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Wang L, Guo M, Wang Y, Chen R, Wei X. The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China. Front Immunol 2024; 15:1444393. [PMID: 39161763 PMCID: PMC11330759 DOI: 10.3389/fimmu.2024.1444393] [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: 06/05/2024] [Accepted: 07/17/2024] [Indexed: 08/21/2024] Open
Abstract
Objectives The present study aimed to assess influenza vaccine hesitancy and vaccine literacy levels among youth and adults in China, as well as the association between them. Methods An online cross-sectional survey was conducted in Mainland China. Participants' total vaccine literacy and three sub-dimension vaccine literacy (knowledge literacy, competence literacy, and decision-making literacy) were assessed by a validated vaccine literacy scale. Having received influenza vaccination in the past three years or intending to accept it in next influenza season indicates less influenza vaccine hesitancy. Results Among 997 participants, a sub-optimal vaccine literacy was observed, with a mean score of 66.83 ± 10.27. Regression models 1-4 revealed that participants with middle (aOR: 1.431, P=0.039, 95% CI: 1.018~2.010) or high (aOR: 1.651, P=0.006, 95% CI: 1.157~2.354) total vaccine literacy, as well as those with high competence literacy (aOR: 1.533, P=0.017, 95% CI: 1.079~2.180), or high decision-making literacy (aOR: 1.822, P=0.001, 95% CI: 1.261~2.632) were more likely to have been vaccinated against influenza at least once in past three years. However, those with a high knowledge literacy were associated with a lower influenza vaccine rate (aOR: 0.676, P=0.046, 95% CI: 0.460~0.994). Regression models 5-8 revealed that participants with middle (aOR: 1.661, P=0.008, 95% CI: 1.142~2.414) or high total vaccine literacy (aOR: 2.645, P=0.000, 95% CI: 1.774~3.942), as well as those with middle (aOR: 1.703, P=0.005, 95% CI: 1.177~2.464) or high competence literacy (aOR: 2.346, P=0.000, 95% CI: 1.159~3.461), or high decision-making literacy (aOR: 2.294, P=0.000, 95% CI: 1.531~3.436) were more likely to express the willingness to receive the influenza vaccine in the next influenza season. Conclusion The participants' influenza vaccine hesitancy was negatively associated with their total vaccine literacy levels and two of the three sub-dimensions: competence literacy and decision-making literacy. Knowledge literacy suggested a positive or no relationship with influenza vaccine hesitancy.
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Affiliation(s)
- Li Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mengjie Guo
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Yan Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Ren Chen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Postema A, Ferreira JA, van der Klis F, de Melker H, Mollema L. Investigating sources of non-response bias in a population-based seroprevalence study of vaccine-preventable diseases in the Netherlands. BMC Infect Dis 2024; 24:249. [PMID: 38395775 PMCID: PMC10885624 DOI: 10.1186/s12879-024-09095-5] [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: 10/13/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND PIENTER 3 (P3), conducted in 2016/17, is the most recent of three nationwide serological surveys in the Netherlands. The surveys aim to monitor the effects of the National Immunisation Programme (NIP) by assessing population seroprevalence of included vaccine preventable diseases (VPDs). The response rate to the main sample was 15.7% (n = 4,983), following a decreasing trend in response compared to the previous two PIENTER studies (P1, 55.0%; 1995/1996 [n = 8,356] and P2, 33.0%; 2006/2007 [n = 5,834]). Non-responders to the main P3 survey were followed-up to complete a "non-response" questionnaire, an abridged 9-question version of the main survey covering demographics, health, and vaccination status. We assess P3 representativeness and potential sources of non-response bias, and trends in decreasing participation rates across all PIENTER studies. METHODS P3 invitees were classified into survey response types: Full Participants (FP), Questionnaire Only (QO), Non-Response Questionnaire (NRQ) and Absolute Non-Responders (ANR). FP demographic and health indicator data were compared with Dutch national statistics, and then the response types were compared to each other. Random forest algorithms were used to predict response type. Finally, FPs from all three PIENTERs were compared to investigate the profile of survey participants through time. RESULTS P3 FPs were in general healthier, younger and higher educated than the Dutch population. Random forest was not able to differentiate between FPs and ANRs, but when predicting FPs from NRQs we found evidence of healthy-responder bias. Participants of the three PIENTERs were found to be similar and are therefore comparable through time, but in line with national trends we found P3 participants were less inclined to vaccinate than previous cohorts. DISCUSSION The PIENTER biobank is a powerful tool to monitor population-level protection against VPDs across 30 years in The Netherlands. However, future PIENTER studies should continue to focus on improving recruitment from under-represented groups, potentially by considering alternative and mixed survey modes to improve both overall and subgroup-specific response. Whilst non-responder bias is unlikely to affect seroprevalence estimates of high-coverage vaccines, the primary aim of the PIENTER biobank, other studies with varied vaccination/disease exposures should consider the influence of bias carefully.
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Affiliation(s)
- Abigail Postema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - José A Ferreira
- Public Health and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Liesbeth Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Marshall DA, Veldwijk J, Janssen EM, Reed SD. Stated-Preference Survey Design and Testing in Health Applications. THE PATIENT 2024:10.1007/s40271-023-00671-6. [PMID: 38294720 DOI: 10.1007/s40271-023-00671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Following the conceptualization of a well-formulated and relevant research question, selection of an appropriate stated-preference method, and related methodological issues, researchers are tasked with developing a survey instrument. A major goal of designing a stated-preference survey for health applications is to elicit high-quality data that reflect thoughtful responses from well-informed respondents. Achieving this goal requires researchers to design engaging surveys that maximize response rates, minimize hypothetical bias, and collect all the necessary information needed to answer the research question. Designing such a survey requires researchers to make numerous interrelated decisions that build upon the decision context, selection of attributes, and experimental design. Such decisions include considering the setting(s) and study population in which the survey will be administered, the format and mode of administration, and types of contextual information to collect. Development of a survey is an interactive process in which feedback from respondents should be collected and documented through qualitative pre-test interviews and pilot testing. This paper describes important issues to consider across all major steps required to design and test a stated-choice survey to elicit patient preferences for health preference research.
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Affiliation(s)
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Shelby D Reed
- Preference Evaluation Research Group, Duke Clinical Research Institute and Department of Population Health Sciences, Duke University, Durham, NC, USA
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Ma W, Zhang L, Ren D, Meng X, Yin J, Sun Q. Parental preferences for rotavirus vaccination for their children under 5 years old in China: A discrete choice experiment. Hum Vaccin Immunother 2023; 19:2179222. [PMID: 36794417 PMCID: PMC10026903 DOI: 10.1080/21645515.2023.2179222] [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] [Indexed: 02/17/2023] Open
Abstract
Rotavirus vaccination is the most effective means to prevent rotavirus gastroenteritis, but its coverage in China is not ideal. We aimed to explore parental preferences for rotavirus vaccination for their children under 5years old to improve vaccination coverage. A Discrete Choice Experiment was conducted online on 415 parents with at least one child under 5years old in 3 cities. Five attributes including vaccine effectiveness, protection duration, risk of mild side-effects, out-of-pocket costs, and time required for vaccination were identified. Each attribute was set at three levels. Mixed-logit models were used to measure parental preferences and the relative importance of vaccine attributes. The optimal vaccination strategy was also explored. 359 samples were included in the analysis. The impacts of the vaccine attribute levels on vaccine choice were all statistically significant (p < .01), except for 1-hour vaccination time. The risk of mild side-effects was the most important factor influencing vaccination. The time required for vaccination was the least important attribute. The largest increase in vaccination uptake (74.45%) occurred with decreased the vaccine risk of mild side-effects from 1/10 to 1/50. The predicted vaccination uptake of the optimal vaccination scenario was 91.79%. When deciding about vaccination, parents preferred the rotavirus vaccination with lower risk of mild side-effects, higher effectiveness, longer protection duration, 2-hour vaccination time and lower cost. The authorities should support enterprises to develop vaccines with lower side-effects, higher effectiveness and longer protection duration in the future. We call for appropriate government subsidies for the rotavirus vaccine.
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Affiliation(s)
- Wenwen Ma
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Liujin Zhang
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Deyu Ren
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaoqing Meng
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jia Yin
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Fenta ET, Tiruneh MG, Delie AM, Kidie AA, Ayal BG, Limenh LW, Astatkie BG, Workie NK, yigzaw ZA, Bogale EK, Anagaw TF. Health literacy and COVID-19 vaccine acceptance worldwide: A systematic review. SAGE Open Med 2023; 11:20503121231197869. [PMID: 37823070 PMCID: PMC10563502 DOI: 10.1177/20503121231197869] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/11/2023] [Indexed: 10/13/2023] Open
Abstract
Objective Health literacy helps an individual to have the capacity to obtain, process, and understand basic health information to make appropriate health decisions. This study aimed to review the association between health literacy and COVID-19 vaccine acceptance. Method This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses steps. Databases including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, World Health Organization libraries, and Google Scholar were used to search all published articles in the area of health literacy and COVID-19 vaccine acceptance until August 1, 2022. Result In this review, 1348 articles were retrieved. Finally, 13 articles were included in the review after the removal of duplicates that did not meet our inclusion criteria. In all, 10 articles showed that health literacy was significantly associated with COVID-19 vaccine acceptance. This review also showed that positive perception of the vaccine, vaccine hesitancy, adverse reaction from vaccines, residence, socioeconomic status, level of education, younger age, being a health worker, and positive belief have associations with health literacy and COVID-19 vaccine acceptance. There was significant heterogeneity in the study population and measurement tools used for health literacy and COVID-19 vaccine acceptance. Conclusion This systematic review provides comprehensive evidence on health literacy and COVID-19 vaccine acceptance globally. There was significant heterogeneity in the study population and measurement tools used for health literacy and COVID-19 vaccine acceptance. Most studies reported that health literacy is significantly associated with COVID-19 vaccine acceptance. Therefore, investing in health literacy using different vaccine promotion strategies may improve COVID-19 vaccine acceptance and health decision-making to decrease the impact of the COVID-19 pandemic.
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Affiliation(s)
- Eneyew Talie Fenta
- Department of Public Health, College Medicine Health Science, Injibara University, Injibara, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Public Health, College Medicine Health Science, Woldia University, Woldia, Ethiopia
| | - Amare Mebrate Delie
- Department of Public Health, College Medicine Health Science, Injibara University, Injibara, Ethiopia
| | - Atitegeb Abera Kidie
- Department of Public Health, College Medicine Health Science, Woldia University, Woldia, Ethiopia
| | - Birtukan Gizachew Ayal
- Department of Public Health, College Medicine Health Science, Woldia University, Woldia, Ethiopia
| | - Liknaw Workie Limenh
- Department of Public Health, Gamby Medical and Business College, Bahir Dar, Ethiopia
- Department of Pharmaceutics, University of Gondar, Gondar, Ethiopia
| | | | - Nigus Kassie Workie
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zeamanuel Anteneh yigzaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Nazari A, Hoseinnia M, Pirzadeh A, Salahshouri A. The Correlation Among COVID-19 Vaccine Acceptance, the Ability to Detect Fake News, and e-Health Literacy. Health Lit Res Pract 2023; 7:e130-e138. [PMID: 37463291 PMCID: PMC10351963 DOI: 10.3928/24748307-20230621-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has seen a rise in the spread of misleading and deceptive information, leading to a negative impact on the acceptance of the COVID-19 vaccine and public opinion. To address this issue, the importance of public e-Health literacy cannot be overstated. It empowers individuals to effectively utilize information technology and combat the dissemination of inaccurate narratives. OBJECTIVE This study aimed to investigate the relationship between the ability to identify disingenuous news, electronic health literacy, and the inclination to receive the COVID-19 immunization. METHODS In this descriptive-analytical cross-sectional study conducted during summer 2021 in Isfahan, Iran, 522 individuals older than age 18 years, seeking medical attention at health centers, were surveyed. The participants were selected through a meticulous multistage cluster sampling process from the pool of individuals referred to these health centers. Along with demographic information, data collection instruments included the standard e-Health literacy questionnaire and a researcher-developed questionnaire designed to identify misinformation. The collected questionnaires were entered into SPSS 24 for statistical analysis, which included the Kruskal-Wallis test, the Chi-square test, the Spearman test, and logistic regression models. KEY RESULTS The study findings revealed a statistically significant relationship between acceptance of the COVID-19 vaccine and the ability to identify deceptive news. An increase of one unit in the score for recognizing misinformation led to a 24% and 32% reduction in vaccine hesitancy and the intention to remain unvaccinated, respectively. Furthermore, a significant correlation was found between the intention to receive the vaccine and e-Health literacy, where an increase of one unit in e-Health literacy score corresponded to a 6% decrease in the intention to remain unvaccinated. Additionally, the study found a notable association between the ability to detect false and misleading information and e-Health literacy. Each additional point in e-Health literacy was associated with a 0.33% increase in the capacity to identify fake news (Spearman's Rho = 0.333, p < .001). CONCLUSION The study outcomes demonstrate a positive correlation between the COVID-19 vaccine acceptance, the ability to identify counterfeit news, and proficiency in electronic health literacy. These findings provide a strong foundation for policymakers and health care practitioners to develop and implement strategies that counter the dissemination of spurious and deceitful information related to COVID-19 and COVID-19 immunization. [HLRP: Health Literacy Research and Practice. 2023;7(3):e130-e138.].
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Hurstak EE, Paasche-Orlow MK, Hahn EA, Henault LE, Taddeo MA, Moreno PI, Weaver C, Marquez M, Serrano E, Thomas J, Griffith JW. The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago. Vaccine 2023; 41:2562-2571. [PMID: 36907736 PMCID: PMC9977617 DOI: 10.1016/j.vaccine.2023.02.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. METHODS Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). RESULTS Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree). CONCLUSIONS Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity. CLINICAL TRIALS NUMBER NCT03584490.
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Affiliation(s)
- Emily E Hurstak
- Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | | | - Elizabeth A Hahn
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Lori E Henault
- Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Michelle A Taddeo
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA.
| | - Claire Weaver
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Melissa Marquez
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Eloisa Serrano
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Jessica Thomas
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - James W Griffith
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
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Tervonen T, Veldwijk J, Payne K, Ng X, Levitan B, Lackey LG, Marsh K, Thokala P, Pignatti F, Donnelly A, Ho M. Quantitative Benefit-Risk Assessment in Medical Product Decision Making: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:449-460. [PMID: 37005055 DOI: 10.1016/j.jval.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 05/06/2023]
Abstract
Benefit-risk assessment is commonly conducted by drug and medical device developers and regulators, to evaluate and communicate issues around benefit-risk balance of medical products. Quantitative benefit-risk assessment (qBRA) is a set of techniques that incorporate explicit outcome weighting within a formal analysis to evaluate the benefit-risk balance. This report describes emerging good practices for the 5 main steps of developing qBRAs based on the multicriteria decision analysis process. First, research question formulation needs to identify the needs of decision makers and requirements for preference data and specify the role of external experts. Second, the formal analysis model should be developed by selecting benefit and safety endpoints while eliminating double counting and considering attribute value dependence. Third, preference elicitation method needs to be chosen, attributes framed appropriately within the elicitation instrument, and quality of the data should be evaluated. Fourth, analysis may need to normalize the preference weights, base-case and sensitivity analyses should be conducted, and the effect of preference heterogeneity analyzed. Finally, results should be communicated efficiently to decision makers and other stakeholders. In addition to detailed recommendations, we provide a checklist for reporting qBRAs developed through a Delphi process conducted with 34 experts.
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Affiliation(s)
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands
| | - Katherine Payne
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Leila G Lackey
- Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | - Anne Donnelly
- Patient Council of the Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
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Shon EJ, Lee L. Effects of Vaccine Literacy, Health Beliefs, and Flu Vaccination on Perceived Physical Health Status among Under/Graduate Students. Vaccines (Basel) 2023; 11:vaccines11040765. [PMID: 37112677 PMCID: PMC10141033 DOI: 10.3390/vaccines11040765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Physicians highlight that receiving the flu vaccine is critical, especially during the COVID-19 pandemic period. Younger groups' flu vaccination coverage is very low, and this tendency is potentially related to a lower level of vaccine literacy and perceptions toward vaccination. This study investigated the relationship between flu vaccine literacy, health beliefs, and flu vaccinations (benefit, barrier, severity, and susceptibility) and their impact on perceived health status controlling for socioeconomic factors. It used the Health Belief Model andHealth Literacy Skills Framework with under/graduate students (N = 382) in Ohio, U.S. Path analyses were performed to examine the causal process using SPSS and Amos 23.0. Indicators of CFI, RMSEA, SRMR, and the chi-square/df of the path models were good-acceptable. Vaccine literacy directly impacted on health beliefs and vaccination. Susceptibility belief directly influenced perceived health status. The mediation effects of health beliefs (benefit, barrier) between vaccine literacy and vaccination were confirmed. The study highlights the need for healthcare providers and governments to work together to improve flu vaccine literacy and reduce negative perceptions toward vaccination among younger populations. Educational programs and official communication channels can be used to address concerns and provide accurate information about vaccines to increase flu vaccination rates and protect public health.
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Affiliation(s)
- En-Jung Shon
- Department of Social Welfare, Duksung Women's University, Seoul 01369, Republic of Korea
| | - Lena Lee
- Department of Teaching, Curriculum, and Educational Inquiry, Miami University, Oxford, OH 45056, USA
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10
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Cameron LD, Lawler S, Robbins-Hill A, Toor I, Brown PM. Political views, health literacy, and COVID-19 beliefs and behaviors: A moderated mediation model. Soc Sci Med 2023; 320:115672. [PMID: 36764089 PMCID: PMC9884608 DOI: 10.1016/j.socscimed.2023.115672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
RATIONALE Mitigating the spread of COVID-19 requires that people understand the need for and engage in protective behaviors. Given the complexity and rapid progression of media information about the pandemic, health literacy could be essential to acquiring the accurate beliefs, concern for societal risks, and appreciation of restrictive policies needed to motivate these behaviors. Yet with the increasingly politicized nature of COVID-related issues in the United States, health literacy could be an asset for those with more liberal views but less so for those with more conservative views. OBJECTIVE This study tested a hypothesized model proposing that political views moderate the associations of health literacy with COVID-19 protective behaviors as well as the mediational roles of accurate and inaccurate COVID-19 beliefs, concern for society, and governmental control attitudes. METHODS We surveyed residents in three diverse regions of California in June 2020 (N = 669) and February 2021 (N = 611). Participants completed measures of health literacy, political views, and COVID-19 beliefs and behaviors. RESULTS Moderated mediational analyses largely supported the proposed model with both samples. Health literacy was associated with more accurate COVID-19 beliefs, less inaccurate COVID-19 beliefs, greater concern for societal risks, more positive attitudes regarding restrictive government control, more protective behavior, less risky behavior, and stronger vaccine intentions; beliefs, concern for society, and governmental control attitudes mediated the health literacy-behavior relationships. As predicted, however, these associations of health literacy with adaptive beliefs, attitudes, and behaviors varied according to political views. The direct and mediated relationships were held for participants with more liberal views and, to a lesser extent, for those with moderate views, but they were weaker or absent for participants with more conservative views. CONCLUSIONS These findings contribute new evidence of processes linking health literacy with adaptive beliefs, attitudes, and behaviors and how social and political contexts can shape those processes.
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Affiliation(s)
- Linda D Cameron
- Department of Psychological Sciences, University of California, Merced, USA.
| | - Sheleigh Lawler
- School of Public Health, The University of Queensland, Australia
| | | | - Imrinder Toor
- Department of Public Health, University of California, Merced, USA
| | - Paul M Brown
- Department of Public Health, University of California, Merced, USA
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Ustuner Top F, Çevik C, Bora Güneş N. The relation between digital literacy, cyberchondria, and parents' attitudes to childhood vaccines. J Pediatr Nurs 2023; 70:12-19. [PMID: 36753874 DOI: 10.1016/j.pedn.2023.01.006] [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] [Received: 10/05/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to examine the relationship between digital literacy, cyberchondria and parents' hesitancy about childhood vaccines. DESIGN AND METHODS The study was cross-sectional, and parents with children aged 3-5 years who had access to the questionnaire were sent online and volunteered to participate. RESULTS The total mean score of the Parents' Attitude to Childhood Vaccines Scale was 44.89 ± 14.99, 31.3% of the parents were hesitant about childhood vaccines. Parental hesitancy about childhood vaccinations was 3.26 times (95% CI, 1.56-6.81) for single participants and 2.77 times (95% CI, 1.33-5.74) for the participants with a high school diploma than primary school graduates, 4.69 times for the participants who did not have a healthcare professional in their family (95% CI, 2.08-10.59), 16.02 times (95% CI, 6.61-10.80) for the participants who did not have a full round of vaccines, 1.81 times higher (95% CI, 1.13-2.88) than the participants who did not have enough information about vaccines. Hesitancy increased as the cyberchondria severity score increased (95% CI, 1.02-1.09), and digital literacy decreased (95% CI, 0.34-0.87). CONCLUSIONS One-third of the parents had hesitations about childhood vaccines. Vaccine hesitancy is affected negatively by digital literacy and positively by cyberchondria. PRACTICE IMPLICATION Meeting parents' accurate and reliable vaccine information will positively affect their attitudes and behaviours. Therefore, the level of cyberchondria among parents should be reduced, and their digital literacy should be increased.
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Affiliation(s)
- Fadime Ustuner Top
- Faculty of Health Sciences, Department of Child Health and Disease Nursing, Giresun University, Giresun, Turkey.
| | - Celalettin Çevik
- Faculty of Health Sciences, Department of Public Health Nursing, Balıkesir University, Balıkesir, Turkey.
| | - Nebahat Bora Güneş
- Department of Pediatric Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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12
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Huls SPI, Veldwijk J, Swait JD, Viberg Johansson J, Ancillotti M, de Bekker-Grob EW. Preference Variation: Where Does Health Risk Attitude Come Into the Equation? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2044-2052. [PMID: 35750590 DOI: 10.1016/j.jval.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/24/2022] [Accepted: 05/02/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Decisions about health often involve risk, and different decision makers interpret and value risk information differently. Furthermore, an individual's attitude toward health-specific risks can contribute to variation in health preferences and behavior. This study aimed to determine whether and how health-risk attitude and heterogeneity of health preferences are related. METHODS To study the association between health-risk attitude and preference heterogeneity, we selected 3 discrete choice experiment case studies in the health domain that included risk attributes and accounted for preference heterogeneity. Health-risk attitude was measured using the 13-item Health-Risk Attitude Scale (HRAS-13). We analyzed 2 types of heterogeneity via panel latent class analyses, namely, how health-risk attitude relates to (1) stochastic class allocation and (2) systematic preference heterogeneity. RESULTS Our study did not find evidence that health-risk attitude as measured by the HRAS-13 distinguishes people between classes. Nevertheless, we did find evidence that the HRAS-13 can distinguish people's preferences for risk attributes within classes. This phenomenon was more pronounced in the patient samples than in the general population sample. Moreover, we found that numeracy and health literacy did distinguish people between classes. CONCLUSIONS Modeling health-risk attitude as an individual characteristic underlying preference heterogeneity has the potential to improve model fit and model interpretations. Nevertheless, the results of this study highlight the need for further research into the association between health-risk attitude and preference heterogeneity beyond class membership, a different measure of health-risk attitude, and the communication of risks.
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Affiliation(s)
- Samare P I Huls
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jorien Veldwijk
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Joffre D Swait
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jennifer Viberg Johansson
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of New Technologies and the Human Future, The Institute for Future Studies, Stockholm, Sweden
| | - Mirko Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Esther W de Bekker-Grob
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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13
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Manolescu LSC, Zugravu C, Zaharia CN, Dumitrescu AI, Prasacu I, Radu MC, Letiția GD, Nita I, Cristache CM, Gales LN. Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination. Vaccines (Basel) 2022; 10:vaccines10101722. [PMID: 36298587 PMCID: PMC9611461 DOI: 10.3390/vaccines10101722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Many countries had initial success with HPV vaccination campaigns worldwide. The HPV vaccine coverage during the COVID-19 pandemic dropped consistently. The aim of our research is to assess the barriers and facilitators of the current Romanian HPV vaccination campaign. METHODS An analytical cross-sectional observational survey was conducted in the Romanian general population; a self-administered questionnaire was used. RESULTS 1122 responders were interviewed; 666 (59.36%) were parents, and 67 (5.97%) HPV vaccinated themselves. A multinominal logistic regression carried out in the parents' category showed that women with university studies and informed from medical sources have greater chances to HPV vaccinate. Reticence regarding vaccination comes from the high cost of the vaccine and a lack of information. Only 118 (10.51%) vaccinated against HPV. From the logistic regression analysis, gender (ORa 0.461 = 95% CI: (0.196; 1.083)), geographic area of residence (ORa = 0.517; 95% CI: (0.331; 0.807)), and the inclusion of the HPV vaccine in the National Vaccination Program (ORa = 2.4; 95% CI: (1.361; 4.235)) were the factors found most associated with HPV vaccination. CONCLUSIONS In the general population, the inclusion of HPV vaccination in the National Vaccination Program would be the most important facilitator of HPV vaccination in Romania. In parents that did not vaccinate their children, one important barrier to HPV vaccination was the high cost of the HPV vaccine and the lack of proper information. The acceptability of HPV vaccination in Romania is low; therefore, public health educational programs are needed.
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Affiliation(s)
- Loredana Sabina Cornelia Manolescu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Virology, Institute of Virology “Stefan S. Nicolau”, 030304 Bucharest, Romania
- Correspondence: ; Tel.: +40-723-699-253
| | - Corina Zugravu
- Department of Fundamental Sciences, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy, Carol Davila, 37 Dionisie Lupu St., 020021 Bucharest, Romania
- National Center for Monitoring the Community Risks, Institute of Public Health, 1-3 Doctor Leonte Anastasievici St., 050463 Bucharest, Romania
| | | | - Anca Irina Dumitrescu
- Department of Fundamental Sciences, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Prasacu
- Department of Fundamental Sciences, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihaela Corina Radu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Birth, Obstetrics and Gynecology Hospital, 100409 Ploiesti, Romania
| | | | - Irina Nita
- Medical Oncology Department, Monza Oncology Hospital, 011461 Bucharest, Romania
| | - Corina Marilena Cristache
- Department of Dental Techniques, Faculty of Midwifery and Nursing (FMAM), “Carol Davila” University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Department of Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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14
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Veldwijk J, Swait JD. The Role of Attribute Screening and Choice Set Formation in Health Discrete Choice Experiments: Modeling the Impact of Benefit and Risk Attributes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1416-1427. [PMID: 35599111 DOI: 10.1016/j.jval.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study aimed to demonstrate the econometric modeling of benefit/risk-based choice set formation (CSF) within health-related discrete choice experiments. METHODS In 4 different case studies, first, a trade-off model was fitted; building on this, a screening model was fitted; and finally, a full CSF model was estimated. This final model allows for attributes to be used first to screen out alternatives from choice tasks before respondents' trade-off attributes and make a choice among feasible alternatives. Educational level and health literacy of respondents were accounted for in all models. RESULTS Model fit in terms of log likelihood, pseudo-R2, Akaike information criterion, and Bayesian information criterion improved from using only trade-off or screening models compared with CSF models in 3 of the 4 case studies. In those studies, significant screening behavior was identified that (1) affected trade-off inferences, (2) rejects the pure trade-off model, and (3) supports the existence of screening on the basis of benefit-risk profiles, and other attributes. Educational level and health literacy showed significant interactions with multiple attributes in all case studies. CONCLUSIONS Choice modelers should pay close attention to noncompensatory respondent behavior when they include benefit or risk attributes in their discrete choice experiment. Further studies should investigate why and when respondents undertake screening behavior. Screening behavior in choice data analysis is always a possibility, so researchers should explore extensions of econometric models to reflect noncompensatory behavior. Assuming that benefit and risk attributes will only affect trade-off behavior is likely to lead to biased conclusions about benefit or risk-based behavior.
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Affiliation(s)
- Jorien Veldwijk
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Joffre D Swait
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
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15
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Montagni I, Ouazzani-Touhami K, Pouymayou A, Pereira E, Texier N, Schück S, Tzourio C. Who is hesitant about Covid-19 vaccines? The profiling of participants in a French online cohort. Rev Epidemiol Sante Publique 2022; 70:123-131. [PMID: 35428543 PMCID: PMC8958178 DOI: 10.1016/j.respe.2022.02.004] [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: 06/16/2021] [Revised: 01/21/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To report the characteristics of vaccine-hesitant individuals in a French-speaking adult population in the context of the SARS-CoV-2 pandemic; and to identify predictors of hesitancy about Covid-19-related vaccines. METHODS Between April and May 2020, 1640 French-speaking adults participating in an online cohort were classified according to their attitudes towards vaccination as: "hesitant", "anti-vaccination", and "pro-vaccination". Descriptive statistics, univariate multinomial regression models and multivariate analyses were compiled and carried out. RESULTS At the time of inclusion, compared to pro-vaccination participants, hesitant participants were more frequently females (p=0.044), not annually vaccinated against flu (p=0.026), less optimistic about the discovery of a treatment against Covid-19 in a few months (p<0.001), less ready to undergo this treatment (p<0.001), presenting less trust in the ability of public health authorities to control the pandemic (p=0.036) and reporting lower scores on knowledge-related scales (p values from <0.001 to 0.002). Univariate analyses confirmed these results with odds ratios ranging from 1.51 [1.05-2.17] to 2.19 [1.56-3.07]. In the multivariate models, the remaining variables associated with hesitant compared to pro-vaccination attitudes were discovery of a treatment against Covid-19 in a few months (OR=2.57 [1.73-3.81]), being ready to undergo this treatment (OR=7.07 [4.89-10.22]), digital vaccine literacy (OR=1.70 [1.14-2.54]) and general health literacy (OR=1.49 [1.03-2.15]). DISCUSSION In a continuum of relative acceptance of Covid-19-related vaccines, hesitant individuals were situated in between the behaviours and characteristics of pro-vaccination and anti-vaccination groups. While their characteristics were in line with the literature, this study was the first to report data on health literacy, digital vaccine literacy and capacity to detect fake news associated with vaccine hesitancy. CONCLUSIONS While failing to identify straightforward predictors, findings suggest that continued education and communication campaigns focused on improving vaccine literacy, particularly among women younger than 35 years, could heighten the proportion of persons accepting vaccination.
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Affiliation(s)
- Ilaria Montagni
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France,Corresponding author : Ilaria Montagni, PhD, 146 rue Léo Saignat, 33000 Bordeaux, France, +33 (0)6 42 19 33 63
| | - Kevin Ouazzani-Touhami
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France,Polyclinique Inkermann, groupe Elsan, 79000 Niort, France
| | - Aude Pouymayou
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
| | - Edwige Pereira
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
| | - Nathalie Texier
- Kap Code, F-75010 Paris, France,Kappa Santé, F-75002 Paris, France
| | - Stéphane Schück
- Kap Code, F-75010 Paris, France,Kappa Santé, F-75002 Paris, France
| | - Christophe Tzourio
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
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16
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van Zoonen K, Ruijs WLM, De Melker HE, Bongers MEJ, Mollema L. How to increase awareness of additional vaccinations; the case of maternal pertussis vaccination. BMC Public Health 2021; 21:1257. [PMID: 34187436 PMCID: PMC8244209 DOI: 10.1186/s12889-021-11344-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective and safe vaccines are available outside national immunization programs (NIP). Increased awareness and vaccine uptake can improve public health. Before the inclusion of maternal pertussis vaccination (MPV) in the Dutch NIP in December 2019, extra communication efforts were undertaken. Here we examine the success of these efforts, investigating women's awareness of and their decision-making process regarding MPV. METHODS Between December 2018 and January 2019, one year before the introduction of MPV in the NIP, and about three years after MPV was recommended by the Dutch Health Council, pregnant and non-pregnant women (i.e. child younger than two years) were invited to fill out an online questionnaire. Participant's decision-making processes regarding MPV were assessed with an adapted Precaution Adoption Process Model (PAPM), including stages of awareness, engagement, information-seeking, and vaccination behaviour. Furthermore, factors related to the decision-making process were examined. RESULTS In total, 942 women were included, of whom 62% were non-pregnant. Most of the pregnant and nonpregnant women were aware of MPV during pregnancy (respectively 69 and 56%). Most aware women had heard about MPV through their midwife and the Public Health Institute (PHI) website. Women unaware of MPV reported a need for information, preferably from their midwives. Most aware women felt MPV was important to them (88%) and were classified as "engaged". Of the eligible and "engaged" pregnant women, 58% were vaccinated, versus 38% of "engaged" non-pregnant women. CONCLUSIONS As the most preferred and trusted source of information, midwives are essential to increasing awareness of MPV. The PHI website is considered to be a reliable information source and is often consulted. To increase awareness, appropriate healthcare workers should be encouraged to actively inform target groups about available, additional vaccinations.
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Affiliation(s)
- K van Zoonen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - W L M Ruijs
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - H E De Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - M E J Bongers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - L Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
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17
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Falahee M, Simons G, DiSantostefano RL, Valor Méndez L, Radawski C, Englbrecht M, Schölin Bywall K, Tcherny-Lessenot S, Kihlbom U, Hauber B, Veldwijk J, Raza K. Treatment preferences for preventive interventions for rheumatoid arthritis: protocol of a mixed methods case study for the Innovative Medicines Initiative PREFER project. BMJ Open 2021; 11:e045851. [PMID: 36916312 PMCID: PMC8039213 DOI: 10.1136/bmjopen-2020-045851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Amidst growing consensus that stakeholder decision-making during drug development should be informed by an understanding of patient preferences, the Innovative Medicines Initiative project 'Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle' (PREFER) is developing evidence-based recommendations about how and when patient preferences should be integrated into the drug life cycle. This protocol describes a PREFER clinical case study which compares two preference elicitation methodologies across several populations and provides information about benefit-risk trade-offs by those at risk of rheumatoid arthritis (RA) for preventive interventions. METHODS AND ANALYSIS This mixed methods study will be conducted in three countries (UK, Germany, Romania) to assess preferences of (1) first-degree relatives (FDRs) of patients with RA and (2) members of the public. Focus groups using nominal group techniques (UK) and ranking surveys (Germany and Romania) will identify and rank key treatment attributes. Focus group transcripts will be analysed thematically using the framework method and average rank orders calculated. These results will inform the treatment attributes to be assessed in a survey including a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). The survey will also include measures of sociodemographic variables, health literacy, numeracy, illness perceptions and beliefs about medicines. The survey will be administered to (1) 400 FDRs of patients with RA (UK); (2) 100 FDRs of patients with RA (Germany); and (3) 1000 members of the public in each of UK, Germany and Romania. Logit-based approaches will be used to analyse the DCE and imputation and interval regression for the PTT. ETHICS AND DISSEMINATION This study has been approved by the London-Hampstead Research Ethics Committee (19/LO/0407) and the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (92_17 B). The protocol has been approved by the PREFER expert review board. The results will be disseminated widely and will inform the PREFER recommendations.
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Affiliation(s)
- Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Larissa Valor Méndez
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | | | | | | | | | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Brett Hauber
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, USA
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Jorien Veldwijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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18
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Grauman Å, Hansson M, James S, Hauber B, Veldwijk J. Communicating Test Results from a General Health Check: Preferences from a Discrete Choice Experiment Survey. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:649-660. [PMID: 33778921 PMCID: PMC8357669 DOI: 10.1007/s40271-021-00512-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health checks can detect risk factors and initiate prevention of cardiovascular diseases but there is no consensus on how to communicate the results. The aim of this study was to investigate the preferences of the general population for communicating health check results. METHODS A randomly selected sample of the Swedish population aged 40-70 years completed a discrete choice experiment survey that included questions on sociodemographics, lifestyle and health and 15 choice questions consisting of six attributes (written results, notification method, consultation time, waiting time, lifestyle recommendation and cost). Data were analyzed with a latent class analysis (LCA). Relative importance of the attributes and predicted uptake for several scenarios were estimated. RESULTS In the analysis, 432 individuals were included (response rate 29.6%). A three-class LCA model best fit the data. Cost was the most important attribute in all classes. Preferences heterogeneity was found for the other attributes; in Class 1, receiving consultation time and the written results were important, respondents in Class 2 dominated on costs and respondents in Class 3 found consultation time, waiting time and lifestyle recommendations to be important. Health literate respondents were more likely to belong to Class 3. The predicted uptake rates ranged from 7 to 88% for different health checks with large differences across the classes. CONCLUSION Cost was most important when deciding whether to participate in a health check. Although cost was the most important factor, it is not sufficient to offer health checks free-of-charge if other requirements regarding how the test results are communicated are not in place; participants need to be able to understand their results.
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Affiliation(s)
- Åsa Grauman
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Brett Hauber
- Pfizer, Inc., New York, NY, USA
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School or Pharmacy, Seattle, WA, USA
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
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19
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Montagni I, Ouazzani-Touhami K, Mebarki A, Texier N, Schück S, Tzourio C. Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health (Oxf) 2021; 43:695-702. [PMID: 33693905 PMCID: PMC7989386 DOI: 10.1093/pubmed/fdab028] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background During the Covid-19 pandemic fake news has been circulating impacting on the general population’s opinion about a vaccine against the SARS-CoV-2. Health literacy measures the capacity of navigating health information. Methods We used data from a prospective national online cohort of 1647 participants. Descriptive statistics, Chi2 and ANOVA independence tests and two multivariable multinomial regression models were performed. Interactions between each variable were tested. Results Detection of fake news and health literacy scores were associated with intention to get vaccinated against SARS-CoV-2 (p < 0.01). The risk of being “anti-vaccination” or “hesitant”, rather than “pro-vaccination”, was higher among individuals reporting bad detection of fake news, respectively OR = 1.93 (95%CI = [1.30;2.87]) and OR = 1.80 (95%CI = [1.29;2.52]). The risk of being in “hesitant”, rather than “pro-vaccination” was higher among individuals having a bad health literacy score (OR = 1.44; 95%CI = [1.04;2.00]). No interaction was found between detection of fake news and health literacy. Conclusions To promote acceptance of a vaccine against SARS-CoV-2, it is recommended to increase individuals’ ability to detect fake news and health literacy through education and communication programs.
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Affiliation(s)
- I Montagni
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
| | - K Ouazzani-Touhami
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France.,Polyclinique Inkermann, groupe Elsan, F-79000 Niort, France
| | | | - N Texier
- Kap Code, F-75010 Paris, France.,Kappa Santé, F-75002 Paris, France
| | - S Schück
- Kap Code, F-75010 Paris, France.,Kappa Santé, F-75002 Paris, France
| | - C Tzourio
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
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20
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Michel JP, Goldberg J. Education, Healthy Ageing and Vaccine Literacy. J Nutr Health Aging 2021; 25:698-701. [PMID: 33949640 PMCID: PMC8040006 DOI: 10.1007/s12603-021-1627-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
Importance and Objective: The Covid pandemic is a timely opportunity to try to broaden our understanding of the links between education and health literacy and explore the vaccine-decision process with a view to identifying interventions that will positively influence vaccine uptake. EVIDENCE Health and vaccine literacy encompass people's knowledge, motivation, and competence to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion. FINDINGS Appropriate vaccine communication, which depends greatly on personal and contextual determinants, as well as on societal and environmental circumstances, is essential to reassure people about vaccine efficacy, safety, and possible side effects. However, vaccine confidence is not solely a question of trust in the vaccine's efficacy, safety. and individual protective benefit of vaccination. It also encompasses the mechanism(s) of vaccine activity, immunization schedules, organization and trust in the healthcare system that promotes and delivers the vaccines, and at what costs. When healthcare professionals as science brokers of vaccine knowledge attempt to increase vaccine knowledge and confidence, they must adjust their communication to the educational or health literacy level of their intended audience. Even if their messages are apparently clear and simple, they absolutely need to verify that they are properly understood. RELEVANCE Specific vaccine communication training appears essential to increase vaccine communication skills among healthcare providers. Moreover, further randomized controlled studies are warranted to improve vaccine empowerment among different populations, from a variety of educational backgrounds.
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Affiliation(s)
- J-P Michel
- Jean-Pierre Michel, Honorary professor of Medicine, Medical University of Geneva, Switzerland, + 41 79 77 83 742 ,
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Zhu S, Chang J, Hayat K, Li P, Ji W, Fang Y. Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment. Vaccine 2020; 38:8310-8317. [DOI: 10.1016/j.vaccine.2020.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/27/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
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Gong T, Chen G, Liu P, Lai X, Rong H, Ma X, Hou Z, Fang H, Li S. Parental Vaccine Preferences for Their Children in China: A Discrete Choice Experiment. Vaccines (Basel) 2020; 8:vaccines8040687. [PMID: 33207667 PMCID: PMC7712304 DOI: 10.3390/vaccines8040687] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Abstract
Vaccination is one of the most cost-effective health investments to prevent and control communicable diseases. Improving the vaccination rate of children is important for all nations, and for China in particular since the advent of the two-child policy. This study aims to elicit the stated preference of parents for vaccination following recent vaccine-related incidents in China. Potential preference heterogeneity was also explored among respondents. Methods: A discrete choice experiment was developed to elicit parental preferences regarding the key features of vaccines in 2019. The study recruited a national sample of parents from 10 provinces who had at least one child aged between 6 months and 5 years old. A conditional logit model and a mixed logit model were used to estimate parental preference. Results: A total of 598 parents completed the questionnaire; among them, 428 respondents who passed the rational tests were analyzed. All attributes except for the severity of diseases prevented by vaccines were statistically significant. The risk of severe side effects and protection rates were the two most important factors explaining parents’ decisions about vaccination. The results of the mixed logit model with interactions indicate that fathers or rural parents were more likely to vaccinate their children, and children whose health was not good were also more likely to be vaccinated. In addition, parents who were not more than 30 years old had a stronger preference for efficiency, and well-educated parents preferred imported vaccines with the lowest risk of severe side effects. Conclusion: When deciding about vaccinations for their children, parents in China are mostly driven by vaccination safety and vaccine effectiveness and were not affected by the severity of diseases. These findings will be useful for increasing the acceptability of vaccination in China.
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Affiliation(s)
- Tiantian Gong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (T.G.); (P.L.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne 3145, Australia;
| | - Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (T.G.); (P.L.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100083, China;
| | - Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai 200032, China;
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
- Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing 100083, China
- Key Laboratory of Reproductive Health National Health Commission of the People’s Republic of China, Beijing 100083, China
- Correspondence: (H.F.); (S.L.)
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (T.G.); (P.L.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Correspondence: (H.F.); (S.L.)
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Ancillotti M, Eriksson S, Andersson DI, Godskesen T, Nihlén Fahlquist J, Veldwijk J. Preferences regarding antibiotic treatment and the role of antibiotic resistance: A discrete choice experiment. Int J Antimicrob Agents 2020; 56:106198. [PMID: 33080314 DOI: 10.1016/j.ijantimicag.2020.106198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/29/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify preferences of the Swedish public regarding antibiotic treatment characteristics and the relative weight of antibiotic resistance in their treatment choices. METHODS A questionnaire including a discrete choice experiment questionnaire was answered by 378 Swedish participants. Preferences of the general public regarding five treatment characteristics (attributes) were measured: contribution to antibiotic resistance, cost, side effects, failure rate and treatment duration. Latent class analysis models were used to determine attribute-level estimates and heterogeneity in preferences. Relative importance of the attributes and willingness to pay for antibiotics with a lower contribution to antibiotic resistance were calculated from the estimates. RESULTS All attributes influenced participants' preferences for antibiotic treatment. For the majority of participants, contribution to antibiotic resistance was the most important attribute. Younger respondents found contribution to antibiotic resistance more important in their choice of antibiotic treatments. Choices of respondents with lower numeracy, higher health literacy and higher financial vulnerability were influenced more by the cost of the antibiotic treatment. Older respondents with lower financial vulnerability and health literacy, and higher numeracy found side effects to be most important. CONCLUSIONS All attributes can be considered as potential drivers of antibiotic use by lay people. Findings also suggest that the behaviour of lay people may be influenced by concerns over the rise of antibiotic resistance. Therefore, stressing individual responsibility for antibiotic resistance in clinical and societal communication has the potential to affect personal decision making.
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Affiliation(s)
- M Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - S Eriksson
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - D I Andersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - T Godskesen
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - J Nihlén Fahlquist
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - J Veldwijk
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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The Acceptance of Key Public Health Interventions by the Polish Population Is Related to Health Literacy, But Not eHealth Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155459. [PMID: 32751180 PMCID: PMC7432801 DOI: 10.3390/ijerph17155459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
Background: Public health and health promotion rely on many different interventions, which range from health education and communication, through community mobilisation and changes to environmental conditions, to legal and fiscal actions. The introduction of the increased tax on sugar-sweetened beverages (SSB), popularly called sugar tax (ST), and a mandatory programme of vaccinations are the strategies inciting the most vivid discussions in Polish society. The study was intended to assess the determinants of the attitudes of Polish society regarding the ST and to vaccinations. Methods: For the analysis, the data originating from the survey of a representative adult sample of Polish society (n = 1000) was used. The survey was based on computer-assisted telephone interviewing (CATI). The assessment of the relationships between the selected variables and the opinions about the introduction of the ST and the safety and effectiveness of vaccinations were carried out using the chi2 test and univariate logistic regression models. Results: The acceptance of the ST and vaccination showed a significant relationship to the level of health literacy (HL) but not to eHealth literacy (eHL). Respondents having a higher rather than lower HL; older rather than younger; married rather than singles; retired, or on a disability pension, rather than vocationally active and nonusers of the Internet rather than users were more likely to show an acceptance for both interventions. Those more frequently using health care services and those with chronic diseases showed a greater belief in the safety and effectiveness of vaccinations. Conclusions: The relationship between the opinions of the two public health interventions analysed and the sociodemographic variables demonstrated similar patterns. Interestingly, the opinions were associated only with HL and not with eHL and users of the Internet were more sceptical about the interventions.
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Veldwijk J, Johansson JV, Donkers B, de Bekker-Grob EW. Mimicking Real-Life Decision Making in Health: Allowing Respondents Time to Think in a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:945-952. [PMID: 32762997 DOI: 10.1016/j.jval.2020.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/05/2019] [Accepted: 02/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To empirically test the impact of allowing respondents time to think (TTT) about their choice options on the outcomes of a discrete choice experiments (DCE). METHODS In total, 613 participants of the Swedish CArdioPulmonary bioImage Study (SCAPIS) completed a DCE questionnaire that measured their preferences for receiving secondary findings of a genetic test. A Bayesian D-efficient design with 60 choice tasks divided over 4 questionnaires was used. Each choice task contained 2 scenarios with 4 attributes: type of disease, disease penetrance probability, preventive opportunities, and effectiveness of prevention. Respondents were randomly allocated to the TTT or no TTT (NTTT) sample. Latent class models (LCMs) were estimated to determine attribute-level values and their relative importance. In addition, choice certainty, attribute-level interpretation, choice consistency, and potential uptake rates were compared between samples. RESULTS In the TTT sample, 92% of the respondents (245 of 267) indicated they used the TTT period to (1) read the information they received (72%) and (2) discuss with their family (24%). In both samples, respondents were very certain about their choices. A 3-class LCM was fitted for both samples. Preference reversals were found for 3 of the 4 attributes in one class in the NTTT sample (34% class-membership probability). Relative importance scores of the attributes differed between the 2 samples, and significant scale effects indicating higher choice consistency in TTT sample were found. CONCLUSIONS Offering respondents TTT influences decision making and preferences. Developers of future DCEs regarding complex health-related decisions are advised to consider this approach to enhance the validity of the elicited preferences.
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Affiliation(s)
- Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | | | - Bas Donkers
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Hoogink J, Verelst F, Kessels R, van Hoek AJ, Timen A, Willem L, Beutels P, Wallinga J, de Wit GA. Preferential differences in vaccination decision-making for oneself or one's child in The Netherlands: a discrete choice experiment. BMC Public Health 2020; 20:828. [PMID: 32487041 PMCID: PMC7268356 DOI: 10.1186/s12889-020-08844-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To optimize the focus of future public information campaigns in The Netherlands promoting the uptake of vaccines among adults and children, we quantified the contribution of several attributes to the vaccination decision. METHOD We performed a discrete choice experiment (DCE) among Dutch adults including six attributes, i.e. vaccine effectiveness, vaccine-preventable burden of disease (specified in severity and frequency), accessibility of vaccination in terms of co-payment and prescription requirements, frequency of mild side-effects, population-level vaccination coverage and local vaccination coverage among family and friends. Participants answered the DCE from their own perspective ('oneself' group) or with regard to a vaccine decision for their youngest child ('child' group). The data was analysed by means of panel mixed logit models. RESULTS We included 1547 adult participants (825 'oneself' and 722 'child'). Vaccine effectiveness was the most important attribute in the 'oneself' group, followed by burden of disease (relative importance (RI) 78%) and accessibility (RI 76%). In the 'child' group, burden of disease was most important, but tied closely with vaccine effectiveness (RI 97%). Of less importance was the risk of mild vaccine-related side-effects and both population and local vaccination coverage. Interestingly, participants were more willing to vaccinate when uptake among the population or family and friends was high, indicating that social influence and social norms plays a role. CONCLUSIONS Vaccine effectiveness and disease severity are key attributes in vaccination decision-making for adults making a decision for themselves and for parents who decide for their children. Hence, public information campaigns for both adult and child vaccination should primarily focus on these two attributes. In addition, reinforcing social norms may be considered.
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Affiliation(s)
- Joram Hoogink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Frederik Verelst
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Roselinde Kessels
- Department of Data Analytics and Digitalization, Maastricht University, Maastricht, The Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
| | - Aura Timen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Julius Centre Utrecht - University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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Benninghoff B, Pereira P, Vetter V. Role of healthcare practitioners in rotavirus disease awareness and vaccination - insights from a survey among caregivers. Hum Vaccin Immunother 2019; 16:138-147. [PMID: 31210567 PMCID: PMC7012184 DOI: 10.1080/21645515.2019.1632685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
An online survey was designed to assess awareness and understanding of Rotavirus (RV) gastroenteritis (RVGE), and knowledge and attitudes towards RV vaccination in Germany, Poland, Turkey, Indonesia, the Philippines and Thailand. Survey participants (n = 1500) comprised parents, expectant parents and guardians of children ≤5 years of age who have sole or joint responsibility for health and well-being decisions relating to their child, who were recruited from an online panel and provided their consent for study participation. Participants from most countries had a high level of awareness of RV infections (mean: 82%) and of those aware of RV, a mean of 61% participants were aware that RV was the most common cause of GE, however the majority (mean: 59%) were unaware that nearly every child would be infected with RVGE by the age of 5 years. Healthcare professional (HCP) recommendation was identified as the key driver for participants seeking vaccination (48%–75% of participants stated this reason, with results differing by country) followed by availability of RV vaccine in the national immunization program. Despite a high level of awareness of RVGE among participants, fostering knowledge regarding the difficulty of RVGE prevention, the risk of RV contraction and the associated serious consequences like dehydration is imperative to improve RV vaccination uptake. HCPs, being the primary influence on participants’ decision on vaccination, are best suited to bridge existing knowledge gaps and recommend parents to vaccinate their children against RVGE.
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Vass C, Rigby D, Payne K. "I Was Trying to Do the Maths": Exploring the Impact of Risk Communication in Discrete Choice Experiments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:113-123. [PMID: 30099692 DOI: 10.1007/s40271-018-0326-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk is increasingly used as an attribute in discrete choice experiments (DCEs). However, risk and probabilities are complex concepts that can be open to misinterpretation, potentially undermining the robustness of DCEs as a valuation method. This study aimed to understand how respondents made benefit-risk trade-offs in a DCE and if these were affected by the communication of the risk attributes. METHODS Female members of the public were recruited via local advertisements to participate in think-aloud interviews when completing a DCE eliciting their preferences for a hypothetical breast screening programme described by three attributes: probability of detecting a cancer; risk of unnecessary follow-up; and cost of screening. Women were randomised to receive risk information as either (1) percentages or (2) percentages and icon arrays. Interviews were digitally recorded then transcribed to generate qualitative data for thematic analysis. RESULTS Nineteen women completed the interviews (icon arrays n = 9; percentages n = 10). Analysis revealed four key themes where women made references to (1) the nature of the task; (2) their feelings; (3) their experiences, for instance making analogies to similar risks; and (4) economic phenomena such as opportunity costs and discounting. CONCLUSION Most women completed the DCE in line with economic theory; however, violations were identified. Women appeared to visualise risk whether they received icon arrays or percentages only. Providing clear instructions and graphics to aid interpretation of risk and qualitative piloting to verify understanding is recommended. Further investigation is required to determine if the process of verbalising thoughts changes the behaviour of respondents.
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Affiliation(s)
- Caroline Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Dan Rigby
- Department of Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Russo S, Jongerius C, Faccio F, Pizzoli SFM, Pinto CA, Veldwijk J, Janssens R, Simons G, Falahee M, de Bekker-Grob E, Huys I, Postmus D, Kihlbom U, Pravettoni G. Understanding Patients' Preferences: A Systematic Review of Psychological Instruments Used in Patients' Preference and Decision Studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:491-501. [PMID: 30975401 DOI: 10.1016/j.jval.2018.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/25/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Research has been mainly focused on how to elicit patient preferences, with less attention on why patients form certain preferences. OBJECTIVES To assess which psychological instruments are currently used and which psychological constructs are known to have an impact on patients' preferences and health-related decisions including the formation of preferences and preference heterogeneity. METHODS A systematic database search was undertaken to identify relevant studies. From the selected studies, the following information was extracted: study objectives, study population, design, psychological dimensions investigated, and instruments used to measure psychological variables. RESULTS Thirty-three studies were identified that described the association between a psychological construct, measured using a validated instrument, and patients' preferences or health-related decisions. We identified 33 psychological instruments and 18 constructs, and categorized the instruments into 5 groups, namely, motivational factors, cognitive factors, individual differences, emotion and mood, and health beliefs. CONCLUSIONS This review provides an overview of the psychological factors and related instruments in the context of patients' preferences and decisions in healthcare settings. Our results indicate that measures of health literacy, numeracy, and locus of control have an impact on health-related preferences and decisions. Within the category of constructs that could explain preference and decision heterogeneity, health locus of control is a strong predictor of decisions in several healthcare contexts and is useful to consider when designing a patient preference study. Future research should continue to explore the association of psychological constructs with preference formation and heterogeneity to build on these initial recommendations.
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Affiliation(s)
- Selena Russo
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy; Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
| | - Chiara Jongerius
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Silvia F M Pizzoli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Cathy Anne Pinto
- Department of Pharmacoepidemiology, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Jorien Veldwijk
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden; Erasmus School of Health Policy and Management and Erasmus Choice Modelling Center, Erasmus University, Rotterdam, the Netherlands
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy and Management and Erasmus Choice Modelling Center, Erasmus University, Rotterdam, the Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Douwe Postmus
- University Medical Center Groningen, Groningen, the Netherlands
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Poulos C, Standaert B, Sloesen B, Stryjewska I, Janitsary A, Hauber B. Preferences for vaccines against children’s diarrheal illness among mothers in Poland and Hungary. Vaccine 2018; 36:6022-6029. [DOI: 10.1016/j.vaccine.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022]
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Vaanholt MCW, Kok MM, von Birgelen C, Weernink MGM, van Til JA. Are component endpoints equal? A preference study into the practice of composite endpoints in clinical trials. Health Expect 2018; 21:1046-1055. [PMID: 30109764 PMCID: PMC6250862 DOI: 10.1111/hex.12798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives To examine patients’ perspectives regarding composite endpoints and the utility patients put on possible adverse outcomes of revascularization procedures. Design In the PRECORE study, a stated preference elicitation method Best‐Worst Scaling (BWS) was used to determine patient preference for 8 component endpoints (CEs): need for redo percutaneous coronary intervention (PCI) within 1 year, minor stroke with symptoms <24 hours, minor myocardial infarction (MI) with symptoms <3 months, recurrent angina pectoris, need for redo coronary artery bypass grafting (CABG) within 1 year, major MI causing permanent disability, major stroke causing permanent disability and death within 24 hours. Setting A tertiary PCI/CABG centre. Participants One hundred and sixty patients with coronary artery disease who underwent PCI or CABG. Main outcome measures Importance weights (IWs). Results Patients considered need for redo PCI within 1 year (IW: 0.008), minor stroke with symptoms <24 hours (IW: 0.017), minor MI with symptoms <3 months (IW: 0.027), need for redo CABG within 1 year (IW: 0.119), recurrent angina pectoris (IW: 0.300) and major MI causing permanent disability (IW: 0.726) less severe than death within 24 hours (IW: 1.000). Major stroke causing permanent disability was considered worse than death within 24 hours (IW: 1.209). Ranking of CEs and the relative values attributed to the CEs differed among subgroups based on gender, age and educational level. Conclusion Patients attribute different weight to individual CEs. This has significant implications for the interpretation of clinical trial data.
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Affiliation(s)
- Melissa C W Vaanholt
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Marieke G M Weernink
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Janine A van Til
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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Individual Preferences for Child and Adolescent Vaccine Attributes: A Systematic Review of the Stated Preference Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:687-700. [PMID: 28474295 DOI: 10.1007/s40271-017-0244-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Discrete choice experiments are increasingly used to assess preferences for vaccines and vaccine service delivery. OBJECTIVES To synthesize and critically assess the application of discrete choice experiments in childhood/adolescent vaccines, to describe how discrete choice experiments have been applied to understand preferences, and to evaluate the use of discrete choice experiment data to inform estimates of vaccine uptake. METHODS We conducted a systematic review of six electronic databases. Included studies were discrete choice experiments and conjoint analyses published from 2000 to 2016 related to childhood/adolescent vaccines where respondents were parents, children/adolescents, or service providers. Validity assessment was used to assess study quality and risk of bias. RESULTS In total, 27 articles were included, representing 21 different studies. A majority of articles were published between 2011 and 2016. Vaccines studied included human papillomavirus (24%), influenza (19%), meningococcal vaccines (14%), childhood vaccines (14%), hypothetical vaccines (10%), hepatitis B (5%), and diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae type b (5%). Most studies assessed parent preferences (67%). The most common attributes were risk (24%), degree/duration of protection (21%), and cost (15%). Commonly reported outcome measures were estimates of uptake (33%), willingness-to-pay (22%), and other marginal rates of substitution (14%). Validity assessments yielded high scores overall. Areas of weakness included low response rates, inefficient experimental design, and failure to conduct formative qualitative work and a pilot of the discrete choice experiment. CONCLUSION This is the first systematic review of childhood/adolescent vaccine-related discrete choice experiments. In future, special attention should be paid to ensuring that choice context and discrete choice experiment design are compatible to generate reliable estimates of uptake.
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Zhou M, Thayer WM, Bridges JFP. Using Latent Class Analysis to Model Preference Heterogeneity in Health: A Systematic Review. PHARMACOECONOMICS 2018; 36:175-187. [PMID: 28975582 DOI: 10.1007/s40273-017-0575-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Latent class analysis (LCA) has been increasingly used to explore preference heterogeneity, but the literature has not been systematically explored and hence best practices are not understood. OBJECTIVE We sought to document all applications of LCA in the stated-preference literature in health and to inform future studies by identifying current norms in published applications. METHODS We conducted a systematic review of the MEDLINE, EMBASE, EconLit, Web of Science, and PsycINFO databases. We included stated-preference studies that used LCA to explore preference heterogeneity in healthcare or public health. Two co-authors independently evaluated titles, abstracts, and full-text articles. Abstracted key outcomes included segmentation methods, preference elicitation methods, number of attributes and levels, sample size, model selection criteria, number of classes reported, and hypotheses tests. Study data quality and validity were assessed with the Purpose, Respondents, Explanation, Findings, and Significance (PREFS) quality checklist. RESULTS We identified 2560 titles, 99 of which met the inclusion criteria for the review. Two-thirds of the studies focused on the preferences of patients and the general population. In total, 80% of the studies used discrete choice experiments. Studies used between three and 20 attributes, most commonly four to six. Sample size in LCAs ranged from 47 to 2068, with one-third between 100 and 300. Over 90% of the studies used latent class logit models for segmentation. Bayesian information criterion (BIC), Akaike information criterion (AIC), and log-likelihood (LL) were commonly used for model selection, and class size and interpretability were also considered in some studies. About 80% of studies reported two to three classes. The number of classes reported was not correlated with any study characteristics or study population characteristics (p > 0.05). Only 30% of the studies reported using statistical tests to detect significant variations in preferences between classes. Less than half of the studies reported that individual characteristics were included in the segmentation models, and 30% reported that post-estimation analyses were conducted to examine class characteristics. While a higher percentage of studies discussed clinical implications of the segmentation results, an increasing number of studies proposed policy recommendations based on segmentation results since 2010. CONCLUSIONS LCA is increasingly used to study preference heterogeneity in health and support decision-making. However, there is little consensus on best practices as its application in health is relatively new. With an increasing demand to study preference heterogeneity, guidance is needed to improve the quality of applications of segmentation methods in health to support policy development and clinical practice.
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Affiliation(s)
- Mo Zhou
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA.
| | - Winter Maxwell Thayer
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 690, Baltimore, MD, 21205, USA
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Paul KT, Wallenburg I, Bal R. Putting public health infrastructures to the test: introducing HPV vaccination in Austria and the Netherlands. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:67-81. [PMID: 28718520 DOI: 10.1111/1467-9566.12595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we draw on the concept of 'infrastructure' to understand their roles in shaping the reception of the vaccine. We reveal how the HPV vaccine had to be made 'good enough', much like the Pap smear (Casper and Clarke ), by means of diverse tinkering practices that transformed both the technology and the infrastructures in which they emerged. At the same time, it was important that the vaccine would not come to problematise Pap smear-based screening. The article points to the contextually contingent nature of policymaking around new medical technologies, and the skillful care with which public health infrastructures such as immunisation and screening programmes are handled and tinkered with.
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Affiliation(s)
| | - Iris Wallenburg
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, Amsterdam
| | - Roland Bal
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, Amsterdam
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Wang X, Zhou X, Leesa L, Mantwill S. The Effect of Vaccine Literacy on Parental Trust and Intention to Vaccinate after a Major Vaccine Scandal. JOURNAL OF HEALTH COMMUNICATION 2018; 23:413-421. [PMID: 29589807 DOI: 10.1080/10810730.2018.1455771] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health literacy, and more specifically vaccine literacy, might be an important factor in reducing the negative effects of exposure to misleading reports on vaccination. This study explores the association between vaccine literacy and vaccination-related outcomes after misleading reports on a scandal concerning locally produced childhood vaccines had emerged in 2016 in China. Data for this study came from a cross-sectional survey, which was conducted in April 2016 in Hangzhou, China. Data were collected in kindergartens and community health centers among parents of children up to 6 years of age. Data were analyzed for 1864 participants. Binary logistic regression models showed that, after controlling for socio-demographics and children's age, parents who had better vaccine literacy (<0.05) were more likely to trust and choose domestically produced vaccines, which account for about 95% of the total vaccinations in China. This study provides evidence on a still largely understudied relationship between vaccine literacy and vaccination-related outcomes. Findings might suggest that higher literacy levels could reduce some of the negative effects of being exposed to misleading information on vaccination, eventually leading to less vaccination hesitancy.
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Affiliation(s)
- Xiaomin Wang
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
| | - Xudong Zhou
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
| | - Lin Leesa
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
- d Division of Policy Translation and Leadership Development , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Sarah Mantwill
- e Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
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Methods to perform systematic reviews of patient preferences: a literature survey. BMC Med Res Methodol 2017; 17:166. [PMID: 29228914 PMCID: PMC5725984 DOI: 10.1186/s12874-017-0448-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews are a commonly used research design in the medical field to synthesize study findings. At present-although several systematic reviews of patient preference studies are published-there is no clear guidance available for researchers to conduct this type of systematic review. The aim of our study was to learn the most current practice of conducting these systematic reviews by conducting a survey of the literature regarding reviews of quantitative patient preference studies. METHODS Our survey included systematic reviews of studies that used a stated quantitative preference design to elicit patient preferences. We identified eligible reviews through a search of the PubMed database. Two investigators with knowledge of the design of patient preference studies independently screened the titles and abstracts, and where needed, screened the full-text of the reviews to determine eligibility. We developed and pilot-tested a form to extract data on the methods used in each systematic review. RESULTS Our search and screening identified 29 eligible reviews. A large proportion of the reviews (19/29, 66%) were published in 2014 or after; among them, nine reviews were published in 2016. The median number of databases searched for preference studies was four (interquartile range = 2 to 7). We found that less than half of the reviews (13/29, 45%) clearly reported assessing risk of bias or the methodological quality of the included preference studies; not a single review was able to perform quantitative synthesis (meta-analysis) of the data on patient preferences. CONCLUSION These results suggest that several methodological issues of performing systematic reviews of patient preferences are not yet fully addressed by research and that the methodology may require future development.
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Della Pelle C, Orsatti V, Cipollone F, Cicolini G. Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey. J Clin Nurs 2017; 27:859-865. [PMID: 29076583 DOI: 10.1111/jocn.14137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To assess the levels of health literacy of Italian caregivers of patients with heart failure. BACKGROUND Health literacy is related to patients' health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure. DESIGN Observational, multicentre, cross-sectional study. METHODS From July 2015-May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used. RESULTS A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46-60 years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients' children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients' spouses and those of older age. CONCLUSION Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers' health literacy, before entrusting them with the care of patients. RELEVANCE TO CLINICAL PRACTICE As this research gives, for the first time, an overview on Italian caregivers' levels of health literacy, its results may be used to improve Italian healthcare professionals' knowledge of caregivers' health literacy, before entrusting them with the care of patients.
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Affiliation(s)
- Carlo Della Pelle
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy.,ASL02Abruzzo - SAPS Chieti, Chieti Scalo, Italy
| | | | - Francesco Cipollone
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy
| | - Giancarlo Cicolini
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy.,ASL02Abruzzo - SAPS Chieti, Chieti Scalo, Italy
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Lorini C, Santomauro F, Donzellini M, Capecchi L, Bechini A, Boccalini S, Bonanni P, Bonaccorsi G. Health literacy and vaccination: A systematic review. Hum Vaccin Immunother 2017; 14:478-488. [PMID: 29048987 PMCID: PMC5806657 DOI: 10.1080/21645515.2017.1392423] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This systematic review describes the current relationship between health literacy (HL) and vaccination (including attitude to vaccines, intention to vaccinate, and vaccine uptake). The aim is to comprehend the role of HL as a determinant of vaccine hesitancy. For this purpose, the following databases were explored from 1 January 2007 to 15 January 2017: PubMed, Embase, PsycINFO, ERIC, Health Evidence, Centre for Reviews and Dissemination, Scopus, Web of Science, and Cochrane Library. Nine studies were included in the final synthesis. The role of HL in predicting vaccine hesitancy or acceptance seems to be influenced by a few key factors. These include country, age, and type of vaccine. However, the relationship between HL and vaccination remains unclear. New research studies are needed-particularly longitudinal ones that use multiple measurement tools. This would facilitate a better understanding of the role of HL in predicting vaccine uptake.
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Affiliation(s)
- Chiara Lorini
- a Department of Health Science , University of Florence , Florence , Italy
| | | | - Martina Donzellini
- b School of Specialization on Hygiene and Preventive Medicine, University of Florence , Florence , Italy
| | - Leonardo Capecchi
- b School of Specialization on Hygiene and Preventive Medicine, University of Florence , Florence , Italy
| | - Angela Bechini
- a Department of Health Science , University of Florence , Florence , Italy
| | - Sara Boccalini
- a Department of Health Science , University of Florence , Florence , Italy
| | - Paolo Bonanni
- a Department of Health Science , University of Florence , Florence , Italy
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Lorini C, Santomauro F, Grazzini M, Mantwill S, Vettori V, Lastrucci V, Bechini A, Boccalini S, Bussotti A, Bonaccorsi G. Health literacy in Italy: a cross-sectional study protocol to assess the health literacy level in a population-based sample, and to validate health literacy measures in the Italian language. BMJ Open 2017; 7:e017812. [PMID: 29138204 PMCID: PMC5695375 DOI: 10.1136/bmjopen-2017-017812] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Health literacy (HL) concerns the knowledge and competences necessary for people to meet complex health demands. The aims of this study are to assess the level of HL in a sample using the Italian version of the Newest Vital Sign and the association of HL and selected antecedents with health outcomes, and to develop and validate the Italian version of the three Brief Health Literacy Screeners, two subjective numeracy items and the short form and the short-short form of the European Health Literacy Survey Questionnaire. METHODS AND ANALYSIS The study adopts a cross-sectional design and is being conducted in Florence, with information collected through telephone interviews. The population-based sample has been randomly selected using the registries of eight general practitioners (GPs). Based on a power calculation, 480 subjects will be included. Participants have been randomly offered two different questionnaires, each containing different HL measures. Data on sociodemographics and important antecedents and consequences of HL will be collected and the distribution of HL levels calculated. The mediating role of HL will be assessed using Preacher and Hayes' model. To assess the concurrent validity of the HL scales, correlation and receiver operating characteristic analyses will be performed. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the Area Vasta Centro. Results will be disseminated via scientific journals and conference presentations, and individual data made available to the GPs.
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Affiliation(s)
- Chiara Lorini
- Departement of Health Science, University of Florence, Florence, Italy
| | | | - Maddalena Grazzini
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Sarah Mantwill
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Virginia Vettori
- Departement of Health Science, University of Florence, Florence, Italy
| | - Vieri Lastrucci
- Departement of Health Science, University of Florence, Florence, Italy
| | - Angela Bechini
- Departement of Health Science, University of Florence, Florence, Italy
| | - Sara Boccalini
- Departement of Health Science, University of Florence, Florence, Italy
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Brieger D, Edwards M, Mudgil P, Whitehall J. Knowledge, attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts. Aust N Z J Public Health 2017; 41:641-646. [PMID: 28898512 DOI: 10.1111/1753-6405.12720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 07/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although the number of national measles cases has greatly decreased since 1980s, there has been resurgence in disease incidence in recent years. While parental knowledge and attitudes toward both disease and vaccinations are known to influence vaccine uptake, the contribution of these factors toward vaccination rates in NSW populations has not been studied. The aim of this study was to investigate the knowledge and opinions on measles and MMR vaccine in NSW Central and North Coast regions. METHODS Parents (n=201) of children <12 years were surveyed with a purpose design survey at public beaches at the Central Coast and community markets at the North Coast. RESULTS Eight per cent of respondents reported not immunising their child with MMR vaccine. Most respondents recognised that measles is a highly contagious disease. Non-immunisers were found to be older, had a lower perceived severity of measles, were less likely to agree with the efficacy and safety of the vaccine, and were more likely to have encountered someone who had suffered side-effects of the vaccine. CONCLUSIONS There is considerable concern over safety of MMR vaccine among non-immunisers. Implications for public health: Improving confidence in MMR vaccine should be a target of future public health interventions.
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Affiliation(s)
- Daniel Brieger
- School of Medicine, Western Sydney University, New South Wales
| | - Matthew Edwards
- School of Medicine, Western Sydney University, New South Wales
| | - Poonam Mudgil
- School of Medicine, Western Sydney University, New South Wales
| | - John Whitehall
- School of Medicine, Western Sydney University, New South Wales
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Vass CM, Payne K. Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet? PHARMACOECONOMICS 2017; 35:859-866. [PMID: 28536955 PMCID: PMC5563347 DOI: 10.1007/s40273-017-0518-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
There is emerging interest in the use of discrete choice experiments as a means of quantifying the perceived balance between benefits and risks (quantitative benefit-risk assessment) of new healthcare interventions, such as medicines, under assessment by regulatory agencies. For stated preference data on benefit-risk assessment to be used in regulatory decision making, the methods to generate these data must be valid, reliable and capable of producing meaningful estimates understood by decision makers. Some reporting guidelines exist for discrete choice experiments, and for related methods such as conjoint analysis. However, existing guidelines focus on reporting standards, are general in focus and do not consider the requirements for using discrete choice experiments specifically for quantifying benefit-risk assessments in the context of regulatory decision making. This opinion piece outlines the current state of play in using discrete choice experiments for benefit-risk assessment and proposes key areas needing to be addressed to demonstrate that discrete choice experiments are an appropriate and valid stated preference elicitation method in this context. Methodological research is required to establish: how robust the results of discrete choice experiments are to formats and methods of risk communication; how information in the discrete choice experiment can be presented effectually to respondents; whose preferences should be elicited; the correct underlying utility function and analytical model; the impact of heterogeneity in preferences; and the generalisability of the results. We believe these methodological issues should be addressed, alongside developing a 'reference case', before agencies can safely and confidently use discrete choice experiments for quantitative benefit-risk assessment in the context of regulatory decision making for new medicines and healthcare products.
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Affiliation(s)
- Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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Wang B, Chen G, Ratcliffe J, Afzali HHA, Giles L, Marshall H. Adolescent values for immunisation programs in Australia: A discrete choice experiment. PLoS One 2017; 12:e0181073. [PMID: 28746348 PMCID: PMC5528895 DOI: 10.1371/journal.pone.0181073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 06/26/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents. Methods This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data. Results This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection. Conclusions Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group.
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Affiliation(s)
- Bing Wang
- The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, South Australia, Australia
- * E-mail:
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Julie Ratcliffe
- Institute for Choice, UniSA Business School, University of South Australia, Adelaide, South Australia, Australia
| | | | - Lynne Giles
- The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Helen Marshall
- The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Mantwill S, Schulz PJ. Does acculturation narrow the health literacy gap between immigrants and non-immigrants-An explorative study. PATIENT EDUCATION AND COUNSELING 2017; 100:760-767. [PMID: 27856066 DOI: 10.1016/j.pec.2016.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/22/2016] [Accepted: 10/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare functional health literacy (HL) levels in three immigrant groups to those of the German- and Italian-speaking non-immigrant population in Switzerland. Moreover, to investigate whether language-independent, respectively language-dependent, functional HL and variables of acculturation were associated with self-reported health status among immigrants. METHODS Language-independent HL was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) in the respective native languages. Language-dependent HL was measured using Brief Health Literacy Screeners (BHLS) asking about participants' confidence in understanding medical information in the language of the host country. Measures of acculturation included length of stay and age when taking residency in Switzerland. RESULTS In particular Albanian- and Portuguese-speaking immigrants had lower levels of functional HL. In unadjusted analysis "age when taking residency in Switzerland" was associated with the BHLS. Adjusted analysis showed that the BHLS were significantly associated with self-reported health among all immigrant groups (p≤0.01). CONCLUSIONS Functional HL that is dependent on understanding of medical information in the language of the new host country is a better predictor for self-reported health status among immigrants than language-independent HL. PRACTICE IMPLICATIONS In the clinical setting limited functional HL might be a significant obstacle to successful disease treatment and prevention in immigrants.
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Affiliation(s)
- Sarah Mantwill
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
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Delanoë A, Lépine J, Turcotte S, Leiva Portocarrero ME, Robitaille H, Giguère AM, Wilson BJ, Witteman HO, Lévesque I, Guillaumie L, Légaré F. Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey. J Med Internet Res 2016; 18:e283. [PMID: 27793792 PMCID: PMC5106559 DOI: 10.2196/jmir.6362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs. OBJECTIVE The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention. METHODS We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses. RESULTS Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92). CONCLUSIONS Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.
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Affiliation(s)
- Agathe Delanoë
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Johanie Lépine
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Turcotte
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Hubert Robitaille
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anik Mc Giguère
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Quebec Centre of Excellence on Aging, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Isabelle Lévesque
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - France Légaré
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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46
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Vanniyasingam T, Cunningham CE, Foster G, Thabane L. Simulation study to determine the impact of different design features on design efficiency in discrete choice experiments. BMJ Open 2016; 6:e011985. [PMID: 27436671 PMCID: PMC4964187 DOI: 10.1136/bmjopen-2016-011985] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are routinely used to elicit patient preferences to improve health outcomes and healthcare services. While many fractional factorial designs can be created, some are more statistically optimal than others. The objective of this simulation study was to investigate how varying the number of (1) attributes, (2) levels within attributes, (3) alternatives and (4) choice tasks per survey will improve or compromise the statistical efficiency of an experimental design. DESIGN AND METHODS A total of 3204 DCE designs were created to assess how relative design efficiency (d-efficiency) is influenced by varying the number of choice tasks (2-20), alternatives (2-5), attributes (2-20) and attribute levels (2-5) of a design. Choice tasks were created by randomly allocating attribute and attribute level combinations into alternatives. OUTCOME Relative d-efficiency was used to measure the optimality of each DCE design. RESULTS DCE design complexity influenced statistical efficiency. Across all designs, relative d-efficiency decreased as the number of attributes and attribute levels increased. It increased for designs with more alternatives. Lastly, relative d-efficiency converges as the number of choice tasks increases, where convergence may not be at 100% statistical optimality. CONCLUSIONS Achieving 100% d-efficiency is heavily dependent on the number of attributes, attribute levels, choice tasks and alternatives. Further exploration of overlaps and block sizes are needed. This study's results are widely applicable for researchers interested in creating optimal DCE designs to elicit individual preferences on health services, programmes, policies and products.
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Affiliation(s)
- Thuva Vanniyasingam
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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47
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Veldwijk J, Determann D, Lambooij MS, van Til JA, Korfage IJ, de Bekker-Grob EW, de Wit GA. Exploring how individuals complete the choice tasks in a discrete choice experiment: an interview study. BMC Med Res Methodol 2016; 16:45. [PMID: 27098746 PMCID: PMC4839138 DOI: 10.1186/s12874-016-0140-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022] Open
Abstract
Background To be able to make valid inferences on stated preference data from a Discrete Choice Experiment (DCE) it is essential that researchers know if participants were actively involved, understood and interpreted the provided information correctly and whether they used complex decision strategies to make their choices and thereby acted in accordance with the continuity axiom. Methods During structured interviews, we explored how 70 participants evaluated and completed four discrete choice tasks aloud. Hereafter, additional questions were asked to further explore if participants understood the information that was provided to them and whether they used complex decision strategies (continuity axiom) when making their choices. Two existing DCE questionnaires on rotavirus vaccination and prostate cancer-screening served as case studies. Results A large proportion of the participants was not able to repeat the exact definition of the risk attributes as explained to them in the introduction of the questionnaire. The majority of the participants preferred more optimal over less optimal risk attribute levels. Most participants (66 %) mentioned three or more attributes when motivating their decisions, thereby acting in accordance with the continuity axiom. However, 16 out of 70 participants continuously mentioned less than three attributes when motivating their decision. Lower educated and less literate participants tended to mention less than three attributes when motivating their decision and used trading off between attributes less often as a decision-making strategy. Conclusion The majority of the participants seemed to have understood the provided information about the choice tasks, the attributes, and the levels. They used complex decision strategies (continuity axiom) and are therefore capable to adequately complete a DCE. However, based on the participants’ age, educational level and health literacy additional, actions should be undertaken to ensure that participants understand the choice tasks and complete the DCE as presumed. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0140-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jorien Veldwijk
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. .,Centre for Research Ethics and Bioethics, Uppsala University, PO box 564, SE-751 22, Uppsala, Sweden.
| | - Domino Determann
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mattijs S Lambooij
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands
| | - Janine A van Til
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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