost, perceived side effects, injection frequency, perceived stigma, service location). Latent class analysis segmented respondents into groups based on their preferences for the attributes presented, and relative importance of preference weights and willingness-to-pay were calculated. While the majority had never used daily oral PrEP, 73% of the 2489 respondents were very or somewhat likely to use LA PrEP. Three latent classes were identified from 2241 respondents in the DCE. The "side effects-averse" class was the largest group (64% of respondents) and placed 61% relative importance on side effects. The "ambivalent" class (20% of respondents) placed higher importance on stigma (17% of relative importance) than other classes. The "cost-conscious" class (16% of respondents) placed higher relative importance (62%) on cost compared with other attributes and classes. Perceived side effects were an important hypothetical barrier for LA PrEP uptake among a large proportion of potential MSM users. Minimizing out-of-pocket costs is likely to increase uptake and may be important to equitable access. Tailored communication strategies are recommended for the different groups of potential LA PrEP users.
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Affiliation(s)
- S. Wilson Beckham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Travis Sanchez
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Rebecca Fowler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Mona Rai
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Patrick Sullivan
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Vani Vannappagari
- ViiV Healthcare & University of North Carolina-Chapel Hill, Research Triangle Park, North Carolina, USA
| | - Supriya Sarkar
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Jennifer L. Glick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Keith Rawlings
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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13
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Gao CX, Dwyer D, Zhu Y, Smith CL, Du L, Filia KM, Bayer J, Menssink JM, Wang T, Bergmeir C, Wood S, Cotton SM. An overview of clustering methods with guidelines for application in mental health research. Psychiatry Res 2023; 327:115265. [PMID: 37348404 DOI: 10.1016/j.psychres.2023.115265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
Cluster analyzes have been widely used in mental health research to decompose inter-individual heterogeneity by identifying more homogeneous subgroups of individuals. However, despite advances in new algorithms and increasing popularity, there is little guidance on model choice, analytical framework and reporting requirements. In this paper, we aimed to address this gap by introducing the philosophy, design, advantages/disadvantages and implementation of major algorithms that are particularly relevant in mental health research. Extensions of basic models, such as kernel methods, deep learning, semi-supervised clustering, and clustering ensembles are subsequently introduced. How to choose algorithms to address common issues as well as methods for pre-clustering data processing, clustering evaluation and validation are then discussed. Importantly, we also provide general guidance on clustering workflow and reporting requirements. To facilitate the implementation of different algorithms, we provide information on R functions and libraries.
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Affiliation(s)
- Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Dominic Dwyer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Ye Zhu
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Catherine L Smith
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lan Du
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Johanna Bayer
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Jana M Menssink
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Teresa Wang
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Christoph Bergmeir
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia; Department of Computer Science and Artificial Intelligence, University of Granada, Granada, Spain
| | - Stephen Wood
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
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14
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Liu R, Li Q, Li Y, Wei W, Ma S, Wang J, Zhang N. Public Preference Heterogeneity and Predicted Uptake Rate of Upper Gastrointestinal Cancer Screening Programs in Rural China: Discrete Choice Experiments and Latent Class Analysis. JMIR Public Health Surveill 2023; 9:e42898. [PMID: 37428530 PMCID: PMC10366669 DOI: 10.2196/42898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Rapid increases in the morbidity and mortality of patients with upper gastrointestinal cancer (UGC) in high-incidence countries in Asia have raised public health concerns. Screening can effectively reduce the incidence and mortality of patients with UGC, but the low population uptake rate seriously affects the screening effect. OBJECTIVE We aimed to determine the characteristics that influence residents' preference heterogeneity for a UGC-screening program and the extent to which these characteristics predict residents' uptake rates. METHODS A discrete choice experiment was conducted in 1000 residents aged 40-69 years who were randomly selected from 3 counties (Feicheng, Linqu, and Dongchangfu) in Shandong Province, China. Each respondent was repeatedly asked to choose from 9 discrete choice questions of 2 hypothetical screening programs comprising 5 attributes: screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model was used to estimate residents' preference heterogeneity for each attribute level, their willingness to pay, and the expected uptake rates. RESULTS Of the 1000 residents invited, 926 (92.6%) were included in the final analyses. The mean age was 57.32 (SD 7.22) years. The best model contained 4 classes of respondents (Akaike information criterion=7140.989, Bayesian information criterion=7485.373) defined by different preferences for the 5 attributes. In the 4-class model, out of 926 residents, 88 (9.5%) were assigned to class 1, named as the negative latent type; 216 (3.3%) were assigned to class 2, named as the positive integrated type; 434 (46.9%) were assigned to class 3, named as the positive comfortable type; and 188 (20.3%) were assigned to class 4, named as the neutral quality type. For these 4 latent classes, "out-of-pocket cost" is the most preferred attribute in negative latent type and positive integrated type residents (45.04% vs 66.04% importance weights), whereas "screening technique" is the most preferred factor in positive comfortable type residents (62.56% importance weight) and "screening interval" is the most valued attribute in neutral quality type residents (47.05% importance weight). Besides, residents in different classes had common preference for painless endoscopy, and their willingness to pay were CNY ¥385.369 (US $59.747), CNY ¥93.44 (US $14.486), CNY ¥1946.48 (US $301.810), and CNY ¥3566.60 (US $552.961), respectively. Residents' participation rate could increase by more than 89% (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow-up for precancerous lesions, 45% mortality reduction, screening every year, and painless endoscopy was implemented. CONCLUSIONS Public preference heterogeneity for UGC screening does exist. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes and levels, except for painless endoscopy. Policy makers should consider these heterogeneities to formulate UGC-screening programs that incorporate the public's needs and preferences to improve participation rates.
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Affiliation(s)
- Ruyue Liu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- School of Public Health, Weifang Medical University, Weifang, China
| | - Qiuxia Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yifan Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wenjian Wei
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Siqi Ma
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jialin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Nan Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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15
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Bywall KS, Esbensen BA, Heidenvall M, Erlandsson I, Lason M, Hansson M, Johansson JV. Physical function and severe side effects matter most to patients with RA (< 5 years): a discrete choice experiment assessing preferences for personalized RA treatment. BMC Rheumatol 2023; 7:17. [PMID: 37400929 DOI: 10.1186/s41927-023-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Early assessment of patient preferences has the potential to support shared decisions in personalized precision medicine for patients with rheumatoid arthritis (RA). The aim of this study was to assess treatment preferences of patients with RA (< 5 years) with previous experience of inadequate response to first-line monotherapy. METHOD Patients were recruited (March-June 2021) via four clinics in Sweden. Potential respondents (N = 933) received an invitation to answer a digital survey. The survey included an introductory part, a discrete choice experiment (DCE) and demographic questions. Each respondent answered 11 hypothetical choice questions as part of the DCE. Patient preferences and preference heterogeneity were estimated using random parameter logit models and latent class analysis models. RESULTS Patients (n = 182) assessed the most important treatment attributes out of physical functional capacity, psychosocial functional capacity, frequency of mild side effects and likelihood of severe side effects. In general, patients preferred a greater increase in functional capacity and decreased side effects. However, a substantial preference heterogeneity was identified with two underlying preference patterns. The most important attribute in the first pattern was the 'likelihood of getting a severe side effect'. Physical functional capacity was the most important attribute in the second pattern. CONCLUSION Respondents focused their decision-making mainly on increasing their physical functional capacity or decreasing the likelihood of getting a severe side effect. These results are highly relevant from a clinical perspective to strengthen communication in shared decision making by assessing patients' individual preferences for benefits and risks in treatment discussions.
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Affiliation(s)
- Karin Schölin Bywall
- School of Health, Care and Social Welfare, Division of Health and Welfare Technology, Mälardalen University, Västerås, Sweden.
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Mats Hansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Jennifer Viberg Johansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
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16
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Böger S, van Bergen I, Beaudart C, Cheung KL, Hiligsmann M. Preference of young adults for COVID-19 vaccination in the United Kingdom: a discrete choice experiment. Expert Rev Pharmacoecon Outcomes Res 2023; 23:921-931. [PMID: 37294709 DOI: 10.1080/14737167.2023.2223983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/17/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine preferences for COVID-19 vaccinations in the young adult population in the United Kingdom (UK). METHOD A discrete choice experiment survey was conducted in UK young adults. Participants were asked to choose between two hypothetical vaccines the one they preferred the most. Vaccines were defined by five attributes (effectiveness, risk of side effects, duration of protection, number of doses, confidence in available evidence), identified following a systematic literature review and qualitative interviews with 13 young adults. A random parameters logit model, a latent class model, and subgroup analyses were used to identify preferences. RESULTS One hundred and forty-nine respondents were included (70% women, mean age 23 years). All five attributes significantly influenced respondents' vaccination decisions. Respondents valued higher effectiveness, lower risk of side effects, longer protection duration, and a smaller number of doses. Based on the range of levels of each attribute, vaccine effectiveness was the most important attribute (relative importance 34%), followed by risk of side effects (32%), and duration of vaccine protection (22%). CONCLUSIONS The five investigated vaccine attributes appear to play an important role in young adults' decision-making process. Results of this study may help health authorities designing appropriate strategies in future vaccines campaigns in the younger UK population.
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Affiliation(s)
- Sophie Böger
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Ilja van Bergen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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17
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Donat-Roca R, Tárrega S, Estapé-Madinabeitia T, Escalona-Marfil C, Ruíz-Moreno J, Seijas R, Romero-Cullerés G, Roig-Busquets R, Mohtadi NG. Spanish Version of the Anterior Cruciate Ligament-Quality of Life Questionnaire: Translation, Cross-cultural Adaptation, and Validation. Orthop J Sports Med 2023; 11:23259671231183405. [PMID: 37492780 PMCID: PMC10363881 DOI: 10.1177/23259671231183405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 07/27/2023] Open
Abstract
Background The Anterior Cruciate Ligament-Quality of Life (ACL-QOL) questionnaire is a patient-reported outcome measure used to assess the effect of an anterior cruciate ligament (ACL) injury on the lives of patients. It was originally written in English, which may affect its use when completed by nonnative English speakers. Purpose To translate and adapt the ACL-QOL to Spanish and provide evidence of its psychometric properties. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods A total of 183 patients with an ACL injury from 4 Catalan hospitals were included: 99 patients who had undergone ACL reconstruction (ACLR) completed the Spanish version of the ACL-QOL (ACL-QOL-Sp) twice (mean interval, 15.2 days) in 2 weeks for test-retest reliability, and 84 patients completed the ACL-QOL-Sp, the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the 12-item Short Form Health Survey (SF-12) before and at 4 and 9 months after ACLR to assess responsiveness. The association between the ACL-QOL-Sp and the other outcome measures was evaluated with the Spearman correlation coefficient. Results The ACL-QOL-Sp showed good internal consistency (Cronbach alpha = 0.96) and test-retest reliability (intraclass correlation coefficient = 0.97). The standard error of measurement was 3.6, also suggesting the precision of measurements. The smallest detectable change was 9.98 in 94% of patients. No association was found between the ACL-QOL-Sp score and the Tegner score or SF-12 mental component summary score; however, a moderate correlation was found with the overall KOOS score (r = -0.545), Lysholm score (r = 0.509), and SF-12 physical component summary score (r = 0.607). The correlation ranged from weak for the KOOS-Symptoms subscore (r = -0.290) to moderate for the KOOS-Quality of Life subscore (r = -0.698). No ceiling or floor effects were observed. The ACL-QOL-Sp showed a moderate effect size (0.73) at 4 months but a large effect size (1.70) at 9 months. Conclusion The ACL-QOL-Sp showed adequate internal consistency, test-retest reliability, and responsiveness in evaluating quality of life after ACLR in Spanish-speaking patients.
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Affiliation(s)
- Rafel Donat-Roca
- Sport, Exercise, and Human Movement Research Group, University of Vic–Central University of Catalonia, Manresa, Spain
| | - Salomé Tárrega
- Epi4Health Research Group, University of Vic–Central University of Catalonia, Manresa, Spain
| | | | - Carles Escalona-Marfil
- Sport, Exercise, and Human Movement Research Group, University of Vic–Central University of Catalonia, Manresa, Spain
| | | | | | - Georgia Romero-Cullerés
- Department of Physical Medicine and Rehabilitation, Althaia–Xarxa Assistencial Universitària de Manresa, Manresa, Spain
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18
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Kpokiri E, Pan SW, Ong JJ, Greaves E, Khan J, Bowen S, Jannaway T, Terris-Prestholt F, Tanton C, Kuper H, Shakespeare T, Tucker JD, Wu D. Preferences for accessing sexual health services among middle-aged and older adults in the UK: a study protocol for a discrete choice experiment using mixed methods. BMJ Open 2023; 13:e066783. [PMID: 37156584 PMCID: PMC10174011 DOI: 10.1136/bmjopen-2022-066783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Sexual health is essential for general health and well-being. Sexual health services for middle-aged and older adults are not prioritised and optimising available services for this population is often overlooked. Not much is known about preferences for accessing sexual health services among middle-aged and older people or level of satisfaction with current services. The aim of this study is to explore preferences for seeking sexual health services among middle-aged and older adults in the UK. This study will use discrete choice experiments (DCEs) including initial qualitative interviews followed by the survey, which have been used as a tool to explore preferences in various health service delivery. METHODS AND ANALYSIS The project will be carried out in two phases. First, we will conduct in-depth semi-structured interviews with 20-30 adults (aged 45+), including disabled people, and those from sexual minority groups resident in the UK. Interviews will explore indications, preferences and factors related to accessing sexual health services. Themes and subthemes emerging from the analysis of the interviews will then be used to design the choice sets and attribute level for the DCEs. For the second phase, for the DCEs, we will design choice sets composed of sexual health service delivery scenarios. The software Ngene will be used to develop the experimental design matrix for the DCE. We will use descriptive statistics to summarise the key sociodemographic characteristics of the study population. Multinomial logit, latent class and mixed logit models will be explored to assess sexual health service preferences and preference heterogeneity. ETHICS AND DISSEMINATION Ethical approval for both parts of this study was granted by the Research and Ethics Committee at the London School of Hygiene & Tropical Medicine. Findings from this study will be disseminated widely to relevant stakeholders via scheduled meetings, webinars, presentations and journal publications.
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Affiliation(s)
- Eneyi Kpokiri
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu, China
| | - Jason J Ong
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Monash University, Melbourne, Victoria, Australia
| | - Emily Greaves
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Junead Khan
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sophie Bowen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fern Terris-Prestholt
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Tanton
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Shakespeare
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph D Tucker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- University of North Carolina Project China, Guangzhou, Guangdong, China
| | - Dan Wu
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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19
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Liao Q, Pu Y, Jin X, Zhuang Z, Xu X, Ren X, Liu G, Ding Q. Physiological and clinical variables identify ARDS classes and therapeutic heterogeneity to glucocorticoids: a retrospective study. BMC Pulm Med 2023; 23:92. [PMID: 36944959 PMCID: PMC10028772 DOI: 10.1186/s12890-023-02384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE We aimed to identify new classes in acute respiratory distress syndrome (ARDS) using physiological and clinical variables and to explore heterogeneity in the effects of glucocorticoid therapy between classes. METHODS Using the Medical Information Mart for Intensive Care-IV database, we identified patients with ARDS. Potential profile analysis was used to identify classes with physiological and clinical data as delineating variables. Baseline characteristics and clinical outcomes were compared between classes. The effect of glucocorticoid treatment was explored by stratifying by class and glucocorticoid treatment. RESULTS From 2008 to 2019, 1104 patients with ARDS were enrolled in the study. The 2-class potential analysis model had the best fit (P < 0.0001), with 78% of patients falling into class 1 and 22% into class 2. Additional classes did not improve the model fit. Patients in class 2 had higher anion gap, lactate, creatinine, and glucose levels and lower residual base, blood pressure, and bicarbonate compared with class 1. In-hospital mortality and 28-day mortality were significantly higher among patients in class 2 than those in class 1 (P < 0.001). Heterogeneity of glucocorticoid treatment was observed, stratified by class and treatment, with no significant effect in class 1 (P = 0.496), increased mortality in class 2 (P = 0.001), and a significant interaction (P = 0.0381). In class 2, 28-day survival was significantly lower with glucocorticoid treatment compared with no hormone treatment (P = 0.001). CONCLUSION We used clinical and physiological variables to identify two classes of non-COVID-19-associated ARDS with different baseline characteristics and clinical outcomes. The response to glucocorticoid therapy varied among different classes of patients.
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Affiliation(s)
- Qingbo Liao
- The Affiliated Suzhou Hospital of Nanjing Medical University, 26 Daoqian Road, Suzhou, 215000, PR China
- Gusu School, Nanjing Medical University, 458 Shizi Road, Suzhou, 215000, PR China
| | - Yufan Pu
- The Affiliated Suzhou Hospital of Nanjing Medical University, 26 Daoqian Road, Suzhou, 215000, PR China
- Gusu School, Nanjing Medical University, 458 Shizi Road, Suzhou, 215000, PR China
| | - Xiaoer Jin
- The Affiliated Suzhou Hospital of Nanjing Medical University, 26 Daoqian Road, Suzhou, 215000, PR China
- Gusu School, Nanjing Medical University, 458 Shizi Road, Suzhou, 215000, PR China
| | - Zhiwei Zhuang
- Department of Emergency, Suzhou Municipal Hospital, 26 Daoqian Road, Suzhou, 215000, PR China
| | - Xiaowen Xu
- Department of Emergency, Suzhou Municipal Hospital, 26 Daoqian Road, Suzhou, 215000, PR China
| | - Xiaoqiang Ren
- Department of Emergency, Suzhou Municipal Hospital, 26 Daoqian Road, Suzhou, 215000, PR China
| | - Gaoqing Liu
- First Affiliated Hospital of Suzhou University, 899 Pinghai Road, Suzhou, 215000, PR China
| | - Qi Ding
- The Affiliated Suzhou Hospital of Nanjing Medical University, 26 Daoqian Road, Suzhou, 215000, PR China.
- Gusu School, Nanjing Medical University, 458 Shizi Road, Suzhou, 215000, PR China.
- Department of Emergency, Suzhou Municipal Hospital, 26 Daoqian Road, Suzhou, 215000, PR China.
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20
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Mutsekwa RN, Campbell KL, Canavan R, Mulhern B, Angus RL, Byrnes JM. Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment. THE PATIENT 2023; 16:165-177. [PMID: 36637751 DOI: 10.1007/s40271-022-00609-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Increased demand for gastroenterology services has resulted in growing waitlists, with patients at risk of exceeding clinically recommended wait-times. Given limited healthcare resources, expanded scope models of care are an option to help address this demand, but little is known about patient preferences for these models of care. METHODS Low-risk gastroenterology patients (n = 1198) referred to an outpatient tertiary service in Australia over a 2-year period were invited to participate in an unlabelled discrete choice experiment with seven attributes: primary healthcare professional, wait-time, continuity of care, consultation length, manner and communication skills, reassurance, and cost. These were developed using qualitative research, literature review, and stakeholders' experiences. A d-efficient fractional design was used to construct four blocks of 12 choice sets, with two alternatives. A 13th choice set was included as a data and quality check. Latent class and mixed logit regression were used for analysis. The resulting preference parameters for individual attributes were then used to calculate willingness to pay and willingness to wait. RESULTS Overall, the model based on the 347 respondents suggested no strong preference for professional background. All other attributes were statistically significant predictors of preference (p < 0.001), with respondents willing to make significant trade-offs (time and cost) before accepting deterioration in attributes. There was strong emphasis on manner and communication skills, with a clinician who listens and provides good explanations overwhelmingly the most important attribute. Latent class analysis identified two patient segments who differed in their preference for the primary treating healthcare professional (doctor or dietitian) based on exposure to either traditional medical or non-medical professional role substitution model. CONCLUSIONS Patients have strong but varied preferences for gastroenterology services based on whether they have been exposed to expanded scope models of care. Design and implementation of new models of care need to consider strategies to overcome any perceived loss in utility or deterioration in healthcare quality for those unfamiliar with professional role substitution.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia. .,Gold Coast Hospital and Health Service, Allied Health Research Team, Southport, QLD, Australia. .,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport, Southport, QLD, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research, University of Technology Sydney, Sydney, NSW, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia.,School of Allied-health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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21
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Patient Preferences in the Management of Hidradenitis Suppurativa: Results of a Multinational Discrete Choice Experiment in Europe. THE PATIENT 2023; 16:153-164. [PMID: 36630078 PMCID: PMC9911507 DOI: 10.1007/s40271-022-00614-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Hidradenitis suppurativa is a chronic inflammatory skin disease that can lead to a substantial reduction in quality of life. Recent studies revealed high levels of unmet care needs of patients with hidradenitis suppurativa, but their preferences in treatment decision making have scarcely been investigated. This study aimed to reveal which treatment attributes adult patients with HS in Europe consider most important in treatment decision-making. METHODS A discrete choice experiment was conducted with adult patients with hidradenitis suppurativa in Europe to reveal which treatment attributes are most important when making treatment decisions. Participants were presented with 15 sets of two treatment options and asked for each to choose the treatment they preferred. The treatments were characterized by six attributes informed by a prior literature review and qualitative research: effectiveness, pain reduction, duration of treatment benefit, risk of mild adverse event, risk of serious infection, and mode of administration. A random parameter logit model was used to estimate patients' preferences with additional subgroup and latent class models used to explore any differences in preferences across patient groups. RESULTS Two hundred and nineteen adult patients with hidradenitis suppurativa were included in the analysis (90% women, mean age 38 years). For all six treatment attributes, significant differences were observed between levels. Given the range of levels of each attribute, the most important treatment attributes were effectiveness (47.9%), followed by pain reduction (17.3%), annual risk of a mild adverse event (14.4%), annual risk of a serious infection (10.3%), mode of administration (5.3%), and duration of treatment benefit (4.8%). Higher levels of effectiveness, namely a 75% or 100% reduction in the abscess and inflammatory nodule count, were preferred over levels of effectiveness primarily investigated in randomized clinical trials of hidradenitis suppurativa (a 50% reduction). Results were largely consistent across subgroups and three latent class groups were identified. CONCLUSIONS This study revealed the most important treatment characteristics for patients with hidradenitis suppurativa that can help inform joint patient-physician decision making in the management of hidradenitis suppurativa. Designing future hidradenitis suppurativa treatments according to stated preferences, namely, to offer higher levels of effectiveness and pain improvement without higher risks of adverse events, may increase patients' treatment concordance and lead to improved disease management outcomes.
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Wang Y, Berger KI, Zhang Y, Shao Y, Goldring RM, Reibman J, Liu M. Novel approach to studying effects of inhalational exposure on lung function in civilians exposed to the World Trade Center disaster. Sci Rep 2023; 13:3218. [PMID: 36828851 PMCID: PMC9958097 DOI: 10.1038/s41598-023-30030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
It is increasingly important to study the impact of environmental inhalation exposures on human health in natural or man-made disasters in civilian populations. The members of the World Trade Center Environmental Health Center (WTC EHC; WTC Survivors) had complex exposures to environmental disaster from the destruction of WTC towers and can serve to reveal the effects of WTC exposure on the entire spectrum of lung functions. We aimed to investigate the associations between complex WTC exposures and measures of spirometry and oscillometry in WTC Survivors and included 3605 patients enrolled between Oct 1, 2009 and Mar 31, 2018. We performed latent class analysis and identified five latent exposure groups. We applied linear and quantile regressions to estimate the exposure effects on the means and various quantiles of pre-bronchodilator (BD) % predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, as well as the resistance at an oscillating frequency of 5 Hz (R5), frequency dependence of resistance R5-20, and reactance area (AX). Compared with Group 5, which had low or unknown exposure and was treated as the reference group, Group 1, the local workers with both acute and chronic exposures, had a lower median of % predicted FVC (-3.6; 95% CI: -5.4, -1.7) and higher (more abnormal) measures of AX at 10th quantile (0.77 cmH2O L-1 s; 95% CI: 0.41, 1.13) and 25th quantile (0.80 cmH2O L-1 s; 95% CI: 0.41, 1.20). Results suggested heterogeneous exposures to the WTC disaster had differential effects on the distributions of lung functions in the WTC Survivors. These findings could provide insights for future investigation of environmental disaster exposures.
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Affiliation(s)
- Yuyan Wang
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Kenneth I Berger
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Yian Zhang
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Yongzhao Shao
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Roberta M Goldring
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Joan Reibman
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| | - Mengling Liu
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
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23
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Brinkmann M, Diedrich L, Hemmerling M, Krauth C, Robra BP, Stahmeyer JT, Dreier M. Heterogeneous Preferences for Colorectal Cancer Screening in Germany: Results of a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:104-114. [PMID: 36031478 DOI: 10.1016/j.jval.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities. METHODS A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model. RESULTS From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2). CONCLUSION Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.
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Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | | | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Kerkhoff AD, Muiruri C, Geng EH, Hickey MD. A world of choices: preference elicitation methods for improving the delivery and uptake of HIV prevention and treatment. Curr Opin HIV AIDS 2023; 18:32-45. [PMID: 36409315 PMCID: PMC9772083 DOI: 10.1097/coh.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW Despite the growing availability of effective HIV prevention and treatment interventions, there are large gaps in their uptake and sustained use across settings. It is crucial to elicit and apply patients' and stakeholders' preferences to maximize the impact of existing and future interventions. This review summarizes quantitative preference elicitation methods (PEM) and how they can be applied to improve the delivery and uptake of HIV prevention and treatment interventions. RECENT FINDINGS PEM are increasingly applied in HIV implementation research; however, discrete choice experiments (DCEs) have predominated. Beyond DCEs, there are other underutilized PEM that may improve the reach and effectiveness of HIV prevention and treatment interventions among individuals by prioritizing their barriers to engagement and determining which attributes of interventions and delivery strategies are most valued. PEM can also enhance the adoption and sustained implementation of strategies to deliver HIV prevention and treatment interventions by assessing which attributes are the most acceptable and appropriate to key stakeholders. SUMMARY Greater attention to and incorporation of patient's and stakeholders' preferences for HIV prevention and treatment interventions and their delivery has the potential to increase the number of persons accessing and retained in HIV prevention and treatment services.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D. Hickey
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
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25
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Jiang S, Ren R, Gu Y, Jeet V, Liu P, Li S. Patient Preferences in Targeted Pharmacotherapy for Cancers: A Systematic Review of Discrete Choice Experiments. PHARMACOECONOMICS 2023; 41:43-57. [PMID: 36372823 PMCID: PMC9813042 DOI: 10.1007/s40273-022-01198-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Targeted pharmacotherapy has been increasingly applied in cancer treatment due to its breakthroughs. However, the unmet needs of cancer patients are still significant, highlighting the urgency to investigate patient preferences. It is unclear how patients deliberate their choices between different aspects of targeted therapy, including cost, efficacy, and adverse events. Since discrete choice experiments (DCEs) have been widely applied to patient preference elicitation, we reviewed DCEs on targeted therapy for different cancers. We also synthesized evidence on the factors influencing patients' choices and their willingness-to-pay (WTP) for survival when treated by targeted therapy. METHODS We searched databases, including PubMed, EMBASE and MEDLINE, up to August 16, 2022, supplemented by a reference screening. The attributes from the selected studies were categorized into three groups: outcomes, costs, and process. We also calculated the relative importance of attributes and WTP for survival whenever possible. The purpose, respondents, explanation, findings, significance (PREFS) checklist was used to evaluate the quality of the included DCE studies. RESULTS The review identified 34 eligible studies from 13 countries covering 14 cancers, such as breast, ovarian, kidney, prostate, and skin cancers. It also reveals a rising trend of DCEs on this topic, as most studies were published after 2018. We found that patients placed higher weights on the outcome (e.g., overall survival) and cost attributes than on process attributes. On average, patients were willing to pay $561 (95% confidence interval [CI]: $415-$758) and $716 (95% CI $524-$958) out-of-pocket for a 1-month increase in progression-free survival and overall survival, respectively. PREFS scores of the 34 studies ranged from 2 to 4, with a mean of 3.38 (SD: 0.65), suggesting a reasonable quality based on the checklist. However, most studies (n = 32, 94%) did not assess the impact of non-responses on the results. CONCLUSIONS This is the first systematic review focusing on patient preferences for targeted cancer therapy. We showcased novel approaches for evidence synthesis of DCE results, especially the attribute relative importance and WTP. The results may inform stakeholders about patient preferences toward targeted therapy and their WTP estimates. More studies with improved study design and quality are warranted to generate more robust evidence to assist decision making.
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Affiliation(s)
- Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ru Ren
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247# Beiyuan Street, Jinan, 250033, China
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
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Liu C, Yang H, Jiao Y, Liu Y, Chang J, Ji Y. Preferences of people with mild cognitive impairment for physical activity interventions in China: protocol for a discrete choice experiment study. BMJ Open 2022; 12:e064153. [PMID: 36241356 PMCID: PMC9577920 DOI: 10.1136/bmjopen-2022-064153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Exercise interventions are important non-pharmacological interventions for patients with mild cognitive impairment (MCI), but patients with MCI have poor compliance and there is no consistent strategy for exercise interventions. Understanding the needs and preferences of MCI patients allows for the development of effective and acceptable exercise intervention programmes that achieve the goals of patient-centred care. This study uses a discrete choice experiment (DCE) to measure and quantify MCI patients' preferences for exercise interventions, and aims at (1) identifying and exploring which elements of exercise intervention programmes are essential for MCI patients; (2) measuring MCI patients' preferences for exercise interventions and summarising relevant characteristics that may influence preference choices and (3) determining whether these preferences vary by participant characteristics and classifying the population types based on the sociodemographic characteristics of the participants. METHODS AND ANALYSIS A DCE will be conducted to explore MCI patients' preferences for exercise interventions. We conducted a systematic literature review and extensive qualitative work to select the best attributes to develop the design of DCE. A partial factorial survey design was generated through an orthogonal experimental design. We will conduct a questionnaire survey in one city each in the eastern (Nanjing), western (Xining), southern (Zhuhai) and northern (Beijing) parts of China and reach the planned sample size (n=278). Final data will be analysed using a mixed logit model and a latent class model. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Nanjing Medical University (2021-666). All participants will be required to provide informed consent. Our findings will be disseminated and shared with interested patient groups and the general public through online blogs, policy briefs, national and international conferences and peer-reviewed journals.
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Affiliation(s)
- Chang Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Hong Yang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yuchen Jiao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yunyue Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jing Chang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Ji
- School of Nursing, Nanjing Medical University, Nanjing, China
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Ajisegiri WS, Peiris D, Abimbola S, Odusanya OO, Tesema AG, Joshi R, Angell B. It is not all about salary: a discrete-choice experiment to determine community health workers' motivation for work in Nigeria. BMJ Glob Health 2022; 7:e009718. [PMID: 36270659 PMCID: PMC9594556 DOI: 10.1136/bmjgh-2022-009718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Community health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery. METHODS A discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated. RESULTS About 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the 'opportunity to convert from CHW to another cadre of health workers, such as nursing' was the most important motivator among the volunteers' CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs. CONCLUSION CHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, New Delhi, India
| | - Blake Angell
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
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Karim S, Craig BM, Vass C, Groothuis-Oudshoorn CGM. Current Practices for Accounting for Preference Heterogeneity in Health-Related Discrete Choice Experiments: A Systematic Review. PHARMACOECONOMICS 2022; 40:943-956. [PMID: 35960434 DOI: 10.1007/s40273-022-01178-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Accounting for preference heterogeneity is a growing analytical practice in health-related discrete choice experiments (DCEs). As heterogeneity may be examined from different stakeholder perspectives with different methods, identifying the breadth of these methodological approaches and understanding the differences are major steps to provide guidance on good research practices. OBJECTIVES Our objective was to systematically summarize current practices that account for preference heterogeneity based on the published DCEs related to healthcare. METHODS This systematic review is part of the project led by the Professional Society for Health Economics and Outcomes Research (ISPOR) health preference research special interest group. The systematic review conducted systematic searches on the PubMed, OVID, and Web of Science databases, as well as on two recently published reviews, to identify articles. The review included health-related DCE articles published between 1 January 2000 and 30 March 2020. All the included articles also presented evidence on preference heterogeneity analysis based on either explained or unexplained factors or both. RESULTS Overall, 342 of the 2202 (16%) articles met the inclusion/exclusion criteria for extraction. The trend showed that analyses of preference heterogeneity increased substantially after 2010 and that such analyses mainly examined heterogeneity due to observable or unobservable factors in individual characteristics. Heterogeneity through observable differences (i.e., explained heterogeneity) is identified among 131 (40%) of the 342 articles and included one or more interactions between an attribute variable and an observable characteristic of the respondent. To capture unobserved heterogeneity (i.e., unexplained heterogeneity), the studies largely estimated either a mixed logit (n = 205, 60%) or a latent-class logit (n = 112, 32.7%) model. Few studies (n = 38, 11%) explored scale heterogeneity or heteroskedasticity. CONCLUSIONS Providing preference heterogeneity evidence in health-related DCEs has been found as an increasingly used practice among researchers. In recent studies, controlling for unexplained preference heterogeneity has been seen as a common practice rather than explained ones (e.g., interactions), yet a lack of providing methodological details has been observed in many studies that might impact the quality of analysis. As heterogeneity can be assessed from different stakeholder perspectives with different methods, researchers should become more technically pronounced to increase confidence in the results and improve the ability of decision makers to act on the preference evidence.
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Affiliation(s)
- Suzana Karim
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Benjamin M Craig
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA
| | - Caroline Vass
- RTI Health Solutions, Manchester, UK
- The University of Manchester, Manchester, UK
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Brinkmann M, Fricke LM, Diedrich L, Robra BP, Krauth C, Dreier M. Attributes in stated preference elicitation studies on colorectal cancer screening and their relative importance for decision-making among screenees: a systematic review. HEALTH ECONOMICS REVIEW 2022; 12:49. [PMID: 36136248 PMCID: PMC9494881 DOI: 10.1186/s13561-022-00394-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The SIGMO study (Sigmoidoscopy as an evidence-based colorectal cancer screening test - a possible option?) examines screening eligible populations' preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment (DCE). Attribute identification and selection are essential for the construction of choice tasks and should be evidence-based. As a part of the SIGMO study this systematic review provides an overview of attributes included in studies eliciting stated preferences for CRC screening tests and their relative importance for decision-making. METHODS Systematic search (November 2021) for English-language studies published since January 2000 in PubMed, Embase, Web of Science, Biomedical Reference Collection: Corporate Edition, LIVIVO and PsycINFO. DCEs and conjoint analysis ranking or rating tasks on screening eligible populations' preferences for stool testing, sigmoidoscopy, and/or colonoscopy were included. Attributes were extracted and their relative importance was calculated and ranked. Risk of bias (RoB) of included studies was assessed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study selection and RoB rating were carried out independently by two reviewers. Data were extracted by one reviewer and checked by another one. RESULTS A total of 23 publications on 22 studies were included. Overall RoB was rated as serious/critical for 21 studies and as moderate for 2 studies. Main reasons for high RoB were non-random sampling, low response rates, lack of non-responder analyses, and, to a lesser extent, weaknesses in the measurement instrument and data analysis. Extracted attributes (n = 120) referred to procedure-related characteristics (n = 42; 35%), structural characteristics of health care (n = 24; 20%), test characteristics (n = 23; 19%), harms (n = 16; 13%), benefits (n = 13; 11%), and level of evidence (n = 2; 2%). Most important attributes were reduction in CRC mortality (and incidence) (n = 7), test sensitivity (n = 7), out-of-pocket costs (n = 4), procedure (n = 3), and frequency (n = 2). CONCLUSIONS Health preference studies on CRC were found to have a high RoB. The composition of choice tasks revealed a lack of attributes on patient-important outcomes (like incidence reduction), while attributes not considered relevant for individual screening decisions (like sensitivity) were frequently used. Future studies eliciting stated preferences in cancer screening should apply the principles of informed decision-making in attribute identification and selection.
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Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Lara Marleen Fricke
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Hollin IL, Paskett J, Schuster ALR, Crossnohere NL, Bridges JFP. Best-Worst Scaling and the Prioritization of Objects in Health: A Systematic Review. PHARMACOECONOMICS 2022; 40:883-899. [PMID: 35838889 PMCID: PMC9363399 DOI: 10.1007/s40273-022-01167-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Best-worst scaling is a theory-driven method that can be used to prioritize objects in health. We sought to characterize all studies of best-worst scaling to prioritize objects in health, to assess trends of using best-worst scaling in prioritization over time, and to assess the relationship between a legacy measure of quality (PREFS) and a novel assessment of subjective quality and policy relevance. METHODS A systematic review identified studies published through to the end of 2021 that applied best-worst scaling to study priorities in health (PROSPERO CRD42020209745), updating a prior review published in 2016. The PubMed, EBSCOhost, Embase, Scopus, APA PsychInfo, Web of Science, and Google Scholar databases were used and were supplemented by a hand search. Data describing the application, development, design, administration/analysis, quality, and policy relevance were summarized and we tested for trends by comparing articles before and after 1 January, 2017. Multivariate statistics were then used to assess the relationships between PREFS, subjective quality, policy relevance, and other possible indicators. RESULTS From a total of 2826 unique papers identified, 165 best-worst scaling studies were included in this review. Applications of best-worst scaling to study priorities in health have continued to grow (p < 0.01) and are now used in all regions of the world, most often to study the priorities of patients/consumers (67%). Several key trends can be observed over time: increased use of pretesting (p < 0.05); increased use of online administration (p < 0.01), and decreased use of paper self-administered surveys (p = 0.02); increased use of heterogeneity analysis (p = 0.02); an increase in having a clearly stated purpose (p < 0.01); and a decrease in comparing respondents to non-respondents (p = 0.01). The average sample size has more than doubled, from 228 to 472 respondents, but formal sample size justifications remain low (5.3%) and unchanged over time (p = 0.68). While the average PREFS score remained unchanged at 3.1/5, both subjective quality and policy relevance trended up, but changes were not statistically significant (p = 0.06 and p = 0.13). Most of the variation in subjective quality was driven by PREFS (R2 = 0.42), but it was also positively assosciated with policy relevance, heterogeneity analysis, and using a balanced incomplete block design, and was negatively associated with not using developmental methods and an increasing sample size. CONCLUSIONS Using best-worst scaling to prioritize objects is now commonly used around the world to assess the priorities of patients and other stakeholders in health. Best practices are clearly emerging for best-worst scaling. Although legacy measures (PREFS) to measure study quality are reasonable, there may need to be new tools to assess both study quality and policy relevance.
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Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA
| | - Jonathan Paskett
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne L R Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.
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Kerkhoff AD, Chilukutu L, Nyangu S, Kagujje M, Mateyo K, Sanjase N, Eshun-Wilson I, Geng EH, Havlir DV, Muyoyeta M. Patient Preferences for Strategies to Improve Tuberculosis Diagnostic Services in Zambia. JAMA Netw Open 2022; 5:e2229091. [PMID: 36036933 PMCID: PMC9425150 DOI: 10.1001/jamanetworkopen.2022.29091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmission and poor clinical outcomes. OBJECTIVE To assess whether patients with TB have differential preferences for strategies to improve the public health reach of TB diagnostic services. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was undertaken in which a discrete choice experiment (DCE) was administered between September 18, 2019, and January 17, 2020, to 401 adults (>18 years of age) with microbiologically confirmed TB in Lusaka, Zambia. The DCE had 7 attributes with 2 to 3 levels per attribute related to TB service enhancements. Latent class analysis was used to identify segments of participants with unique preferences. Multiscenario simulations were used to estimate shares of preferences for different TB service improvement strategies. MAIN OUTCOMES AND MEASURES The main outcomes were patient preference archetypes and estimated shares of preferences for different strategies to improve TB diagnostic services. Collected data were analyzed between January 3, 2022, to July 2, 2022. RESULTS Among 326 adults with TB (median [IQR] age, 34 [27-42] years; 217 [66.8%] male; 158 [48.8%] HIV positive), 3 groups with distinct preferences for TB service improvements were identified. Group 1 (192 participants [58.9%]) preferred a facility that offered same-day TB test results, shorter wait times, and financial incentives for testing. Group 2 (83 participants [25.4%]) preferred a facility that provided same-day TB results, had greater privacy, and was closer to home. Group 3 (51 participants [15.6%]) had no strong preferences for service improvements and had negative preferences for receiving telephone-based TB test results. Groups 1 and 2 were more likely to report at least a 4-week delay in seeking health care for their current TB episode compared with group 3 (29 [51.3%] in group 1, 95 [35.8%] in group 2, and 10 [19.6%] in group 3; P < .001). Strategies to improve TB diagnostic services most preferred by all participants were same-day TB test results alone (shares of preference, 69.9%) and combined with a small financial testing incentive (shares of preference, 79.3%), shortened wait times (shares of preference, 76.1%), or greater privacy (shares of preference, 75.0%). However, the most preferred service improvement strategies differed substantially by group. CONCLUSIONS AND RELEVANCE In this study, patients with TB had heterogenous preferences for TB diagnostic service improvements associated with differential health care-seeking behavior. Tailored strategies that incorporate features most valued by persons with undiagnosed TB, including same-day results, financial incentives, and greater privacy, may optimize reach by overcoming key barriers to timely TB care engagement.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco School of Medicine, San Francisco
| | | | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kondwelani Mateyo
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Nsala Sanjase
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco School of Medicine, San Francisco
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Gadsden T, Sujarwoto S, Purwaningtyas N, Maharani A, Tampubolon G, Oceandy D, Praveen D, Angell B, Jan S, Palagyi A. Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment. BMJ Glob Health 2022; 7:bmjgh-2022-008936. [PMID: 35953209 PMCID: PMC9379506 DOI: 10.1136/bmjgh-2022-008936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. Methods A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses. Results Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income. Conclusion CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
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Affiliation(s)
- Thomas Gadsden
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gindo Tampubolon
- Global Development Institute, The University of Manchester, Manchester, UK
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Devarsetty Praveen
- Better Care India, The George Institute for Global Health India, Hyderabad, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Blake Angell
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Palagyi
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
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Boeri M, Hauber B, Cappelleri JC. Considerations Around Coding the Membership Probability Function in a Latent Class Analysis: Renewed Insights. PHARMACOECONOMICS 2022; 40:653-661. [PMID: 35696072 DOI: 10.1007/s40273-022-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
This technical note discusses how dummy and effects coding of categorical respondent characteristics in a class membership probability function should be interpreted by researchers employing a latent class analysis to explore preference heterogeneity in a discrete-choice experiment. Previous work highlighted issues arising from such coding when interpreting an alternative specific constant that represents an opt-out alternative or current situation in a discrete-choice experiment and did not fully address how this coding impacts the interpretation of parameters resulting from the membership probability function in a latent class analysis. Although latent class membership probability could be predicted separately for each respondent or subgroup of respondents, conclusions are often drawn directly from the model estimation using the full sample, which requires correctly interpreting the estimated parameters. In these cases, the misinterpretation that may arise if the problem is ignored could impact the policy conclusions and recommendations drawn based on the discrete-choice experiment results. This note provides an example comparing dummy and effects coding used to model respondent characteristics in the membership probability function in a discrete-choice experiment aimed to explore preferences for the treatment of chronic pain in the USA.
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Affiliation(s)
- Marco Boeri
- Health Preference Assessment, RTI Health Solutions, 123B Forsyth House, Cromac Square, Belfast, BT2 8LA, Northern Ireland, UK.
- Queen's University of Belfast, Belfast, Northern Ireland, UK.
| | - Brett Hauber
- Pfizer, Inc., New York, NY, USA
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Joseph C Cappelleri
- Statistics, Pfizer, Inc., Groton, CT, USA
- School of Public Health, Brown University, Providence, RI, USA
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Matura LA, Fargo JD, Boyle K, Fritz JS, Smith KA, Mazurek JA, Pinder D, Archer‐Chicko CL, Palevsky HI, Pack AI, Sommers MS, Kawut SM. Symptom phenotypes in pulmonary arterial hypertension: The PAH "symptome". Pulm Circ 2022; 12:e12135. [PMID: 36186717 PMCID: PMC9511227 DOI: 10.1002/pul2.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Women with pulmonary arterial hypertension (PAH) experience multiple symptoms, including dyspnea, fatigue, and sleep disturbance, that impair their health-related quality of life (HRQOL). However, we know little about phenotypic subgroups of patients with PAH with similar, concurrent, multiple symptoms. The objectives of this study were to define the "symptome" by symptom cluster phenotypes and compare characteristics such as biomarkers, cardiac structure and function (echocardiography), functional capacity (6-min walk distance), and HRQOL between the groups. This cross-sectional study included 60 women with PAH. Subjects completed an assessment battery: Pulmonary Arterial Hypertension Symptom Scale, Pittsburgh Sleep Quality Index, Multidimensional Dyspnea Profile, Patient-Reported Outcomes Measurement Information System (PROMIS®) Physical Function, PROMIS® Sleep-Related Impairment, and the emPHasis-10. Subjects also underwent transthoracic echocardiography, phlebotomy, 6-min walk distance, and actigraphy. The three symptoms of dyspnea, fatigue, and sleep disturbance were used to define the symptom clusters. Other PAH symptoms, plasma and serum biomarkers, cardiac structure and function (echocardiography), exercise capacity (6-min walk distance), sleep (actigraphy), and HRQOL were compared across phenotypes. The mean age was 50 ± 18 years, 51% were non-Hispanic white, 32% were non-Hispanic Black and 40% had idiopathic PAH. Cluster analysis identified Mild (n = 28, 47%), Moderate (n = 20, 33%), and Severe Symptom Cluster Phenotypes (n = 12, 20%). There were no differences for age, race, or PAH etiology between the phenotypes. WHO functional class (p < 0.001), norepinephrine levels (p = 0.029), right atrial pressure (p = 0.001), physical function (p < 0.001), sleep onset latency (p = 0.040), and HRQOL (p < 0.001) all differed significantly across phenotypes. We identified three distinctive symptom cluster phenotypes (Mild, Moderate, and Severe) for women with PAH that also differed by PAH-related symptoms, physical function, right atrial pressure, norepinephrine levels, and HRQOL. These phenotypes could suggest targeted interventions to improve symptoms and HRQOL in those most severely affected.
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Affiliation(s)
- Lea Ann Matura
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jamison D. Fargo
- Department of Psychology, Emma Eccles Jones College of Education and Human ServicesUtah State UniversityLoganUtahUSA
| | - Kathleen Boyle
- Department of NursingThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jason S. Fritz
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kerri A. Smith
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jeremy A. Mazurek
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Diane Pinder
- Institutional Review BoardUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Harold I. Palevsky
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Allan I. Pack
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Steven M. Kawut
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Prescribing antibiotics: Factors driving decision-making in general practice. A discrete choice experiment. Soc Sci Med 2022; 305:115033. [PMID: 35617765 DOI: 10.1016/j.socscimed.2022.115033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners' (GPs) decision-making when prescribing antibiotics. AIM To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics. METHODS A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated. RESULTS The questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers. CONCLUSION The most important factor affecting Danish GPs' decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.
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Support for COVID-19-Related Substance Use Services Policy Changes: a New York State-Wide Survey. J Behav Health Serv Res 2022; 49:262-281. [PMID: 35112221 PMCID: PMC8810146 DOI: 10.1007/s11414-021-09784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/05/2022]
Abstract
This study aims to describe which substance use service (SUS) organizations and who within these organizations support the maintenance of policies targeted at improving substance use treatment services. An online survey assessing respondent, organizational and program demographics, and knowledge and support regarding policy changes was distributed to all certified SUS and harm reduction programs in NYS. Bivariate and latent class analyses were used to identify patterns and associations to policy choices. Across the 227 respondents, there was a support for maintaining expansion of insurance coverage, virtual behavioral health/counseling and medication initiation/maintenance visits, reductions in prior authorizations, and access to prevention/harm reduction services. Three classes of support for policies were derived: (1) high-supporters (n = 49; 21%), (2) low-supporters (n = 66; 29%), and (3) selective-supporters. Having knowledge of policy changes was associated with membership in the high-supporters class. Implications regarding the role of knowledge in behavioral health policies dissemination structures, decision-making, and long-term expansion of SUS are discussed.
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Han Y, Zhang L, Fang Y. Novel subgroups of functional ability in older adults and their associations with adverse outcomes. BMC Geriatr 2022; 22:390. [PMID: 35505297 PMCID: PMC9066860 DOI: 10.1186/s12877-022-03081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background There is no general agreement on a standard form of functional classification in older adults and is mainly assessed by Activities of Daily Living (ADL) and/or Instrument Activity of Daily Living. A refined classification based on evaluation the limitations of intrinsic capacity, environment and social interaction, could provide a basis to predict the future disability and identify individuals with increased risk of adverse outcomes. Methods A new functional classification among older adults aged 60 and over was conducted by latent class analysis and compared with the traditional classifications, based on the China Health and Retirement Longitudinal Study. To further investigate the scientific validity of this new classification, associations with 7-year mortality and ADLs impairments among categories were tested by using Survival curves and Cox proportional hazard models. This was followed by the confirmatory analysis related to the prospective data. Competing risk analysis was also performed to analysis the sensitivity to further support our conclusions. Results Five categories were identified among 5,992 older adults which gave the best fitting, yielding a significant Bootstrap Likelihood Ratio Test (p < 0.001) and Lo-Mendell-Rubin adjusted likelihood ratio test (p < 0.001), with an entropy over 0.80. The presence of five categories: “health” (34.0%), “sub-disorder status” (36.6%), “acute diseases” (10.3%), “somatic functional disorder” (7.7%), and “viability disorder” (11.4%), which matched well with the functional independence rates by the international classifications. Among them, those in “sub-disorder status” were considered as an intermediate status between disability and health. The findings also revealed that those who were in “acute disease”, “somatic functional disorders”, “health” and “sub-disorder status” had a significant lower risk of mortality and ADLs limitations than “viability disorder”. And the risks gradually increased towards the less functionally independent end of the classification. However, the distribution of characteristics among five categories were in a synchronous change, indicating a stable classification. Conclusions A new classification representing the functional heterogeneity of older adults could effectively stratify the risk of mortality and ADLs limitations. Identifying the clusters of functional decline might be useful in predicting subsequent ageing trends, designing personalized intervention, and delaying the progression of disability and preventing its occurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03081-9.
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Affiliation(s)
- Ying Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China
| | - Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China.,School of Economics, Xiamen University, 422 Siming South Road, Xiamen, Fujian, 361005, PR China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China.
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Luo Y, Wang A, Zeng Y, Zhang J. A latent class analysis of resilience and its relationship with depressive symptoms in the parents of children with cancer. Support Care Cancer 2022; 30:4379-4387. [PMID: 35099615 DOI: 10.1007/s00520-022-06860-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Depressive symptoms are among the most common afflictions that plague the parents of children with cancer. Given that resilience is an important factor that inhibits the development and progression of depressive symptoms, it can be harnessed as a potential solution for this psychological issue. This study aimed to identify the latent classes of resilience in the parents of children with cancer and explore the relationships of these classes with depressive symptoms. METHODS The study was conducted in three tertiary hospitals in mainland China. The parents of children (0-19 years old) with cancer were invited to participate in the study. We used standardised self-report questionnaires to collect data. A latent class analysis was performed to identify the classes of resilience in the parents of children with cancer. RESULTS The study recruited 258 participants. Four classes of resilience were identified, namely, good adaptation and optimism (24.9%), high strength and low control (12.1%), moderate resilience (37.3%), and maladaptation and low tenacity (25.6%). The mothers (OR = 3.48, P = 0.003) and parents with more than one child (OR = 2.73, P = 0.023) were more likely to belong to the maladaptation and low tenacity class. The depressive symptoms experienced by the participants differed significantly between the four classes of resilience (F = 30.80, P < 0.001). CONCLUSION Targeted interventions should be developed and implemented based on the characteristics of each class of resilience to maximise the effectiveness of interventions and thereby promote parental well-being.
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Affiliation(s)
- Yuanhui Luo
- Xiangya School of Nursing, Central South University, No. 172, Tong-zi-po Road, Yue Lu District, Changsha, China.
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China.
| | - Anni Wang
- School of Nursing, Fu Dan University, Shanghai, China
| | - Yue Zeng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Jingping Zhang
- Xiangya School of Nursing, Central South University, No. 172, Tong-zi-po Road, Yue Lu District, Changsha, China
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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40
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Brown A, Jones S, Yim J. Health preference research: An overview for medical radiation sciences. J Med Radiat Sci 2022; 69:394-402. [PMID: 35388630 PMCID: PMC9442284 DOI: 10.1002/jmrs.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022] Open
Abstract
Understanding preferences of key stakeholders including patients, clinicians and policymakers can inform clinical practice, workforce and policy. It also allows health services to evaluate existing clinical practices, policies and procedures. This commentary aims to introduce medical radiation professionals to health preference research by describing commonly used preference methodologies, with a particular focus on discrete choice experiments. Relevant examples of health preference research will be highlighted to demonstrate the application of health preference research in medical radiation sciences.
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Affiliation(s)
- Amy Brown
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | - Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Jackie Yim
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Centre for Health Economics Research and Evaluation, Business School, University of Technology Sydney, Sydney, New South Wales, Australia
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Walsh DA, Boeri M, Abraham L, Atkinson J, Bushmakin A, Cappelleri JC, Hauber B, Klein K, Russo L, Viktrup L, Turk D. Exploring patient preference heterogeneity for pharmacological treatments for chronic pain: A latent class analysis. Eur J Pain 2022; 26:648-667. [PMID: 34854164 PMCID: PMC9303786 DOI: 10.1002/ejp.1892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several pharmaceutical treatments for chronic pain caused by osteoarthritis (OA) and chronic low back pain (CLBP) are available or currently under development, each associated with different adverse events (AEs) and efficacy profiles. It is therefore important to understand what trade-offs patients are willing to make when choosing between treatments. METHODS A discrete-choice experiment (DCE) was conducted with 437 adults with chronic pain caused by OA and/or CLBP. Respondents were presented with a series of scenarios and asked to choose between pairs of hypothetical treatments, each defined by six attributes: level of symptom control; risks of heart attack, rapidly progressive osteoarthritis and dependency; frequency and mode of administration and cost. Attributes were based on known profiles of oral nonsteroidal anti-inflammatory drugs, opioids and injected nerve growth factor inhibitors, the last of which were under clinical development at the time of the study. Data were analysed using a latent class (LC) model to explore preference heterogeneity. RESULTS Overall, respondents considered improving symptom control and reducing risk of physical dependency to be the most important attributes. The LC analysis identified four participant classes: an 'efficacy-focused' class (33.7%), a 'cost-averse' class (29.4%), a 'physical-dependence-averse' class (19.6%) and a 'needle-averse' class (17.3%). Subgroup membership was incompletely predicted by participant age and their responses to comprehension questions. CONCLUSIONS Preference heterogeneity across respondents indicates a need for a personalized approach to offering treatment options. Symptom improvement, cost, physical dependence and route of administration might be important to different patients. SIGNIFICANCE Multiple treatment options that differ substantially in terms of efficacy and adverse events are available for the management of chronic pain. With a growing emphasis on a patient-centred care model that incorporates patients' priorities and values into treatment decisions, there is a need to understand how individuals with chronic musculoskeletal pain balance the benefits and risks of treatment and how treatment priorities vary among individuals. This study was designed to identify patient preferences for different characteristics of treatments for the management of chronic pain and to investigate how preferences differ among respondents.
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Affiliation(s)
- David A. Walsh
- Pain Centre Versus Arthritis and NIHR Nottingham BRC, Academic RheumatologyUniversity of NottinghamNottinghamUK
| | - Marco Boeri
- Health Preference AssessmentRTI Health SolutionsBelfastUK
- Queen’s University of BelfastBelfastUK
| | - Lucy Abraham
- Health Economics and Outcomes ResearchPfizer, LtdSurreyUK
| | | | | | | | - Brett Hauber
- Worldwide Medical and SafetyPfizer, IncCollegevillePennsylvaniaUnited States
| | - Kathleen Klein
- Health Preference AssessmentRTI Health SolutionsResearch Triangle ParkNorth CarolinaUSA
| | - Leo Russo
- Worldwide Medical and SafetyPfizer, IncCollegevillePennsylvaniaUnited States
| | - Lars Viktrup
- Eli Lilly Research LaboratoriesEli Lilly and CompanyIndianapolisIndianaUSA
| | - Dennis Turk
- Department of Anesthesiology and Pain ResearchUniversity of WashingtonSeattleWashingtonUSA
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Sypek MP, Howell M, Howard K, Wong G, Duncanson E, Clayton PD, Hughes P, McDonald S. Healthcare professional and community preferences in deceased donor kidney allocation: A best-worst scaling survey. Am J Transplant 2022; 22:886-897. [PMID: 34839582 DOI: 10.1111/ajt.16898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 01/25/2023]
Abstract
Deceased donor kidneys are a scarce community resource; therefore, the principles underpinning organ allocation should reflect societal values. This study aimed to elicit community and healthcare professional preferences for principles guiding the allocation of kidneys from deceased donors and compare how these differed across the populations. A best-worst scaling survey including 29 principles in a balanced incomplete block design was conducted among a representative sample of the general community (n = 1237) and healthcare professionals working in transplantation (n = 206). Sequential best-worst multinomial logistic regression was used to derive scaled preference scores (PS) (range 0-100). Thematic analysis of free text responses was performed. Five of the six most valued principles among members of the community related to equity, including priority for the longest waiting (PS 100), difficult to transplant (PS 94.5) and sickest (PS 93.9), and equitable access for men and women (PS 94.0), whereas the top four principles for healthcare professional focused on maximizing utility (PS 89.9-100). Latent class analysis identified unmeasured class membership among community members. There are discordant views between community members and healthcare professionals. These should be considered in the design, evaluation, and implementation of deceased donor kidney allocation protocols.
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Affiliation(s)
- Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Philip D Clayton
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hughes
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Zimba R, Romo ML, Kulkarni SG, Berry A, You W, Mirzayi C, Westmoreland DA, Parcesepe AM, Waldron L, Rane MS, Kochhar S, Robertson MM, Maroko AR, Grov C, Nash D. Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment. JMIR Public Health Surveill 2021; 7:e32846. [PMID: 34793320 PMCID: PMC8722498 DOI: 10.2196/32846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. OBJECTIVE This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. METHODS We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. RESULTS Of the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider's office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. CONCLUSIONS We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.
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Affiliation(s)
- Rebecca Zimba
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Matthew L Romo
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Sarah G Kulkarni
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Amanda Berry
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - William You
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Chloe Mirzayi
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Drew A Westmoreland
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Levi Waldron
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Madhura S Rane
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Christian Grov
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
| | - Denis Nash
- Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States
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Burns JG, Glenk K, Eory V, Simm G, Wall E. Preferences of European dairy stakeholders in breeding for resilient and efficient cattle: A best-worst scaling approach. J Dairy Sci 2021; 105:1265-1280. [PMID: 34955264 DOI: 10.3168/jds.2021-20316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
Including resilience in the breeding objective of dairy cattle is gaining increasing attention, primarily as anticipated challenges to production systems, such as climate change, may make some perturbations more difficult to moderate at the farm level. Consequently, the underlying biological mechanisms by which resilience is achieved are likely to become an important part of the system itself, increasing value on the animal's ability to be unperturbed by variable production circumstances, or to quickly return to pre-perturbed levels of productivity and health. However, because the value of improving genetic traits to a system is usually based on known profit functions or bioeconomic models linked to current production conditions, it can be difficult to define longer-term value, especially under uncertain future production circumstances and where nonmonetary values may be progressively more important. We present the novel application of a discrete choice experiment, used to investigate potential antagonisms in the values of genetic improvements for 8 traits to dairy cattle system stakeholders in Europe when the production goal was either efficiency or resilience. A latent class model was used to identify heterogeneous preferences within each production goal, and postestimation was used to identify associations between these preferences and sociodemographic characteristics of respondents. Results suggested 3 distinct latent preference classes for each production goal. For the efficiency goal, yield and feed efficiency traits were generally highly valued, whereas for the resilience goal, health and robustness traits were generally highly valued. In both cases, these traits generally carried a low value in the other production scenario. Overall, in both scenarios, longevity was highly valued; however, the value of this trait in terms of resilience will depend on phenotyping across diverse environments to sufficiently capture performance under various anticipated system challenges. Additionally, results showed significant associations between membership of latent preference classes with education level and profession. In conclusion, as resilience becomes increasingly important, it is likely that a continued reliance on the short-term economic value of traits alone will lead decision makers to misrepresent the importance of some traits, including those with substantial contextual values in terms of resilience.
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Affiliation(s)
- J G Burns
- Global Academy of Agriculture and Food Security, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, United Kingdom; Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom.
| | - K Glenk
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
| | - V Eory
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
| | - G Simm
- Global Academy of Agriculture and Food Security, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, United Kingdom
| | - E Wall
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
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Beller J, Schäfers J, Geyer S, Haier J, Epping J. Patterns of Changes in Oncological Care due to COVID-19: Results of a Survey of Oncological Nurses and Physicians from the Region of Hanover, Germany. Healthcare (Basel) 2021; 10:15. [PMID: 35052179 PMCID: PMC8775491 DOI: 10.3390/healthcare10010015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Healthcare staff is confronted with intensive decisional conflicts during the pandemic. Due to the specific burden of this moral distress in oncology, the investigation aimed at quantification of these conflicts and identification of risk factors that determine the extent and severity of these conflicts. We examined the heterogeneity of changes in oncology care due to COVID-19. METHODS We conducted a survey of oncological physicians and nurses in the region of Hanover, Germany in the second half of 2020. Overall, N = 200 respondents, 54% nurses, were included in the sample. Indicators of changes in oncology care were used to determine profiles of changes. To characterize these profiles, a diverse set of variables, including decision conflicts, uncertainty, age, gender, work experience, changes in communication with patients, psychological distress, work stress, process organization, and personnel resources, was obtained. Latent class analysis was conducted to determine these latent profiles. RESULTS We found that three distinct profiles best described the overall changes in oncology care due to COVID-19 in our sample, with each profile being associated with specific characteristics: (1) "Few Changes in Oncology Care" profile with 33% of participants belonging to this profile, (2) "Medium Changes in Oncology Care" profile with 43% of participants, and (3) "Severe Changes in Oncology Care" profile (24%). Participants from these profiles significantly differed regarding their age, work experience, occupational group, the prevalence of decision conflicts, decision uncertainty, quality of communication with patients, and quality of process organization. CONCLUSIONS Distinct profiles of change in oncology care due to COVID-19 can be identified. Most participants reported small to medium changes, while some participants also reported severe changes. Profiles also differed regarding their associated characteristics. As such, specific consequences for better pandemic preparedness can be derived based on the current study. Future studies should investigate the patterns of changes in routine care due to COVID-19.
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Affiliation(s)
- Johannes Beller
- Comprehensive Cancer Center, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.); (J.E.)
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Jürgen Schäfers
- Comprehensive Cancer Center, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.); (J.E.)
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Jörg Haier
- Comprehensive Cancer Center, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.); (J.E.)
| | - Jelena Epping
- Comprehensive Cancer Center, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.); (J.E.)
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
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Morbidity profiles in Europe and Israel: international comparisons from 20 countries using biopsychosocial indicators of health via latent class analysis. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim
I examined health/morbidity profiles across 20 countries, determined their associated demographic characteristics and risk factors and compared the distribution of these health/morbidity profiles across countries.
Subject and methods
I used population-based data drawn from the European Social Survey (N = 20092, 52% female, ages 40+) covering 20 mostly European countries (Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Great Britain, Hungary, Ireland, Israel, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden and Switzerland) from 2014. Diverse indicators of health/morbidity were used, including self-rated health, self-rated disability, self-reported health problems and mental health symptoms using the CES-D. Latent class analysis was conducted to determine health/morbidity profiles across countries.
Results
I found that four distinct health profiles best describe overall health/morbidity status in the international sample, each associated with specific demographic and behavioural risk factors: ‘healthy’ profile (62% of participants), ‘unhappy but healthy’ profile (14%), ‘high morbidity, mostly physical’ profile (16%) and ‘high morbidity, mostly psychological’ profile (8%). With few exceptions, participants from Northern Europe and Western Europe were more likely to belong to the ‘healthy’ and the ‘unhappy but healthy’ profiles, whereas participants from Eastern Europe were more likely to belong to the ‘high morbidity, mostly physical’ profile. Distribution of the ‘high morbidity, mostly psychological’ profile appeared to be more uniform across regions.
Conclusions
Distinct morbidity/health profiles could be identified across countries, and countries varied regarding the relative distribution of these profiles. Specific prevention and treatment consequences associated with each profile are discussed. Future studies should further investigate the patterns of overall health and morbidity in Europe’s populations.
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Sumpton D, Kelly A, Craig JC, Hassett G, Kane B, Oliffe M, Tong A, Howell M. Preferences for biologic treatment in patients with psoriatic arthritis: a discrete choice experiment. Arthritis Care Res (Hoboken) 2021; 74:1234-1243. [PMID: 34514744 DOI: 10.1002/acr.24782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 07/17/2021] [Accepted: 09/07/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic DMARDs to manage psoriatic arthritis. METHODS We conducted a discrete choice experiment in patients with psoriatic arthritis from three rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of five levels and the following seven attributes had a range of three levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences. RESULTS Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference were (β coefficient in absolute values, 95% confidence interval): oral route compared to subcutaneous and intravenous routes (β coefficient 1.00, fixed-parameter), avoiding severe side effects (0.72, 0.50 to 0.95), increasing ability to attend to normal activities (0.66, 0.36 to 0.96), avoiding infections (0.38, 0.23 to 0.53), improvement in enthesitis pain (0.28, 0.20 to 0.36), improvement in psoriasis (0.28, CI 0.20 to 0.36), increasing chance of remission (0.27, 0.19 to 0.36) and improvement in joint pain (0.26, 0.00 to 0.52). CONCLUSION When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities and avoiding infection over clinical measures of efficacy.
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Affiliation(s)
- Daniel Sumpton
- Sydney School of Public Health, University of Sydney, Sydney, 2006.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, 2145.,Department of Rheumatology, Concord Repatriation and General Hospital, Concord, 2170
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, 2145.,Department of Rheumatology, Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, 2170.,Western Sydney Clinical School, University of New South Wales Medicine, Sydney, 2052
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, 5042
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, 2170.,Western Sydney Clinical School, University of New South Wales Medicine, Sydney, 2052.,School of Medicine, Western Sydney University, Campbelltown, 2560
| | - Barry Kane
- Department of Rheumatology, Concord Repatriation and General Hospital, Concord, 2170
| | - Michael Oliffe
- Department of Rheumatology, Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, 2170.,School of Medicine, Western Sydney University, Campbelltown, 2560
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, 2006.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, 2145
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, 2006.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, 2145
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Mühlbacher AC, Sadler A, Lamprecht B, Juhnke C. Patient preferences in the treatment of hemophilia A: A latent class analysis. PLoS One 2021; 16:e0256521. [PMID: 34424920 PMCID: PMC8382185 DOI: 10.1371/journal.pone.0256521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine subgroup-specific treatment preferences and characteristics of patients with hemophilia A. METHODS Best-Worst Scaling (BWS) Case 3 (four attributes: application type; bleeding frequencies/year; inhibitor development risk; thromboembolic events of hemophilia A treatment risk) conducted via online survey. Respondents chose the best and the worst option of three treatment alternatives. Data were analyzed via latent class model (LCM), allowing capture of heterogeneity in the sample. Respondents were grouped into a predefined number of classes with distinct preferences. RESULTS The final dataset contained 57 respondents. LCM analysis segmented the sample into two classes with heterogeneous preferences. Preferences within each were homogeneous. For class 1, the most decisive factor was bleeding frequency/year. Respondents seemed to focus mainly on this in their choice decisions. With some distance, inhibitor development was the second most important. The remaining attributes were of far less importance for respondents in this class. Respondents in class 2 based their choice decisions primarily on inhibitor development, also followed, by some distance, the second most important attribute bleeding frequency/year. There was statistical significance (P < 0.05) between the number of annual bleedings and the probability of class membership. CONCLUSIONS The LCM analysis addresses heterogeneity in respondents' choice decisions, which helps to tailor treatment alternatives to individual needs. Study results support clinical and allocative decision-making and improve the quality of interpretation of clinical data.
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Affiliation(s)
- Axel C. Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
- Gesellschaft für empirische Beratung GmbH, Freiburg, Germany
- Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Andrew Sadler
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | | | - Christin Juhnke
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
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Johnson FR, Gonzalez JM, Yang JC, Ozdemir S, Kymes S. Who Would Pay Higher Taxes for Better Mental Health? Results of a Large-Sample National Choice Experiment. Milbank Q 2021; 99:771-793. [PMID: 34375477 PMCID: PMC8452366 DOI: 10.1111/1468-0009.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points Public funding for mental health programs must compete with other funding priorities in limited state budgets. Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits. Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size. In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.
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Angell B, Khan M, Islam R, Mandeville K, Naher N, Hutchinson E, McKee M, Ahmed SM, Balabanova D. Incentivising doctor attendance in rural Bangladesh: a latent class analysis of a discrete choice experiment. BMJ Glob Health 2021; 6:bmjgh-2021-006001. [PMID: 34326070 PMCID: PMC8323362 DOI: 10.1136/bmjgh-2021-006001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at their posts. Methods We conducted a discrete choice experiment with 308 doctors across four hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included based on a literature review, qualitative research and a consensus-building workshop with policymakers and key health-system stakeholders: relationship with the community, security measures, attendance-based policies and incentive payments. Respondents’ choices were analysed with mixed multinomial logistic and latent class models and were used to simulate the likely uptake of jobs under different policy packages. Results All attributes significantly impacted doctor choices (p<0.01). Doctors strongly preferred jobs at rural facilities where there was a supportive relationship with the community (β=0.93), considered good attendance in education and training (0.77) or promotion decisions (0.67), with functional security (0.67) and higher incentive payments (0.5 per 10% increase of base salary). Jobs with disciplinary action for poor attendance were disliked by respondents (−0.63). Latent class analysis identified three groups of doctors who differed in their uptake of jobs. Scenario modelling identified intervention packages that differentially impacted doctor behaviour and combinations that could feasibly improve doctors’ attendance. Conclusion Bangladeshi doctors have strong but varied preferences over interventions to overcome absenteeism. We generated evidence suggesting that interventions considering the perspective of the doctors themselves could result in substantial reductions in absenteeism. Designing policy packages that take account of the different situations facing doctors could begin to improve their ability and motivation to be present at their job and generate sustainable solutions to absenteeism in rural Bangladesh.
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Affiliation(s)
- Blake Angell
- Health Systems Science, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia .,Institute for Global Health, University College London, London, UK
| | - Mushtaq Khan
- Economics and Head of Anti-Corruption Evidence Research Partnership Consortium (ACE), SOAS, London, UK
| | - Raihanul Islam
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kate Mandeville
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nahitun Naher
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eleanor Hutchinson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Dina Balabanova
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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