1
|
Jolliffe L, Christie LJ, Fearn N, Nohrenberg M, Liu R, Williams JF, Parsons MW, Pearce AM. A systematic review of discrete choice experiments in stroke rehabilitation. Top Stroke Rehabil 2024; 31:632-643. [PMID: 38372124 DOI: 10.1080/10749357.2024.2312641] [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: 10/01/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions. MATERIAL AND METHODS A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality. RESULTS Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers). CONCLUSIONS Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.
Collapse
Affiliation(s)
- Laura Jolliffe
- Department of Occupational Therapy, Peninsula Health, Melbourne, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Michael Nohrenberg
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Rasia Liu
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Julie F Williams
- Walter McGrath Library, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Mark W Parsons
- Department of Neurology, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- School of Medicine and Health, UNSW, Sydney, Australia
- Sydney Brain Centre, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Alison M Pearce
- School of Public Health, The University of Sydney, Camperdown, Australia
- The Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, The University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
dosReis S, Espinal Pena D, Fincannon A, Gorman EF, Amill-Rosario A. Discrete Choice Experiments to Elicit Patient Preferences for the Treatment of Major Depressive Disorder: A Systematic Review. THE PATIENT 2024:10.1007/s40271-024-00706-6. [PMID: 38969878 DOI: 10.1007/s40271-024-00706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Individual preferences for treatment options for major depressive disorder can impact therapeutic decision making, adherence, and ultimately outcomes. OBJECTIVES This systematic review of discrete choice experiments (DCEs) on patient preferences for major depressive disorder treatment assessed the range of DCE applications in major depressive disorder to document patient stakeholder involvement in DCE development and to identify the relative importance of treatment attributes. METHODS We searched MEDLINE via Ovid (1946-present), EMBASE (Elsevier interface), Cochrane Central Register of Controlled Trials (Wiley interface), and PsycINFO (EBSCO interface) databases on 29 May, 2024. Covidence software facilitated the review, which four members completed independently. The review was conducted in two phases: title and abstract and then a full-text review. We used an established quality reporting tool to evaluate selected articles. The Covidence extraction tool was adapted for this study. RESULTS A total of 19 articles were included in this review. Most studies elicited preferences for depression treatment (63.2%) and care delivery (10.5%). Two assessed willingness to pay. Individuals prefer a combination of medicine and counseling over each treatment alone. Treatment efficacy, relapse prevention, and symptom relief were among the most important attributes. Individuals were willing to accept larger risks to achieve symptom improvement. Few studies examined preference heterogeneity with latent subgroups. CONCLUSIONS Discrete choice experiments for major depressive disorder treatment preferences enable an assessment of trade-offs for first-line therapeutic options. Patient stakeholders are infrequently involved as collaborators in the DCE development. Few examined preference heterogeneity among subgroups.
Collapse
Affiliation(s)
- Susan dosReis
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA.
| | - Dafne Espinal Pena
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Alexandra Fincannon
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, MD, USA
| | - Alejandro Amill-Rosario
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, 21201, USA
- Department of Practice, Science, and Health Outcomes Research, School of Pharmacy, PAVE Center, Baltimore, MD, USA
| |
Collapse
|
3
|
Fujii T, Ishimura M, Takao S, Deguchi A. Preference of treatment characteristics among people with haemophilia or their caregivers, and physicians in the Japanese healthcare environment. Haemophilia 2024; 30:914-924. [PMID: 38695524 DOI: 10.1111/hae.15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Studies of treatment preferences in haemophilia have been conducted in many countries. This study is the first to examine treatment characteristic preferences among people with haemophilia (PWH) and their caregivers, and physicians in Japan. AIM To examine current treatment preferences of PWH and their caregivers, plus those of physicians at haemophilia treatment centres (HTCs) and non-HTCs for different treatment characteristics in Japan. METHODS Physicians listed on a survey panel were invited to participate in the survey and to refer PWH and caregivers to participate in the survey. Web-based surveys were conducted to examine physician and PWH/caregiver background, prophylaxis background, prophylaxis goals, understanding of haemophilia treatment products, important information sources, preferences while choosing prophylaxis products, understanding of the patient's condition, and potential product switching. A discrete choice experiment exercise was included in the survey. RESULTS A total of 107 physicians and 44 PWH/caregivers participated in the study. Key treatment goals of physicians included optimisation of haemophilia management. PWH/caregivers were focused on quality of life and reduced treatment burden. Consistent differences in haemophilia treatment strategies at HTCs and non-HTCs were observed for prescribed treatments, preferences in choosing prophylaxis products, understanding of patients' condition, and reasons for potential product switch. CONCLUSION Our study utilises real-world survey data and presents preferences for haemophilia treatment characteristics among physicians, PWH and their caregivers in Japan, which could encourage improvements in individualised treatment and disease management. Alignment between treatment approaches at HTCs and non-HTCs could facilitate improvements in the quality of care for PWH across Japan.
Collapse
Affiliation(s)
- Teruhisa Fujii
- Division of Transfusion Medicine, Hemophilia Treatment Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan
| | - Satomi Takao
- Medical Affairs Department, Novo Nordisk Pharma Ltd., Tokyo, Japan
| | - Ayumi Deguchi
- Medical Affairs Department, Novo Nordisk Pharma Ltd., Tokyo, Japan
| |
Collapse
|
4
|
Salisbury A, Ciardi J, Norman R, Smit AK, Cust AE, Low C, Caruana M, Gordon L, Canfell K, Steinberg J, Pearce A. Public Preferences for Genetic and Genomic Risk-Informed Chronic Disease Screening and Early Detection: A Systematic Review of Discrete Choice Experiments. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00893-1. [PMID: 38916649 DOI: 10.1007/s40258-024-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Genetic and genomic testing can provide valuable information on individuals' risk of chronic diseases, presenting an opportunity for risk-tailored disease screening to improve early detection and health outcomes. The acceptability, uptake and effectiveness of such programmes is dependent on public preferences for the programme features. This study aims to conduct a systematic review of discrete choice experiments assessing preferences for genetic/genomic risk-tailored chronic disease screening. METHODS PubMed, Embase, EconLit and Cochrane Library were searched in October 2023 for discrete choice experiment studies assessing preferences for genetic or genomic risk-tailored chronic disease screening. Eligible studies were double screened, extracted and synthesised through descriptive statistics and content analysis of themes. Bias was assessed using an existing quality checklist. RESULTS Twelve studies were included. Most studies focused on cancer screening (n = 10) and explored preferences for testing of rare, high-risk variants (n = 10), largely within a targeted population (e.g. subgroups with family history of disease). Two studies explored preferences for the use of polygenic risk scores (PRS) at a population level. Twenty-six programme attributes were identified, with most significantly impacting preferences. Survival, test accuracy and screening impact were most frequently reported as most important. Depending on the clinical context and programme attributes and levels, estimated uptake of hypothetical programmes varied from no participation to almost full participation (97%). CONCLUSION The uptake of potential programmes would strongly depend on specific programme features and the disease context. In particular, careful communication of potential survival benefits and likely genetic/genomic test accuracy might encourage uptake of genetic and genomic risk-tailored disease screening programmes. As the majority of the literature focused on high-risk variants and cancer screening, further research is required to understand preferences specific to PRS testing at a population level and targeted genomic testing for different disease contexts.
Collapse
Affiliation(s)
- Amber Salisbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Joshua Ciardi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cynthia Low
- Lived Experience Expert, Adelaide, SA, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Zhu A, Rajendran S, Hajian H, Aitken S. Patient Factors Influencing Prescription of Antithrombotic Medication After Lower Limb Endovascular Intervention. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00461-1. [PMID: 38802038 DOI: 10.1016/j.ejvs.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/21/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE There is significant practice variation in the use of antithrombotic therapy after endovascular intervention for lower limb peripheral arterial disease, with differences in medication choice and duration. Prescriber decision making is complex, and patient factors have been shown to substantially contribute to prescribing variation. To determine the influence of patient factors on antithrombotic prescribing, a discrete choice experiment was distributed to vascular surgeons and trainees across Australia and Aotearoa New Zealand. METHODS After pilot testing, the discrete choice experiment questionnaire was distributed to 300 vascular surgeons and trainee members of the Australian and New Zealand Society for Vascular Surgery. Multinomial logistic regression models were used to analyse patient factors that had the most influence on decisions to prescribe a second antithrombotic agent, and the preferred choice of antithrombotic (clopidogrel 75 mg daily or rivaroxaban 2.5 mg twice daily) in addition to aspirin 100 mg daily. The odds ratio (OR) with 95% confidence interval (CI) reported preference strength. RESULTS A total of 44 questionnaires were completed between September and October 2023, reaching the 15% targeted response rate. Prescribing a second antithrombotic was more likely after femoropopliteal stenting compared with angioplasty (OR 1.89, 95% CI 1.20 - 2.13), and in chronic limb threatening ischaemia compared with intermittent claudication (OR 1.58, 95% CI 1.20 - 2.13). Most respondents preferred clopidogrel over rivaroxaban (62%), with over a third of respondents exclusively prescribing clopidogrel. Patients with stents (OR 1.77, 95% CI 1.32 - 2.37) or moderate bleeding risk (OR 1.38, 95% CI 0.97 - 1.84) were more likely to receive clopidogrel than rivaroxaban. CONCLUSION This study demonstrates that vascular surgeons primarily prioritise antithrombotic prescribing decisions by procedure type. Clopidogrel is more likely to be prescribed than rivaroxaban as a second agent in combination with aspirin, especially after stenting. Knowing these clinician preferences can target implementation strategies towards supporting decision making in subgroups of patients according to individual risk profiles.
Collapse
Affiliation(s)
- Alison Zhu
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Department of Vascular Surgery, Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia.
| | - Saissan Rajendran
- Department of Vascular Surgery, Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Hamid Hajian
- Department of Vascular Surgery, Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Sarah Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Department of Vascular Surgery, Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia; Centre for PAD Research, Heart Research Institute, Camperdown, NSW, Australia
| |
Collapse
|
6
|
Thai T, Lancsar E, Spinks J, Freeman C, Chen G. Understanding Australian pharmacy degree holders' job preferences through the lens of motivation-hygiene theory. Soc Sci Med 2024; 348:116832. [PMID: 38569288 DOI: 10.1016/j.socscimed.2024.116832] [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: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Increasing the contribution of pharmacists to primary care has been long discussed, particularly in the context of health workforce shortages and the push to better integrate all providers across primary care. This study examines the employment preferences of Australian pharmacy degree holders (PDHs) elicited through a discrete choice experiment (DCE), to better understand the drivers of current labour force choices. A labelled DCE was developed incorporating the six employment sectors: hospital pharmacy, community pharmacy, primary healthcare settings, pharmaceutical industry, government/academia, and non-pharmacy-related sector. Each alternative was described by five attributes using Herzberg's Two Factor Theory as a conceptual framework. They include motivators - role and career opportunities, and hygiene factors-flexible work schedule, geographic location, and salary. Unforced choice data were analysed using conditional logit and mixed logit models. Based on a sample of 678 PDHs in Australia, our findings indicated pharmaceutical industry is the least preferred sector, followed by non-pharmacy-related sector. Motivators in the form of role and career opportunities are the most important attributes in hospital pharmacy while hygiene factors - geographic location and salary significantly drive the choice of community pharmacy and primary care settings. We provided evidence of a willingness to adopt expanded roles in community pharmacy. This unique interpretation of the key drivers of employment preference in light of motivators and hygiene factors provides policy makers with important information when designing policies to attract and retain PDHs across employment sectors.
Collapse
Affiliation(s)
- Thao Thai
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, 63A Eggleston Road, Acton ACT, 2601, Australia
| | - Jean Spinks
- Centre for the Business and Economics of Health, Lev 5, Bld 14, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Christopher Freeman
- The University of Queensland, School of Pharmacy, Brisbane, QLD, Australia; The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
| |
Collapse
|
7
|
Mohammed Selim S, Senanayake S, McPhail SM, Carter HE, Naicker S, Kularatna S. Consumer Preferences for a Healthcare Appointment Reminder in Australia: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00692-9. [PMID: 38605246 DOI: 10.1007/s40271-024-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND It is essential to consider the evidence of consumer preferences and their specific needs when determining which strategies to use to improve patient attendance at scheduled healthcare appointments. OBJECTIVES This study aimed to identify key attributes and elicit healthcare consumer preferences for a healthcare appointment reminder system. METHODS A discrete choice experiment was conducted in a general Australian population sample. The respondents were asked to choose between three options: their preferred reminder (A or B) or a 'neither' option. Attributes were developed through a literature review and an expert panel discussion. Reminder options were defined by four attributes: modality, timing, content and interactivity. Multinomial logit and mixed multinomial logit models were estimated to approximate individual preferences for these attributes. A scenario analysis was performed to estimate the likelihood of choosing different reminder systems. RESULTS Respondents (n = 361) indicated a significant preference for an appointment reminder to be delivered via a text message (β = 2.42, p < 0.001) less than 3 days before the appointment (β = 0.99, p < 0.001), with basic details including the appointment cost (β = 0.13, p < 0.10), and where there is the ability to cancel or modify the appointment (β = 1.36, p < 0.001). A scenario analysis showed that the likelihood of choosing an appointment reminder system with these characteristics would be 97%. CONCLUSIONS Our findings provide evidence on how healthcare consumers trade-off between different characteristics of reminder systems, which may be valuable to inform current or future systems. Future studies may focus on exploring the effectiveness of using patient-preferred reminders alongside other mitigation strategies used by providers.
Collapse
Affiliation(s)
- Shayma Mohammed Selim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia.
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia
- Digital Health and Informatics Directorate, Metro South Health, Woolloongabba, Brisbane, QLD, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4159, Australia
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| |
Collapse
|
8
|
Skolarus TA, Hawley ST, Forman J, Sales AE, Sparks JB, Metreger T, Burns J, Caram MV, Radhakrishnan A, Dossett LA, Makarov DV, Leppert JT, Shelton JB, Stensland KD, Dunsmore J, Maclennan S, Saini S, Hollenbeck BK, Shahinian V, Wittmann DA, Deolankar V, Sriram S. Unpacking overuse of androgen deprivation therapy for prostate cancer to inform de-implementation strategies. Implement Sci Commun 2024; 5:37. [PMID: 38594740 PMCID: PMC11005280 DOI: 10.1186/s43058-024-00576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Many men with prostate cancer will be exposed to androgen deprivation therapy (ADT). While evidence-based ADT use is common, ADT is also used in cases with no or limited evidence resulting in more harm than benefit, i.e., overuse. Since there are risks of ADT (e.g., diabetes, osteoporosis), it is important to understand the behaviors facilitating overuse to inform de-implementation strategies. For these reasons, we conducted a theory-informed survey study, including a discrete choice experiment (DCE), to better understand ADT overuse and provider preferences for mitigating overuse. METHODS Our survey used the Action, Actor, Context, Target, Time (AACTT) framework, the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation-Behavior (COM-B) Model, and a DCE to elicit provider de-implementation strategy preferences. We surveyed the Society of Government Service Urologists listserv in December 2020. We stratified respondents based on the likelihood of stopping overuse as ADT monotherapy for localized prostate cancer ("yes"/"probably yes," "probably no"/"no"), and characterized corresponding Likert scale responses to seven COM-B statements. We used multivariable regression to identify associations between stopping ADT overuse and COM-B responses. RESULTS Our survey was completed by 84 respondents (13% response rate), with 27% indicating "probably no"/"no" to stopping ADT overuse. We found differences across respondents who said they would and would not stop ADT overuse in demographics and COM-B statements. Our model identified 2 COM-B domains (Opportunity-Social, Motivation-Reflective) significantly associated with a lower likelihood of stopping ADT overuse. Our DCE demonstrated in-person communication, multidisciplinary review, and medical record documentation may be effective in reducing ADT overuse. CONCLUSIONS Our study used a behavioral theory-informed survey, including a DCE, to identify behaviors and context underpinning ADT overuse. Specifying behaviors supporting and gathering provider preferences in addressing ADT overuse requires a stepwise, stakeholder-engaged approach to support evidence-based cancer care. From this work, we are pursuing targeted improvement strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03579680.
Collapse
Affiliation(s)
- Ted A Skolarus
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA.
- Department of Surgery, Urology Section, University of Chicago, Chicago, USA.
| | - Sarah T Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jane Forman
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Anne E Sales
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Jordan B Sparks
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tabitha Metreger
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer Burns
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Megan V Caram
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Archana Radhakrishnan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lesly A Dossett
- Department of Surgery, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Danil V Makarov
- VA New York Harbor Healthcare System and NYU School of Medicine Departments of Urology and Population Health, New York, NY, USA
| | - John T Leppert
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Jeremy B Shelton
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
- Department of Urology, University of California, Los Angeles, USA
| | - Kristian D Stensland
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Dunsmore
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Steven Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sameer Saini
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Vahakn Shahinian
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniela A Wittmann
- Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Varad Deolankar
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - S Sriram
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Morrish N, Snowsill T, Dodman S, Medina-Lara A. Preferences for Genetic Testing to Predict the Risk of Developing Hereditary Cancer: A Systematic Review of Discrete Choice Experiments. Med Decis Making 2024; 44:252-268. [PMID: 38323553 PMCID: PMC10988993 DOI: 10.1177/0272989x241227425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Understanding service user preferences is key to effective health care decision making and efficient resource allocation. It is of particular importance in the management of high-risk patients in whom predictive genetic testing can alter health outcomes. PURPOSE This review aims to identify the relative importance and willingness to pay for attributes of genetic testing in hereditary cancer syndromes. DATA SOURCES Searches were conducted in Medline, Embase, PsycINFO, HMIC, Web of Science, and EconLit using discrete choice experiment (DCE) terms combined with terms related to hereditary cancer syndromes, malignancy synonyms, and genetic testing. STUDY SELECTION Following independent screening by 3 reviewers, 7 studies fulfilled the inclusion criteria, being a DCE investigating patient or public preferences related to predictive genetic testing for hereditary cancer syndromes. DATA EXTRACTION Extracted data included study and respondent characteristics, DCE attributes and levels, methods of data analysis and interpretation, and key study findings. DATA SYNTHESIS Studies covered colorectal, breast, and ovarian cancer syndromes. Results were summarized in a narrative synthesis and the quality assessed using the Lancsar and Louviere framework. LIMITATIONS This review focuses only on DCE design and testing for hereditary cancer syndromes rather than other complex diseases. Challenges also arose from heterogeneity in attributes and levels. CONCLUSIONS Test effectiveness and detection rates were consistently important to respondents and thus should be prioritized by policy makers. Accuracy, cost, and wait time, while also important, showed variation between studies, although overall reduction in cost may improve uptake. Patients and the public would be willing to pay for improved detection and clinician over insurance provider involvement. Future studies should seek to contextualize findings by considering the impact of sociodemographic characteristics, health system coverage, and insurance policies on preferences. HIGHLIGHTS Test effectiveness and detection rates are consistently important to respondents in genetic testing for hereditary cancer syndromes.Reducing the cost of genetic testing for hereditary cancer syndromes may improve uptake.Individuals are most willing to pay for a test that improves detection rates, identifies multiple cancers, and for which results are shared with a doctor rather than with an insurance provider.
Collapse
Affiliation(s)
- N. Morrish
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - T. Snowsill
- Health Economics Group, Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - A. Medina-Lara
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
10
|
Lin Y, Xie J, Wu D, Wang Y, Cai Y, Zhao Q, Zhang L, Li J, He W, Xu DR. Job preferences of Chinese primary health care workers: A discrete choice experiment. J Health Serv Res Policy 2024; 29:84-91. [PMID: 38108294 DOI: 10.1177/13558196231219386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting. METHODS In a discrete choice experiment, PHWs from 15 primary health care centers in Guangzhou, China, made trade-offs between several hypothetical job scenario combinations of salary, type of health institution, bianzhi (permanent post), work years required for promotion, career development and training opportunities, educational opportunities for children, and community respect. Based on the estimate of the mixed logit model, willingness to pay and policy simulations were applied to estimate the utility of each attribute. RESULTS Data were collected from 446 PHWs. The PHWs were willing to forgo Chinese Renminbi 2806.1 (US$ 438.5) per month to obtain better education opportunities for their children, making it the most important non-monetary factor. Their preferences were also influenced relatively more by salary, bianzhi, and community respect, than with the other attributes we tested for, work years required for promotion, career development and training opportunities, and type of health institution. CONCLUSION Salary is a robust predictive factor, while three non-monetary factors (opportunities for children's education, bianzhi, and community respect) are essential in retaining health workers in primary care.
Collapse
Affiliation(s)
- Yingxi Lin
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Jinfeng Xie
- Panyu Shiqiao Street Community Health Service Center, Guangzhou, China
| | - Dan Wu
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Yingyu Wang
- Haizhu Nanzhou Street Community Health Service Center, Gguangzhou, China
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Qing Zhao
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Lanping Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Jiaqi Li
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Wenjun He
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, SMU Institute for Global Health (SIGHT) and Center for World Health Organization Studies, School of Health Management and Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| |
Collapse
|
11
|
Zhu A, Tang R, Rajendran S, Hajian H, Aitken SJ. Prescriber decision-making on antithrombotic therapy after endovascular intervention for peripheral artery disease: a protocol for a discrete choice experiment. BMJ Open 2024; 14:e079668. [PMID: 38508643 PMCID: PMC10961582 DOI: 10.1136/bmjopen-2023-079668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a major risk factor for cardiovascular morbidity and mortality, despite surgical and endovascular treatments. Emerging evidence supports the use of immediate antithrombotic medications after endovascular intervention for PAD, however, there is a lack of consensus regarding choice and duration of antithrombotic therapy. Prescriber decision-making is a complex process, with prior studies demonstrating patient factors can influence variability in antithrombotic therapy for PAD. However, it remains unclear the relative contribution of these factors. This paper describes a planned study that aims to (1) determine the influence of patient factors on clinician preference for antithrombotic therapy following endovascular intervention and (2) compare differences in prescribing preferences between consultant vascular surgeons and trainees. METHODS AND ANALYSIS This cross-sectional survey will evaluate antithrombotic prescribing choices using a discrete choice experiment (DCE) that has been developed and piloted for this study. A list of attributes and levels was generated using a mixed-methods approach. This included an extensive literature review and semistructured interviews with prescribing clinicians. Following final selection of included attributes, specialised software was used to construct a D-efficient design for the DCE questionnaire. The electronic questionnaire will be administered to vascular trainees and consultant surgeons across Australia. These data will be analysed using multinomial logistic regression, treating the decision to prescribe antithrombotic therapy as a function of both the attributes of the two alternatives, as well as characteristics of the respondent. Latent class analysis will be used to explore heterogeneity of responses. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Sydney Human Ethics committee (2023/474). The results of this study will be published in peer-reviewed journals and presented at national vascular surgical conferences. These results will be used to improve understanding how clinicians make prescribing decisions and to inform future strategy to enhance guideline-directed prescribing.
Collapse
Affiliation(s)
- Alison Zhu
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Robert Tang
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Saissan Rajendran
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hamid Hajian
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| |
Collapse
|
12
|
Pestana J, Frutuoso J, Costa E, Fonseca F. Heterogeneity in physician's job preferences in a dual practice context - Evidence from a DCE. Soc Sci Med 2024; 343:116551. [PMID: 38242030 DOI: 10.1016/j.socscimed.2023.116551] [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: 07/07/2023] [Revised: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Many countries are facing challenges in recruiting and retaining physicians, particularly in regions where the public and private sectors compete for doctors. Understanding the factors influencing physicians' job choices can help inform policies aimed at attracting and retaining this valuable workforce. This study aims to elicit the strength of physicians' preferences regarding various job-related aspects, including earnings, time flexibility, discussion of clinical cases, frequency of facilities and equipment updates, training opportunities and autonomy in decision making. To achieve this, a Discrete Choice Experiment (DCE) was administered to 697 physicians. Each participant completed a series of eight choice tasks, where they had to choose between two hypothetical jobs differing in these attributes with levels mirroring positions in the public and private sectors in Portugal. The resulting choices were analysed using mixed logit, generalized multinomial logit and latent classes models to account for diverse unobserved variations in physicians' preferences and to explore preference heterogeneity across different observable characteristics. Jobs that offered more autonomy and training opportunities were strongly preferred, as physicians would require additional compensation to work with reduced autonomy (equivalent to 28.62% of gross income) or less frequent training (equivalent to 22.75%). This study also shows that the ranking of the job characteristics is similar between physicians working exclusively in the public sector and those engaged in dual practice. Nevertheless, public sector physicians place more emphasis on the availability of frequent training possibilities and frequent updates of facilities and equipment compared to their counterparts in dual practice. These findings contribute to existing knowledge by highlighting the significance of non-monetary attributes and shedding light on the preferences of physicians across various employment scenarios. They offer valuable insights for policy development aimed at influencing physicians' allocation of time between sectors.
Collapse
Affiliation(s)
- Joana Pestana
- Nova School of Business and Economics, Lisbon, Portugal.
| | - João Frutuoso
- Serviço de Medicina Intensiva do Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Eduardo Costa
- Nova School of Business and Economics, Lisbon, Portugal
| | | |
Collapse
|
13
|
Luo N, Bai R, Sun Y, Li X, Liu L, Xu X, Liu L. Job preferences of master of public health students in China: a discrete choice experiment. BMC MEDICAL EDUCATION 2024; 24:24. [PMID: 38178052 PMCID: PMC10768294 DOI: 10.1186/s12909-023-04993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The shortage of public health personnel and the uneven distribution between urban and rural areas are thorny issues in China. Master of public health (MPH) is an integral part of public health human resources in the future, and it is of far-reaching significance to discuss their work preferences. The present study wants to investigate the job preference of MPH, understand the relative importance of different job attributes, and then put forward targeted incentive measures. METHODS Discrete choice experiment (DCE) was used to evaluate the job preference of MPHs in two medical colleges in Liaoning Province. Attributes include employment location, bianzhi, working environment, career development prospects, work value and monthly income. Thirty-six choice sets were developed using a fractional factorial design. Mixed logit models were used to analysis the DCE data. RESULTS The final sample comprised 327 MPHs. All the attributes and levels included in the study are statistically significant. Monthly income is the most important factor for MPHs. For non-economic factors, they value career development prospects most, followed by the employment location. Respondents' preferences are heterogeneous and influenced by individual characteristics. Subgroup analysis showed that respondents from different family backgrounds have different job preferences. Policy simulation suggested that respondents were most sensitive to a salary increase, and the combination of several non-economic factors can also achieve the same effect. CONCLUSIONS Economic factors and non-economic factors significantly affect the job preference of MPHs. To alleviate the shortage and uneven distribution of public health personnel, more effective policy intervention should comprehensively consider the incentive measures of the work itself and pay attention to the individual characteristics and family backgrounds of the target object.
Collapse
Affiliation(s)
- Nansheng Luo
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Ru Bai
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Yu Sun
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xueying Li
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Libing Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xin Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004, Shenyang, Liaoning, China.
| | - Li Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China.
| |
Collapse
|
14
|
Mühlbacher AC, Sadler A, Juhnke C. Preferences for Monitoring Comprehensive Heart Failure Care: A Latent Class Analysis. THE PATIENT 2024; 17:83-95. [PMID: 38017336 PMCID: PMC10770186 DOI: 10.1007/s40271-023-00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To measure preference heterogeneity for monitoring systems among patients with a chronic heart failure. METHODS A best-worst scaling experiment (BWS case 3) was conducted among patients with chronic heart failure to assess preferences for hypothetical monitoring care scenarios. These were characterized by the attributes mobility, risk of death, risk of hospitalization, type and frequency of monitoring, risk of medical device, and system-relevant complications. A latent class analysis (LCA) was used to analyze and interpret the data. In addition, a market simulator was used to examine which treatment configurations participants in the latent classes preferred. RESULTS Data from 278 respondents were analyzed. The LCA identified four heterogeneous classes. For class 1, the most decisive factor was mobility with a longer distance covered being most important. Class 2 respondents directed their attention toward attribute "monitoring," with a preferred monitoring frequency of nine times per year. The attribute risk of hospitalization was most important for respondents of class 3, closely followed by risk of death. For class 4, however, risk of death was most important. A market simulation showed that, even with high frequency of monitoring, most classes preferred therapy with high improvement in mobility, mortality, and hospitalization. CONCLUSION Using LCA, variations in preferences among different groups of patients with chronic heart failure were examined. This allows treatment alternatives to be adapted to individual needs of patients and patient groups. The findings of the study enhance clinical and allocative decision-making while elevating the quality of clinical data interpretation.
Collapse
Affiliation(s)
- Axel C Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
- Gesellschaft für empirische Beratung GmbH (GEB), Freiburg, Germany.
- Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Andrew Sadler
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Christin Juhnke
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| |
Collapse
|
15
|
Vo LK, Allen MJ, Cunich M, Thillainadesan J, McPhail SM, Sharma P, Wallis S, McGowan K, Carter HE. Stakeholders' preferences for the design and delivery of virtual care services: A systematic review of discrete choice experiments. Soc Sci Med 2024; 340:116459. [PMID: 38048738 DOI: 10.1016/j.socscimed.2023.116459] [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: 05/11/2023] [Revised: 09/27/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023]
Abstract
This systematic review aimed to synthesise evidence from discrete choice experiments (DCEs) eliciting preferences for virtual models of care, as well as to assess the quality of those DCEs and compare the relative preferences for different stakeholder groups. Articles were included if published between January 2010 and December 2022. Data were synthesised narratively, and attributes were assessed for frequency, significance, and relative importance using a semi-quantitative approach. Overall, 21 studies were included encompassing a wide range of virtual care modalities, with the most common setting being virtual consultations for outpatient management of chronic conditions. A total of 135 attributes were identified and thematically classified into six categories: service delivery, service quality, technical aspects, monetary aspects, health provider characteristics and health consumer characteristics. Attributes related to service delivery were most frequently reported but less highly ranked. Service costs were consistently significant across all studies where they appeared, indicating their importance to the respondents. All studies examining health providers' preferences reported either system performance or professional endorsement attributes to be the most important. Substantial heterogeneity in attribute selection and preference outcomes were observed across studies reporting on health consumers' preferences, suggesting that the consideration of local context is important in the design and delivery of person-centred virtual care services. In general, the experimental design and analysis methods of included studies were clearly reported and justified. An improvement was observed in the quality of DCE design and analysis in recent years, particularly in the attribute development process. Given the continued growth in the use of DCEs within healthcare settings, further research is needed to develop a standardised approach for quantitatively synthesising DCE findings. There is also a need for further research on preferences for virtual care in post-pandemic contexts, where emerging evidence suggests that preferences may differ to those observed in pre-pandemic times.
Collapse
Affiliation(s)
- Linh K Vo
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Social Work and Public Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Michelle J Allen
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Social Work and Public Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health, Sydney Medical School, Central Clinical School Central Sydney (Patyegarang) Precinct, The University of Sydney, John Hopkins Dr, Camperdown, NSW, 2006, Australia; Sydney Health Economics Collaborative, Sydney Local Health District, King George V Building, Camperdown, NSW, 2050, Australia; Implementation and Policy, Cardiovascular Initiative, The University of Sydney, Camperdown, NSW, 2050, Australia; Sydney Institute for Women, Children and Their Families, 18 Marsden Street, Camperdown, NSW, 2050, Australia.
| | - Janani Thillainadesan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Hospital, Hospital Rd, Concord, NSW, 2139, Australia; Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown, NSW, 2050, Australia.
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Social Work and Public Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia; Digital Health and Informatics Directorate, Metro South Health, Ipswich Road, QLD, 4102, Australia.
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Social Work and Public Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Shannon Wallis
- Preventative and Prison Health Services, West Moreton Health, 2 Bell Street, Ipswich, QLD, 4305, Australia.
| | - Kelly McGowan
- Preventative and Prison Health Services, West Moreton Health, 2 Bell Street, Ipswich, QLD, 4305, Australia.
| | - Hannah E Carter
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Social Work and Public Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| |
Collapse
|
16
|
Tian Z, Guo W, Zhai M, Li H. Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China. BMC MEDICAL EDUCATION 2023; 23:890. [PMID: 38012762 PMCID: PMC10680353 DOI: 10.1186/s12909-023-04873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute. METHODS Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute. RESULTS A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students. CONCLUSIONS The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.
Collapse
Affiliation(s)
- Zhuang Tian
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Wei Guo
- Public Health Service Center in Rencheng District, Jining, 272412, China
| | - Min Zhai
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Hongmin Li
- School of Public Health, Jining Medical University, Jining, 272067, China.
| |
Collapse
|
17
|
Sharma P, Kularatna S, Abell B, Eagleson K, Vo LK, Halahakone U, Senanayake S, McPhail SM. Preferences in the Design and Delivery of Neurodevelopmental Follow-Up Care for Children: A Systematic Review of Discrete Choice Experiments. Patient Prefer Adherence 2023; 17:2325-2341. [PMID: 37745632 PMCID: PMC10517687 DOI: 10.2147/ppa.s425578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Neurodevelopmental disorders are a significant cause of morbidity. Early detection of neurodevelopmental delay is essential for timely diagnosis and intervention, and it is therefore important to understand the preferences of parents and clinicians for engaging with neurodevelopmental surveillance and follow-up care. Discrete choice experiment (DCE) may be an appropriate method for quantifying these preferences. This review systematically examined how DCEs have been designed and delivered in studies examining neurodevelopmental care of children and identified the preferred attributes that have been reported. PubMed, Embase, CINAHL, and Scopus databases were systematically searched. Studies were included if they used DCE to elicit preferences for a neurodevelopmental follow-up program for children. Two independent reviewers conducted the title and abstract and full-text screening. Risk of bias was assessed using a DCE-specific checklist. Findings were presented using a narrative synthesis. A total of 6618 records were identified and 16 papers were included. Orthogonal (n=5) and efficient (n=5) experimental designs were common. There was inconsistent reporting of design-related features. Analysis was primarily completed using mixed logit (n=6) or multinomial logit (n=3) models. Several key attributes for neurodevelopmental follow-up care were identified including social, behavioral and emotional support, therapy, waiting time, and out-of-pocket costs. DCE has been successfully used as a preference elicitation method for neurodevelopmental-related care. There is scope for improvement in the design and analysis of DCE in this field. Nonetheless, attributes identified in these studies are likely to be important considerations in the design and implementation of programs for neurodevelopmental care.
Collapse
Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Linh K Vo
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ureni Halahakone
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| |
Collapse
|
18
|
Meusel V, Mentzakis E, Baji P, Fiorentini G, Paolucci F. Priority setting in the German healthcare system: results from a discrete choice experiment. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:411-431. [PMID: 37184821 PMCID: PMC10462569 DOI: 10.1007/s10754-023-09347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/04/2023] [Indexed: 05/16/2023]
Abstract
Worldwide, social healthcare systems must face the challenges of a growing scarcity of resources and of its inevitable distributional effects. Explicit criteria are needed to define the boundaries of public reimbursement decisions. As Germany stands at the beginning of such a discussion, more formalised priority setting procedures seem in order. Recent research identified multi-criteria decision analysis (MCDA) as a promising approach to inform and to guide decision-making in healthcare systems. In that regard, this paper aims to analyse the relative weight assigned to various criteria in setting priority interventions in Germany. A discrete choice experiment (DCE) was employed in 2015 to elicit equity and efficiency preferences of 263 decision makers, through six attributes. The experiment allowed us to rate different policy interventions based on their features in a composite league table (CLT). As number of potential beneficiaries, severity of disease, individual health benefits and cost-effectiveness are the most relevant criteria for German decision makers within the sample population, the results display an overall higher preference towards efficiency criteria. Specific high priority interventions are mental disorders and cardiovascular diseases.
Collapse
Affiliation(s)
- V Meusel
- Faculty of Medicine, FAU Erlangen-Nürnberg, Erlangen, Germany.
| | - E Mentzakis
- Department of Economics, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - P Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - G Fiorentini
- Department of Economics, University of Bologna, Bologna, Italy
| | - F Paolucci
- Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University, Perth, WA, Australia
- Department of Sociology and Law & Economics, University of Bologna, Bologna, Italy
| |
Collapse
|
19
|
Alamri AS, Georgiou S, Stylianou S. Discrete choice experiments: An overview on constructing D-optimal and near-optimal choice sets. Heliyon 2023; 9:e18256. [PMID: 37539251 PMCID: PMC10393626 DOI: 10.1016/j.heliyon.2023.e18256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Discrete choice experiments (DCEs) are frequently used to estimate and forecast the behavior of an individual's choice. DCEs are based on stated preference; therefore, underlying experimental designs are required for this type of study. According to psychologists, DCE designs consist of a small number of choice sets with a limited size in the number of alternatives within a choice set to increase the response efficiency in the questionnaire. Even though algorithmic constructions (known as efficient designs) become quite common for practitioners, optimal designs (sometimes so-called orthogonal designs) continue to be used in choice experiment studies, particularly in the case that prior information about the extent of the population preference is not available. Various approaches have been developed to construct DCE designs with fewer choice sets. However, the question in many practitioners' minds is which techniques perform better (i.e. given small designs with high efficiency) in a given circumstance. In this paper and to address these concerns, we conducted an overview of the constructions of discrete choice experiments in the literature for models with only main effects. The various ways of constructing optimal and near-optimal designs were compared in terms of their ability to minimize the number of choice sets in the survey. Our findings shed light on the optimal sample sizes needed for efficient experimentation which then can help the researchers to design more effective experiments in this area.
Collapse
Affiliation(s)
- Abdulrahman S. Alamri
- School of Science, Royal Melbourne Institute of Technology University, Melbourne, VIC, 3000, Australia
- Department of Statistics, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Stelios Georgiou
- School of Science, Royal Melbourne Institute of Technology University, Melbourne, VIC, 3000, Australia
| | - Stella Stylianou
- School of Science, Royal Melbourne Institute of Technology University, Melbourne, VIC, 3000, Australia
| |
Collapse
|
20
|
Yu Z, Chen Y, Xia Q, Qu Q, Dai T. Identification of status quo and association rules for chronic comorbidity among Chinese middle-aged and older adults rural residents. Front Public Health 2023; 11:1186248. [PMID: 37325337 PMCID: PMC10267321 DOI: 10.3389/fpubh.2023.1186248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Background Chronic comorbidity has become a major challenge in chronic disease prevention and control. This issue is particularly pronounced in rural areas of developing countries, where the prevalence of chronic disease comorbidity is high, especially among middle-aged and older adults populations. However, the health status of middle-aged and older adults individuals in rural areas of China has received inadequate attention. Therefore, it is crucial to investigate the correlation among chronic diseases to establish a reference basis for adjusting health policies aimed at promoting the prevention and management of chronic diseases among middle-aged and older adults individuals. Methods This study selected 2,262 middle-aged and older adults residents aged 50 years or older in Shangang Village, Jiangsu Province, China, as the study population. To analyze the chronic comorbidity of middle-aged and older adults residents with different characteristics, we used the χ2 test with SPSS statistical software. Data analysis was conducted using the Apriori algorithm of Python software, set to mine the strong association rules of positive correlation between chronic disease comorbidities of middle-aged and older adults residents. Results The prevalence of chronic comorbidity was 56.6%. The chronic disease comorbidity group with the highest prevalence rate was the lumbar osteopenia + hypertension group. There were significant differences in the prevalence of chronic disease comorbidity among middle-aged and older adults residents in terms of gender, BMI, and chronic disease management. The Apriori algorithm was used to screen 15 association rules for the whole population, 11 for genders, and 15 for age groups. According to the order of support, the most common association rules of comorbidity of three chronic diseases were: {lumbar osteopenia} → {hypertension} (support: 29.22%, confidence: 58.44%), {dyslipidemia} → {hypertension} (support: 19.14%, confidence: 65.91%) and {fatty liver} → {hypertension} (support: 17.82%, confidence: 64.17%). Conclusion The prevalence of chronic comorbidity among middle-aged and older adults rural residents in China is relatively high. We identified many association rules among chronic diseases, dyslipidemia is mostly the antecedent, and hypertension is primarily the result. In particular, the majority of comorbidity aggregation patterns consisted of hypertension and dyslipidemia. By implementing scientifically-proven prevention and control strategies, the development of healthy aging can be promoted.
Collapse
Affiliation(s)
- Zijing Yu
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Yuquan Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Qianhang Xia
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Qingru Qu
- PBC School of Finance, Tsinghua University, Beijing, China
| | - Tao Dai
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
21
|
Kularatna S, Allen M, Hettiarachchi RM, Crawford-Williams F, Senanayake S, Brain D, Hart NH, Koczwara B, Ee C, Chan RJ. Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment. THE PATIENT 2023:10.1007/s40271-023-00631-0. [PMID: 37213062 DOI: 10.1007/s40271-023-00631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVE It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. METHODS Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. RESULTS Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors' preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. CONCLUSIONS Attributes identified can be used in future DCE studies to elicit cancer survivors' preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.
Collapse
Affiliation(s)
- Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Michelle Allen
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Ruvini M Hettiarachchi
- Centre for the Business and Economics of Health, The University of Queensland, QLD, Brisbane, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - David Brain
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carolyn Ee
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| |
Collapse
|
22
|
Arora N, Dit Sourd RC, Quaife M, Vassall A, Ferrari G, Alangea DO, Tawiah T, Dwommoh Prah RK, Jewkes R, Hanson K, Torres Rueda S. The stated preferences of community-based volunteers for roles in the prevention of violence against women and girls in Ghana: A discrete choice analysis. Soc Sci Med 2023; 324:115870. [PMID: 37012185 DOI: 10.1016/j.socscimed.2023.115870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
Violence against women and girls (VAWG) is a human rights violation with substantial health-related consequences. Interventions to prevent VAWG, often implemented at the community level by volunteers, have been proven effective and cost-effective. One such intervention is the Rural Response System in Ghana, a volunteer-run program which hires community based action teams (COMBATs) to sensitise the community about VAWG and to provide counselling services in rural areas. To increase programmatic impact and maximise the retention of these volunteers, it is important to understand their preferences for incentives. We conducted a discrete choice experiment (DCE) among 107 COMBAT volunteers, in two Ghanaian districts in 2018, to examine their stated preferences for financial and non-financial incentives that could be offered in their roles. Each respondent answered 12 choice tasks, and each task comprised four hypothetical volunteering positions. The first three positions included different levels of five role attributes. The fourth option was to cease volunteering as a COMBAT volunteer (opt-out). We found that, overall, COMBAT volunteers cared most for receiving training in volunteering skills and three-monthly supervisions. These results were consistent between multinomial logit, and mixed multinomial logit models. A three-class latent class model fitted our data best, identifying subgroups of COMBAT workers with distinct preferences for incentives: The younger 'go getters'; older 'veterans', and the 'balanced bunch' encompassing the majority of the sample. The opt-out was chosen only 4 (0.3%) times. Only one other study quantitatively examined the preferences for incentives of VAWG-prevention volunteers using a DCE (Kasteng et al., 2016). Understanding preferences and how they vary between sub-groups can be leveraged by programme managers to improve volunteer motivation and retention. As effective VAWG-prevention programmes are scaled up from small pilots to the national level, data on volunteer preferences may be useful in improving volunteer retention.
Collapse
Affiliation(s)
- Nikita Arora
- London School of Hygiene and Tropical Medicine, United Kingdom.
| | | | - Matthew Quaife
- London School of Hygiene and Tropical Medicine, United Kingdom.
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, United Kingdom.
| | | | | | | | | | - Rachel Jewkes
- South Africa Medical Research Council, South Africa.
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, United Kingdom.
| | | |
Collapse
|
23
|
Li Y, Howell JR, Cimiotti JP. Nurse practitioner job preference: A discrete choice experiment. Int J Nurs Stud 2023; 138:104407. [PMID: 36481595 PMCID: PMC9671868 DOI: 10.1016/j.ijnurstu.2022.104407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN A two-stage design using a mixed method approach. SETTING(S) The state of Georgia in the United States. PARTICIPANTS 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (β = -1.50); administration that was not very responsive and supportive (β = -1.04); being supervised by a physician (β = -0.58); not having their own panel of patients (β = -0.42); and not billing under their own National Provider Identifier (β = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.
Collapse
Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA,Corresponding author at: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30324, USA
| | - John R. Howell
- Department of Marketing and Global Supply Chain, Brigham Young University, Provo, UT, USA
| | | |
Collapse
|
24
|
O'Connell S, Queally M, Savage E, Murphy DM, Mc Carthy VJC. Preferences for support in managing symptoms of an asthma flare-up: a pilot study of a discrete choice experiment. J Asthma 2023; 60:393-402. [PMID: 35748303 DOI: 10.1080/02770903.2022.2054429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Information on the preferences of people with asthma for support in managing a flare-up can inform service design which may facilitate appropriate help-seeking. To date, little is known about support preferences for managing a flare-up. The aim of this study was to develop and pilot a discrete choice experiment (DCE) to elicit the preferences of people with asthma with regards to support in managing a flare-up.Methods: Steps in developing the DCE included identification and selection of attributes and levels of the support services, construction of choice tasks, experimental design, construction of DCE instrument, and pretest (n=16) and pilot (n=38) studies of the DCE instrument. A multinomial logit model was used to examine the strength and direction of the six attributes in the pilot study.Results: Our results indicate that from a patient perspective, having a healthcare professional that listens to their concerns was the most valued attribute of support in asthma flare-up management. The other features of support valued by participants were timely access to consultation, a healthcare professional with knowledge of their patient history, a specialist doctor and face-to-face communication. Having a written action plan was the least valued attribute.Conclusions: Our findings suggest patient preference for a model of support in managing their symptoms which includes timely, face-to-face access to a healthcare professional that knows them and listens to their concerns. The findings of the pilot study need to be verified with a larger sample and using models to account for preference heterogeneity.
Collapse
Affiliation(s)
- Selena O'Connell
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Michelle Queally
- Department of Enterprise and Technology, Galway Mayo Institute of Technology, Galway, Ireland
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Desmond M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | | |
Collapse
|
25
|
Xue T, Liu C, Li Z, Liu J, Tang Y. Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China. Front Public Health 2022; 10:1008217. [PMID: 36605239 PMCID: PMC9807867 DOI: 10.3389/fpubh.2022.1008217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to determine how primary care physicians weigh intervenable patient attributes in their decisions of antibiotic prescribing for upper respiratory tract infections (URTIs). Methods A discrete choice experiment (DCE) was conducted on 386 primary care physicians selected through a stratified cluster sampling strategy in Hubei province, China. The patient attributes tested in the DCE were identified through semi-structured interviews with 13 primary care physicians, while the choice scenarios were determined by a D-efficient design with a zero prior parameter value. Conditional logit models (CL) and mixed logit models (MXL) were established to determine the preference of the study participants in antibiotic prescribing for URTI patients with various attributes. Relative importance (RI) was calculated to reflect the influence of each attribute. Results In addition to age and duration of symptoms, the interventionable patient attributes were also considered by the primary care physicians in their antibiotic prescribing decisions. They preferred to prescribe antibiotics for URTI patients with difficulties to schedule a follow-up appointment (p < 0.001) and for those without a clear indication of refusal to antibiotics (p < 0.001). Patient request for antibiotics had an RI ranging from 15.2 to 16.3%, compared with 5.1-5.4% for easiness of follow-up appointment. The influence of these two interventionable patient attributes was most profound in the antibiotic prescribing decisions for patients aged between 60 and 75 years as indicated by their interaction effects with age (β = 0.69 for request for antibiotics, p < 0.01; β = -1.2 for easiness of follow-up, p < 0.001). Conclusion Reducing patient pressure and improving accessibility and continuity of care may help primary care physicians make rational antibiotic prescribing decisions for URTIs.
Collapse
Affiliation(s)
- Tianqin Xue
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Zhuoxian Li
- Medical Record Management Department, Yueyang Maternal and Child Health-Care Hospital, Yueyang, Hunan, China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China,*Correspondence: Yuqing Tang ✉
| |
Collapse
|
26
|
Kıyak YS, Budakoğlu Iİ, García-Estañ J, Atta K, Coşkun Ö, Koyun E. What do Turkish, Spanish, and Pakistani medical students value in specialty training positions? A discrete choice experiment. BMC MEDICAL EDUCATION 2022; 22:752. [PMID: 36320062 PMCID: PMC9628137 DOI: 10.1186/s12909-022-03798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/08/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of this study was to find out specialty training preferences of senior medical students from three medical schools in Turkey, Spain, and Pakistan. METHODS A Discrete Choice Experiment was carried out using an electronic form for students in three countries in 2021-2022 term. Each choice set in the form consisted of two hypothetical specialty training positions. The attributes were location, earnings, working conditions, personal perspective, quality of education, probability of malpractice, and prestige. Conditional logit model was used to estimate participants' preferences and "willingness to accept" values. RESULTS The most valued attribute was "personal perspective on specialty area" for Turkish and Spanish students, while this attribute was not meaningful for Pakistani students. Turkish students needed a 204% of change in their income for a swap between the specialty that they like and not like. This tradeoff necessitated a 300% change for Spanish students. The most valued attribute for Pakistani students, which was "working conditions", necessitated a 97% increase in income to switch from working in good conditions to working in poor conditions. CONCLUSION In this first multinational DCE study in the medical education literature, we found the preferences of medical students in Turkey, Spain, and Pakistan are affected to various extents by several factors.
Collapse
Affiliation(s)
- Yavuz Selim Kıyak
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Işıl İrem Budakoğlu
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Komal Atta
- Department of Medical Education, University Medical and Dental College, The University of Faisalabad, Faisalabad, Pakistan
| | - Özlem Coşkun
- Department of Medical Education and Informatics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emin Koyun
- Department of Cardiology, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
27
|
Ajisegiri WS, Peiris D, Abimbola S, Odusanya OO, Tesema AG, Joshi R, Angell B. It is not all about salary: a discrete-choice experiment to determine community health workers' motivation for work in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2022-009718. [PMID: 36270659 PMCID: PMC9594556 DOI: 10.1136/bmjgh-2022-009718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Community health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery. Methods A discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated. Results About 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs. Conclusion CHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.
Collapse
Affiliation(s)
- Whenayon Simeon Ajisegiri
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health, New Delhi, India
| | - Blake Angell
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| |
Collapse
|
28
|
Williams G, Kinchin I. The application of discrete choice experiments eliciting young peoples' preferences for healthcare: a systematic literature review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022:10.1007/s10198-022-01528-9. [PMID: 36169764 DOI: 10.1007/s10198-022-01528-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Understanding young people's preferences for healthcare is critical for reducing the negative effect of undesirable choices. This review aims to synthesise the evidence obtained from discrete choice experiments (DCEs) eliciting young people's preferences for healthcare interventions and service deliveries, specifically, to (1) examine the methodology, including a selection of attributes and levels, experimental design, estimation procedure and validity; (2) evaluate similarities, differences and rigour of designs to the general population DCEs; and, (3) compare the DCEs' application to the seven health priority areas defined by the World Health Organisation (WHO). METHODS A systematic review searching Medline, EconLIT, PsychINFO, Scopus, and Web of Science was performed up until May 2021. INCLUSION CRITERIA a DCE, eliciting young peoples' preferences (10-24 years of age), on a healthcare-related topic defined by WHO, peer-reviewed, full-text available in English. A bespoke checklist was used to assess the methodological quality of the included studies. RESULTS Eighteen DCE studies were included in the review, exploring interventions and service in sexual and reproductive health (n = 9; 50%), smoking cessation (n = 4; 22%), mental health (n = 1), nutrition (n = 1), unintentional injuries (n = 1), vaccination against severe but rare diseases (n = 1); and diabetes (n = 1). Compared to the general population, DCEs eliciting young people's preferences had a high proportion of monetary measures and a smaller number of choices per respondent with the overwhelming number of surveys using fractional factorial design. The majority of studies were of moderate quality (50-75% of the criteria met). CONCLUSIONS While identified DCEs touched on most health priority areas, the scope was limited. The conduct and reporting of DCEs with young people could be improved by including the state-of-the-art design, estimation procedures and analysis.
Collapse
Affiliation(s)
- Galina Williams
- School of Business, Accounting and Law, CQUniversity, Brisbane, Australia.
| | - Irina Kinchin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| |
Collapse
|
29
|
Hollin IL, Paskett J, Schuster ALR, Crossnohere NL, Bridges JFP. Best-Worst Scaling and the Prioritization of Objects in Health: A Systematic Review. PHARMACOECONOMICS 2022; 40:883-899. [PMID: 35838889 PMCID: PMC9363399 DOI: 10.1007/s40273-022-01167-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Best-worst scaling is a theory-driven method that can be used to prioritize objects in health. We sought to characterize all studies of best-worst scaling to prioritize objects in health, to assess trends of using best-worst scaling in prioritization over time, and to assess the relationship between a legacy measure of quality (PREFS) and a novel assessment of subjective quality and policy relevance. METHODS A systematic review identified studies published through to the end of 2021 that applied best-worst scaling to study priorities in health (PROSPERO CRD42020209745), updating a prior review published in 2016. The PubMed, EBSCOhost, Embase, Scopus, APA PsychInfo, Web of Science, and Google Scholar databases were used and were supplemented by a hand search. Data describing the application, development, design, administration/analysis, quality, and policy relevance were summarized and we tested for trends by comparing articles before and after 1 January, 2017. Multivariate statistics were then used to assess the relationships between PREFS, subjective quality, policy relevance, and other possible indicators. RESULTS From a total of 2826 unique papers identified, 165 best-worst scaling studies were included in this review. Applications of best-worst scaling to study priorities in health have continued to grow (p < 0.01) and are now used in all regions of the world, most often to study the priorities of patients/consumers (67%). Several key trends can be observed over time: increased use of pretesting (p < 0.05); increased use of online administration (p < 0.01), and decreased use of paper self-administered surveys (p = 0.02); increased use of heterogeneity analysis (p = 0.02); an increase in having a clearly stated purpose (p < 0.01); and a decrease in comparing respondents to non-respondents (p = 0.01). The average sample size has more than doubled, from 228 to 472 respondents, but formal sample size justifications remain low (5.3%) and unchanged over time (p = 0.68). While the average PREFS score remained unchanged at 3.1/5, both subjective quality and policy relevance trended up, but changes were not statistically significant (p = 0.06 and p = 0.13). Most of the variation in subjective quality was driven by PREFS (R2 = 0.42), but it was also positively assosciated with policy relevance, heterogeneity analysis, and using a balanced incomplete block design, and was negatively associated with not using developmental methods and an increasing sample size. CONCLUSIONS Using best-worst scaling to prioritize objects is now commonly used around the world to assess the priorities of patients and other stakeholders in health. Best practices are clearly emerging for best-worst scaling. Although legacy measures (PREFS) to measure study quality are reasonable, there may need to be new tools to assess both study quality and policy relevance.
Collapse
Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA
| | - Jonathan Paskett
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne L R Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.
| |
Collapse
|
30
|
Methodology to derive preference for health screening programmes using discrete choice experiments: a scoping review. BMC Health Serv Res 2022; 22:1079. [PMID: 36002895 PMCID: PMC9400308 DOI: 10.1186/s12913-022-08464-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/08/2022] [Indexed: 12/18/2022] Open
Abstract
Background While involving users in healthcare decision-making has become increasingly common and important, there is a lack of knowledge about how to best design community-based health screening programs. Reviews of methods that incorporate discrete choice experiments (DCEs) are scarce, particularly for non-cancer illnesses like cardiovascular disease, diabetes and liver disease. We provide an overview of currently available applications and methods available by using DCEs in health screening programs, for chronic conditions. Methods A scoping review was undertaken, where four electronic databases were searched for key terms to identify eligible DCE studies related to community health screening. We included studies that met a pre-determined criteria, including being published between 2011 and 2021, in English and reported findings on human participants. Data were systematically extracted, tabulated, and summarised in a narrative review. Results A total of 27 studies that used a DCE to elicit preferences for cancer (n = 26) and cardiovascular disease screening (n = 1) programmes were included in the final analysis. All studies were assessed for quality, against a list of 13 criteria, with the median score being 9/13 (range 5–12). Across the 27 studies, the majority (80%) had the same overall scores. Two-thirds of included studies reported a sample size calculation, approximately half (13/27) administered the survey completely online and over 75% used the general public as the participating population. Conclusion Our review has led to highlighting several areas of current practice that can be improved, particularly greater use of sample size calculations, increased use of qualitative methods, better explanation of the chosen experimental design including how choice sets are generated, and methods for analysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08464-7.
Collapse
|
31
|
Gadsden T, Sujarwoto S, Purwaningtyas N, Maharani A, Tampubolon G, Oceandy D, Praveen D, Angell B, Jan S, Palagyi A. Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment. BMJ Glob Health 2022; 7:bmjgh-2022-008936. [PMID: 35953209 PMCID: PMC9379506 DOI: 10.1136/bmjgh-2022-008936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. Methods A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses. Results Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income. Conclusion CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
Collapse
Affiliation(s)
- Thomas Gadsden
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gindo Tampubolon
- Global Development Institute, The University of Manchester, Manchester, UK
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Devarsetty Praveen
- Better Care India, The George Institute for Global Health India, Hyderabad, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Blake Angell
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Palagyi
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| |
Collapse
|
32
|
Liu R, Lu Y, Li Y, Wei W, Sun C, Zhang Q, Wang X, Wang J, Zhang N. Preference for endoscopic screening of upper gastrointestinal cancer among Chinese rural residents: a discrete choice experiment. Front Oncol 2022; 12:917622. [PMID: 35965546 PMCID: PMC9363665 DOI: 10.3389/fonc.2022.917622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background The low uptake rate of upper gastrointestinal cancer (UGC) screening substantially reduces the benefits of endoscopic screening. This study aimed to obtain residents’ UGC screening preferences to optimize screening strategies and increase the participation rate. Methods A discrete choice experiment (DCE) was conducted to assess UGC screening preferences of 1,000 rural residents aged 40 to 70 years from three countries (Linqu, Feicheng, and Dongchangfu) of Shandong province in China. The DCE questionnaire was developed from five attributes: out-of-pocket costs, screening interval, regular follow-up for precancerous lesions, mortality reduction, and screening technique. The data from the DCE were analyzed within the framework of random utility theory using a mixed logit model. Results In total, 926 of 959 residents who responded were analyzed. The mean (SD) age was 57.32 (7.22) years. The five attributes all significantly affected residents’ preferences, and the painless endoscopy had the most important impact (β=2.927, P<0.01), followed by screening interval of every year (β = 1.184, P<0.01). Policy analyses indicated that switching the screening technique to painless endoscopy would increase the participation rate up to 89.84% (95%CI: 87.04%-92.63%). Residents aged 40–49, with a history of cancer, with a family income of more than ¥30,000 were more likely to participate in a screening. Conclusions UGC screening implementation should consider residents’ preferences to maximize the screening participation rate. Resources permitting, we can carry out the optimal screening program with shorter screening intervals, lower out-of-pocket costs, less pain, follow-up, and higher UGC mortality reduction.
Collapse
Affiliation(s)
- Ruyue Liu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Youhua Lu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yifan Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wenjian Wei
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chen Sun
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qianqian Zhang
- School of Public Health, Shandong University, Jinan, China
| | - Xin Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jialin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Nan Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Nan Zhang,
| |
Collapse
|
33
|
Wu P, Li Z, Guo W, Wang L, Chang X, Zhang Y, Wang L, Wang L, Liu Q. Optimizing the Practice Environment for Medical Staff in the Post-pandemic Era: A Discrete Choice Experiment. Front Public Health 2022; 10:911868. [PMID: 35923954 PMCID: PMC9340264 DOI: 10.3389/fpubh.2022.911868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to elicit the stated job preferences of Chinese medical staff in the post-pandemic era and identify the relative importance of different factors in the practice environment. Methods We used an online discrete choice experiment (DCE) survey instrument to elicit the job preferences of medical staff (doctors and nurses) in tertiary hospitals in Anhui, China. Attributes and levels were generated using qualitative methods, and four attributes were considered: career development, workload, respect from society, and monthly income. A set of profiles was created using a D-efficient design. The data were analyzed considering potential preference heterogeneity, using the conditional logit model and the latent class logit (LCL) model. Results A total of 789 valid questionnaires were included in the analysis, with an effective response rate of 73.33%. Career development, workload, respect from society, and monthly income were significant factors that influenced job preferences. Three classes were identified based on the LCL model, and preference heterogeneity among different medical staff was demonstrated. Class 1 (16.17%) and Class 2 (43.51%) valued respect from society most, whereas Class 3 (40.32%) prioritized monthly income. We found that when respect from society was raised to a satisfactory level (50–75% positive reviews), the probability of medical staff choosing a certain job increased by 69.9%. Conclusion Respect from society was the most preferred attribute, while workload, monthly income, and career development were all key factors in the medical staff's job choices. The heterogeneity of the medical professionals' preferences shows that effective policy interventions should be customized to accommodate these drive preferences.
Collapse
Affiliation(s)
- Peilin Wu
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Zhenjing Li
- Postgraduate Affairs Department of the Party Committee, Anhui Medical University, Hefei, China
| | - Wei Guo
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Li Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Xiangxiang Chang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Yanqun Zhang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Li Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Lidan Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
- Center for Health Policy Research, Anhui Medical University, Hefei, China
- *Correspondence: Lidan Wang
| | - Qunying Liu
- Medical Humanities Research Center, Anhui Medical University, Hefei, China
| |
Collapse
|
34
|
Factors influencing attraction and retention of frontline health workers in remote and rural areas in Nigeria: a discrete choice experiment. J Public Health Policy 2022; 43:347-359. [DOI: 10.1057/s41271-022-00351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/21/2022]
|
35
|
Liu S, Gu Y, Yang Y, Schroeder E, Chen Y. Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey. HUMAN RESOURCES FOR HEALTH 2022; 20:46. [PMID: 35606873 PMCID: PMC9125964 DOI: 10.1186/s12960-022-00743-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China. METHODS A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children's education opportunities, working environment, career promotion speed and bianzhi (formally established post). RESULTS A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed). CONCLUSION Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.
Collapse
Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109 Australia
| | - Yi Yang
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Elizabeth Schroeder
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109 Australia
- Department of Health Systems and Populations, Macquarie University, Macquarie Park, NSW 2109 Australia
| | - Yingyao Chen
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| |
Collapse
|
36
|
Arora N, Quaife M, Hanson K, Lagarde M, Woldesenbet D, Seifu A, Crastes dit Sourd R. Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non-attendance from taste heterogeneity. HEALTH ECONOMICS 2022; 31:806-819. [PMID: 35178825 PMCID: PMC9305885 DOI: 10.1002/hec.4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
When measuring preferences, discrete choice experiments (DCEs) typically assume that respondents consider all available information before making decisions. However, many respondents often only consider a subset of the choice characteristics, a heuristic called attribute non-attendance (ANA). Failure to account for ANA can bias DCE results, potentially leading to flawed policy recommendations. While conventional latent class logit models have most commonly been used to assess ANA in choices, these models are often not flexible enough to separate non-attendance from respondents' low valuation of certain attributes, resulting in inflated rates of ANA. In this paper, we show that semi-parametric mixtures of latent class models can be used to disentangle successfully inferred non-attendance from respondent's "weaker" taste sensitivities for certain attributes. In a DCE on the job preferences of health workers in Ethiopia, we demonstrate that such models provide more reliable estimates of inferred non-attendance than the alternative methods currently used. Moreover, since we find statistically significant variation in the rates of ANA exhibited by different health worker cadres, we highlight the need for well-defined attributes in a DCE, to ensure that ANA does not result from a weak experimental design.
Collapse
Affiliation(s)
- Nikita Arora
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Matthew Quaife
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Kara Hanson
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Mylene Lagarde
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | | | - Abiy Seifu
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | | |
Collapse
|
37
|
Ashaye A, Thomas C, Dalal M, Kota V, Krucien N, Sae-Hau M, Weiss E, Campbell S, Marsh K. Patient preferences for frontline therapies for Philadelphia chromosome-positive acute lymphoblastic leukemia: a discrete choice experiment. Future Oncol 2022; 18:2075-2085. [PMID: 35209721 DOI: 10.2217/fon-2022-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: We examined the preferences of adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) for benefits and risks of tyrosine kinase inhibitors combined with chemotherapy for first-line treatment. Methods: In a discrete choice experiment, 201 patients chose between hypothetical treatment alternatives with varied levels of remission duration and overall survival (OS), and risks of major cardiovascular (CV) events and myelosuppression. Results: Although OS was the most important attribute to patients with Ph+ ALL, they were willing to tolerate a 2.9% increase in CV risk for 1 additional month of OS. Older patients (>59 years) and patients not in remission were less likely to tolerate increased CV risk. Conclusion: Preferences and risk tolerance varied between patients, highlighting the importance of shared decision making when selecting treatments for Ph+ ALL.
Collapse
Affiliation(s)
- Ajibade Ashaye
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Mehul Dalal
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | - Vamsi Kota
- Section of Hematology & Oncology, Georgia Cancer Center at Augusta University, Augusta, GA 30912, USA
| | | | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Scott Campbell
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | |
Collapse
|
38
|
Witter S, Herbst CH, Smitz M, Balde MD, Magazi I, Zaman RU. How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea. PLoS One 2021; 16:e0245569. [PMID: 34914691 PMCID: PMC8675729 DOI: 10.1371/journal.pone.0245569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.
Collapse
Affiliation(s)
- Sophie Witter
- Institute of Global Health and Development & ReBUILD for Resilience, Queen Margaret University, Edinburgh, United Kingdom
- Oxford Policy Management, Oxford, United Kingdom
- * E-mail:
| | | | - Marc Smitz
- Oxford Policy Management, Oxford, United Kingdom
| | - Mamadou Dioulde Balde
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Conakry, Guinea
| | | | | |
Collapse
|
39
|
Cleland Jennifer A, Porteous T, Ourega-Zoé E, Mandy R, Skåtun D. Won't you stay just a little bit longer? A discrete choice experiment of UK doctors' preferences for delaying retirement. Health Policy 2021; 126:60-68. [PMID: 34887102 DOI: 10.1016/j.healthpol.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND AIMS Health systems around the world face difficulties retaining their workforce, which is exacerbated by the early retirement of experienced clinicians. This study aims to determine how to incentivise doctors to delay their retirement. METHODS We used a discrete choice experiment to estimate the relative importance of job characteristics in doctors' willingness to delay retirement, and the number of extra years they were willing to delay retirement when job characteristics improved. 2885 British Medical Association members aged between 50 and 70 years, registered with the General Medical Council, practising in Scotland (in December 2019), and who had not started to draw a pension were invited. We compared the preferences of hospital doctors (HDs) and general practitioners (GPs). RESULTS The response rate was 27.4% (n = 788). The number of extra years expected to work was the most important job characteristic for both respondents, followed by work intensity for GPs, whereas working hours and on-call were more important for HDs. Personalised working conditions and pension taxation were the least important characteristics for both groups. Setting all characteristics to their BEST levels, GPs would be willing to delay retirement by 4 years and HDs by 7 years. CONCLUSIONS Characteristics related to the job rather than pension could have the greatest impact on delaying retirement among clinicians.
Collapse
Affiliation(s)
- Anne Cleland Jennifer
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University Singapore, 308232, Singapore.
| | - Terry Porteous
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
| | - Ejebu Ourega-Zoé
- School of Health Sciences, University Road, University of Southampton, SO17 1BJ, UK
| | - Ryan Mandy
- Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
| | - Diane Skåtun
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
| |
Collapse
|
40
|
Lamba S, Arora N, Keraga DW, Kiflie A, Jembere BM, Berhanu D, Dubale M, Marchant T, Schellenberg J, Umar N, Estafinos AS, Quaife M. Stated job preferences of three health worker cadres in Ethiopia: a discrete choice experiment. Health Policy Plan 2021; 36:1418-1427. [PMID: 34313307 PMCID: PMC8505867 DOI: 10.1093/heapol/czab081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/24/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Attracting, training and retaining high-quality health workers are critical for a health system to function well, and it is important to know what health workers value in their roles. Many studies eliciting the labour market preferences of health workers have interviewed doctors or medical students, and there has been little research on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient facing staff who manage health facilities. This study estimated the job preferences of public health sector community health extension workers (HEWs), care providers including nurses and midwives, and non-patient-facing administrative and managerial staff in Ethiopia. We used a discrete choice experiment to estimate which aspects of a job are most influential to health worker choices. A multinomial logistic regression model estimated the importance of six attributes to respondents: salary, training, workload, facility quality, management and opportunities to improve patient outcomes. We found that non-financial factors were important to respondents from all three cadres: e.g., supportive management [odds ratio (OR) = 2.96, P-value = 0.001] was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities (OR = 3.45, P-value < 0.001), supportive management (OR = 3.26, P-value < 0.001) and good facility quality (OR = 2.42, P-value < 0.001) were valued the most amongst HEWs. Similarly, supportive management (OR = 3.22, P-value < 0.001), good facility quality (OR = 2.69, P-value < 0.001) and training opportunities (OR = 2.67, P-value < 0.001) influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices of HEWs (OR = 1.43, P-value = 0.02) and care providers (OR = 2.00, P-value < 0.001), which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.
Collapse
Affiliation(s)
- Shyam Lamba
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Nikita Arora
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Abiyou Kiflie
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Della Berhanu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mehret Dubale
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Tanya Marchant
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Nasir Umar
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Abiy Seifu Estafinos
- School of Public Health, Addis Ababa University, P.O. Box: 9086, Addis Ababa, Ethiopia
| | - Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| |
Collapse
|
41
|
What Are the Important Factors Influencing the Recruitment and Retention of Doctoral Students in a Public Health Setting? A Discrete Choice Experiment Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189474. [PMID: 34574396 PMCID: PMC8467983 DOI: 10.3390/ijerph18189474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
Objectives: This study aims to investigate the employment preferences of doctoral students majoring in social medicine and health care management (SMHCM), to inform policymakers and future employers on how to address recruitment and retention requirements at CDCs across China. Methods: An online discrete choice experiment (DCE) was conducted to elicit doctoral SMHCM students’ job preferences. The scenarios were described with seven attributes: monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed, and bianzhi. A conditional logit model and a mixed logit model were used to evaluate the relative importance of the selected attributes. Results: A total of 167 doctoral SMHCM students from 24 universities completed the online survey. All seven attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income and employment location were of most concern for doctoral SMHCM students when deciding their future jobs. Among the presented attributes, working environment was of least concern. For the sub-group analysis, employment located in a first-tier city was more likely to lead to a higher utility value for doctoral students who were women, married, from an urban area, and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. Conclusions: Our study suggests that monthly income and employment location were valued most by doctoral SMHCM students when choosing a job. A more effective human resource policy intervention to attract doctoral SMHCM students to work in CDCs, especially CDCs in third-tier cities should consider both the incentives provided by the job characteristics and the background of students. Doctoral students are at the stages of career preparation, so the results of this study would be informative for policymakers and help them to design the recruitment and retention policies for CDCs.
Collapse
|
42
|
Diks ME, Hiligsmann M, van der Putten IM. Vaccine preferences driving vaccine-decision making of different target groups: a systematic review of choice-based experiments. BMC Infect Dis 2021; 21:879. [PMID: 34454441 PMCID: PMC8397865 DOI: 10.1186/s12879-021-06398-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Choice-based experiments have been increasingly used to elicit preferences for vaccines and vaccination programs. This study aims to systematically identify and examine choice-based experiments assessing (differences in) vaccine preferences of vaccinees, representatives and health advisors. METHODS Five electronic databases were searched on choice-based conjoint analysis studies or discrete choice experiments capturing vaccine preferences of children, adolescents, parents, adults and healthcare professionals for attributes of vaccines or vaccine settings up to September 2020. Data was extracted using a standardized form covering all important aspects of choice experiments. A quality assessment was used to assess the validity of studies. Attributes were categorized into outcome, process, cost and other. The importance of attributes was assessed by the frequency of reporting and statistical significance. Results were compared between high-quality studies and lower-quality studies. RESULTS A total of 42 studies were included, with the majority conducted in high-income countries after 2010 (resp. n = 34 and n = 37). Preferences of representatives were studied in nearly half of the studies (47.6%), followed by vaccinees (35.7%) and health advisors (9.5%). Sixteen high-quality studies passed the quality assessment. Outcome- and cost- related attributes such as vaccine effectiveness, vaccine risk, cost and protection duration were most often statistically significant across both target groups, with vaccine effectiveness being the most important. Risks associated with vaccination, such as side effects, were more often statistically significant in studies targeting vaccinees, while cost-related attributes were more often statistically significant in studies of representatives. Process-related attributes such as vaccine accessibility and time were least important across both target groups. CONCLUSION To our knowledge, this is the first systematic review in which vaccine preferences of different target groups were assessed and compared. The same attributes were most important for vaccine decisions of vaccinees and representatives, with only minor differences in level of evidence for vaccine risk and cost. Future research on vaccine preferences of health advisors and/or among target groups in low-resource settings would give insight into the generalizability of current findings.
Collapse
Affiliation(s)
- Marilyn Emma Diks
- Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229, Maastricht, Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229, Maastricht, Netherlands
| | - Ingeborg Maria van der Putten
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229, Maastricht, Netherlands.
| |
Collapse
|
43
|
Esu EB, Chibuzor M, Aquaisua E, Udoh E, Sam O, Okoroafor S, Ongom M, Effa E, Oyo-Ita A, Meremikwu M. Interventions for improving attraction and retention of health workers in rural and underserved areas: a systematic review of systematic reviews. J Public Health (Oxf) 2021; 43:i54-i66. [PMID: 33856468 DOI: 10.1093/pubmed/fdaa235] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/04/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. METHODS This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. RESULTS There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rural students and rural placements improved attraction and retention although most studies were without control groups, which made conclusions on effectiveness difficult. CONCLUSIONS Cost-effective utilization of limited resources and the adoption and implementation of evidence-based health workforce policies and interventions that are tailored to meet national health system contexts and needs are essential.
Collapse
Affiliation(s)
- E B Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - M Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Aquaisua
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Cross River Health & Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - E Udoh
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Paediatrics Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
| | - O Sam
- Universal Health Coverage/Life Course, World Health Organization Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - S Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - M Ongom
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - E Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - A Oyo-Ita
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| |
Collapse
|
44
|
Angell B, Khan M, Islam R, Mandeville K, Naher N, Hutchinson E, McKee M, Ahmed SM, Balabanova D. Incentivising doctor attendance in rural Bangladesh: a latent class analysis of a discrete choice experiment. BMJ Glob Health 2021; 6:bmjgh-2021-006001. [PMID: 34326070 PMCID: PMC8323362 DOI: 10.1136/bmjgh-2021-006001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at their posts. Methods We conducted a discrete choice experiment with 308 doctors across four hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included based on a literature review, qualitative research and a consensus-building workshop with policymakers and key health-system stakeholders: relationship with the community, security measures, attendance-based policies and incentive payments. Respondents’ choices were analysed with mixed multinomial logistic and latent class models and were used to simulate the likely uptake of jobs under different policy packages. Results All attributes significantly impacted doctor choices (p<0.01). Doctors strongly preferred jobs at rural facilities where there was a supportive relationship with the community (β=0.93), considered good attendance in education and training (0.77) or promotion decisions (0.67), with functional security (0.67) and higher incentive payments (0.5 per 10% increase of base salary). Jobs with disciplinary action for poor attendance were disliked by respondents (−0.63). Latent class analysis identified three groups of doctors who differed in their uptake of jobs. Scenario modelling identified intervention packages that differentially impacted doctor behaviour and combinations that could feasibly improve doctors’ attendance. Conclusion Bangladeshi doctors have strong but varied preferences over interventions to overcome absenteeism. We generated evidence suggesting that interventions considering the perspective of the doctors themselves could result in substantial reductions in absenteeism. Designing policy packages that take account of the different situations facing doctors could begin to improve their ability and motivation to be present at their job and generate sustainable solutions to absenteeism in rural Bangladesh.
Collapse
Affiliation(s)
- Blake Angell
- Health Systems Science, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia .,Institute for Global Health, University College London, London, UK
| | - Mushtaq Khan
- Economics and Head of Anti-Corruption Evidence Research Partnership Consortium (ACE), SOAS, London, UK
| | - Raihanul Islam
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kate Mandeville
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nahitun Naher
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eleanor Hutchinson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Dina Balabanova
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
45
|
Liu P, Liu S, Gong T, Li Q, Chen G, Li S. Job preferences of undergraduate pharmacy students in China: a discrete choice experiment. HUMAN RESOURCES FOR HEALTH 2021; 19:79. [PMID: 34229701 PMCID: PMC8259344 DOI: 10.1186/s12960-021-00626-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/29/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pharmacists are a crucial part of the health workforce and play an important role in achieving universal health coverage. In China, pharmaceutical human resources are in short supply, and the distribution is unequal. This study aimed to identify the key job characteristics that influence the job preferences of undergraduate pharmacy students and to elicit the relative importance of different job characteristics to shed light on future policy interventions. METHODS A discrete choice experiment was conducted to assess the job preferences of undergraduate pharmacy students from 6 provinces in mainland China. A face-to-face interview was used to collect data. Conditional logit and mixed logit models were used to analyse data, and the final model was chosen according to the model fit statistics. A series of policy simulations was also conducted. RESULTS In total, 581 respondents completed the questionnaire, and 500 respondents who passed the internal consistency test were analysed. All attributes were statistically significant except for open management. Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was preference heterogeneity among respondents, e.g., male students preferred open management, and female students preferred jobs in public institutions. Furthermore, students with an urban background or from a single-child family placed higher value on a job in the city compared to their counterparts. CONCLUSION The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of pharmacy students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of pharmacy school graduates.
Collapse
Affiliation(s)
- Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Tiantian Gong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
| | - Quan Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, 3145 Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
| |
Collapse
|
46
|
Cleland J, Johnston P. Putting spin on the great gamble. J R Coll Physicians Edinb 2021; 51:199-207. [PMID: 34131691 DOI: 10.4997/jrcpe.2021.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,
| | - Peter Johnston
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| |
Collapse
|
47
|
Mumbauer A, Strauss M, George G, Ngwepe P, Bezuidenhout C, de Vos L, Medina-Marino A. Employment preferences of healthcare workers in South Africa: Findings from a discrete choice experiment. PLoS One 2021; 16:e0250652. [PMID: 33909698 PMCID: PMC8081228 DOI: 10.1371/journal.pone.0250652] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
There is a maldistribution of human resources for health globally, with many Lower- and Middle-Income Countries experiencing significant shortages. We examined healthcare workers' job preferences in South Africa to identify factors which potentially influence employment decisions. A discrete choice experiment was conducted among 855 South African healthcare workers critical to its national HIV testing and treatment programs. Job characteristics included workload, workplace culture, availability of equipment, training opportunities, sector and facility type, location, salary and benefits. Main effects analysis was conducted using fixed effects logistic regression. Interaction effects identified divergence in preferences. Heavy workload (OR = 0.78; 95% C.I. 0.74-0.83), poor workplace culture (odds ratio 0.66; 95% C.I. 0.62-0.69), insufficient availability of equipment (OR = 0.67; 95% C.I. 0.63-0.70) and infrequent training opportunities (OR = 0.75; 95% C.I. 0.71-0.80) had large, significant effects on worker preferences. An increase in salary of 20% (OR = 1.29; 95% C.I. 1.16-1.44) had a positive effect on preferences, while a salary decrease of 20% (OR = 0.55; 95% C.I. 0.49-0.60) had a strong negative effect. Benefits packages had large positive effects on preferences: respondents were twice as likely to choose a job that included medical aid, pension and housing contributions worth 40% of salary (OR = 2.06; 95% C.I. 1.87-2.26), holding all else constant. Although salary was important across all cadres, benefits packages had larger effects on job preferences than equivalent salary increases. Improving working conditions is critical to attracting and retaining appropriate health cadres responsible for the country's HIV services, especially in the public sector and underserved, often rural, communities. Crucially, our evidence suggests that factors amenable to improvement such as workplace conditions and remuneration packages have a greater influence on healthcare workers employment decisions than employment sector or location.
Collapse
Affiliation(s)
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, East London, Eastern Cape, South Africa
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, East London, Eastern Cape, South Africa
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, Eastern Cape, South Africa
| | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, Eastern Cape, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
48
|
Sarikhani Y, Ostovar T, Rossi-Fedele G, Edirippulige S, Bastani P. A Protocol for Developing a Discrete Choice Experiment to Elicit Preferences of General Practitioners for the Choice of Specialty. Value Health Reg Issues 2021; 25:80-89. [PMID: 33845340 DOI: 10.1016/j.vhri.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Discrete choice experiment (DCE) has been increasingly used in studies investigating preferences of the health workforce. This pilot study aimed to provide a comprehensive protocol for design and quality assessment of a DCE to elicit preferences of general practitioners for the choice of specialty. METHODS We conducted 3 rigorous qualitative studies, including a review of literature, qualitative interviews, and focus group discussion to develop attributes and levels of the DCE. Then a D-efficient fractional factorial design was applied to generate choice tasks and to block them into 4 equal versions using SAS software. Two hundred and forty general practitioners participated in a pilot study conducted to evaluate the quality of the instrument using 7 tests. RESULTS The qualitative studies resulted in the development of 8 attributes and 24 levels. Experimental design led to the generation of 36 choice tasks divided into 4 blocks. The pilot study revealed that the instrument has validity and reliability and also indicated that the design is comprehensible and feasible. CONCLUSIONS This study provided an integrated, comprehensive framework for development and quality assessment of a DCE that could be used in other studies. The pilot study indicated that the instrument is of sufficient quality because it was developed using rigorous qualitative studies and accurate experimental design method.
Collapse
Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Ostovar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Peivand Bastani
- Health Human Recourses Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
49
|
Gottert A, McClair TL, Hossain S, Dakouo SP, Abuya T, Kirk K, Bellows B, Agarwal S, Kennedy S, Warren C, Sripad P. Development and validation of a multi-dimensional scale to assess community health worker motivation. J Glob Health 2021; 11:07008. [PMID: 33763222 PMCID: PMC7957275 DOI: 10.7189/jogh.11.07008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ensuring that Community Health Workers (CHWs) are motivated is critical to their performance, retention and well-being - and ultimately to the effectiveness of community health systems worldwide. While CHW motivation is as multi-dimensional construct, there is no multi-dimensional measure available to guide programming. In this study, we developed and validated a pragmatic, multi-dimensional measure of CHW motivation. METHODS Scale validation entailed qualitative and survey research in Mali and Bangladesh. We developed a pool of work satisfaction items as well as several items assessing the importance of hypothesized sub-dimensions of motivation, based on the literature and expert consultations. Qualitative research helped finalize scale sub-dimensions and items. We tested the scale in surveys with CHWs in Mali (n = 152, 40% female, mean age 32) and Bangladesh (n = 76 women, mean age 46). We applied a split-sample exploratory/confirmatory factor analysis (EFA/CFA) in Mali, and EFA in Bangladesh, then assessed reliability. We also gauged convergent/predictive validity, assessing associations between scale scores with conceptually related variables. RESULTS The final 22-item scale has four sub-dimensions: Quality of supervision, Feeling valued and capacitated in your work, Peer respect and support, and Compensation and workload. Model fit in CFAs was good, as were reliabilities for the full scale (alpha: 0.84 in Mali, 0.93 in Bangladesh) and all sub-dimensions. To construct scores for the final scale, we weighted the scores for each sub-dimension by CHW-reported importance of that sub-dimension. Final possible range was -6 to +6 (sub-dimensions), -24 to +24 (full scale). Mean (standard deviation) of full-scale scores were 5.0 (3.3) in Mali and 14.5 (5.3) in Bangladesh. In both countries, higher motivation was significantly associated with higher overall interest in their work, feeling able to improve health/well-being in their community, as well as indicators of higher performance and retention. CONCLUSIONS We found that the Multi-dimensional Motivation (MM) scale for CHWs is a valid and reliable measure that comprehensively assesses motivation. We recommend the scale be employed in future research around CHW performance and community health systems strengthening worldwide. The scale should be further evaluated within longitudinal studies assessing CHW performance and retention outcomes over time.
Collapse
Affiliation(s)
- Ann Gottert
- Population Council, Washington D.C. & New York, New York, USA
| | - Tracy L McClair
- Population Council, Washington D.C. & New York, New York, USA
| | | | | | | | - Karen Kirk
- Population Council, Washington D.C. & New York, New York, USA
| | - Ben Bellows
- Population Council, Washington D.C. & New York, New York, USA
| | - Smisha Agarwal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Kennedy
- Population Council, Washington D.C. & New York, New York, USA
| | | | - Pooja Sripad
- Population Council, Washington D.C. & New York, New York, USA
| |
Collapse
|
50
|
Bao M, Huang C. Job preferences of medical and nursing students seeking employment in rural China: a discrete choice experiment. BMC MEDICAL EDUCATION 2021; 21:146. [PMID: 33673842 PMCID: PMC7934374 DOI: 10.1186/s12909-021-02573-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final-year students in a medical university in Guizhou Province, China. METHODS Attributes of potential jobs were developed through the literature review, semi-structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. RESULTS The final sample comprised 787 medical and nursing students. The statistically significant results indicated "Bianzhi" (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. CONCLUSIONS Strategies for patient-doctor relationships, Bianzhi and salary should be considered to attract final-year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.
Collapse
Affiliation(s)
- Meiling Bao
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China.
- School of Public Health, Zhengzhou University, Zhengzhou, China.
| |
Collapse
|