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Finkelstein EA, Ozdemir S, Huynh VA, Chay J, Mühlbacher A, Tan HK. Navigating Public Policy Responses to a Pandemic: The Balancing Act Between Physical Health, Mental Health, and Household Income. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1121-1129. [PMID: 38718978 DOI: 10.1016/j.jval.2024.04.019] [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: 12/14/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE During COVID-19, governments imposed restrictions that reduced pandemic-related health risks but likely increased personal and societal mental health risk, partly through reductions in household income. This study aimed to quantify the public's willingness to accept trade-offs between pandemic health risks, household income reduction, and increased risk of mental illness that may result from future pandemic-related policies. METHODS A total of 547 adults from an online panel participated in a discrete choice experiment where they were asked to choose between hypothetical future pandemic scenarios. Each scenario was characterized by personal and societal risks of dying from the pandemic, experiencing long-term complications, developing anxiety/depression, and reductions in household income. A latent class regression was used to estimate trade-offs. RESULTS Respondents state a willingness to make trade-offs across these attributes if the benefits are large enough. They are willing to accept 0.8% lower household income (0.7-1.0), 2.7% higher personal risk of anxiety/depression (1.8-3.6), or 3.2% higher societal rate of anxiety/depression (1.7-4.7) in exchange for 300 fewer deaths from the pandemic. CONCLUSION Results reveal that individuals are willing to accept lower household income and higher rates of mental illness, both personal and societal, if the physical health benefits are large enough. Respondents placed greater emphasis on maintaining personal, as opposed to societal, mental health risk and were most interested in preventing pandemic-related deaths. Governments should consider less restrictive policies when pandemics have high morbidity but low mortality to avoid the prospect of improving physical health while simultaneously reducing net social welfare.
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Affiliation(s)
- Eric Andrew Finkelstein
- Signature Programme in Health Services and System Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Population Health Sciences, Duke University, Durham, NC, USA.
| | - Semra Ozdemir
- Signature Programme in Health Services and System Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Vinh Anh Huynh
- Signature Programme in Health Services and System Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Junxing Chay
- Signature Programme in Health Services and System Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre, Singapore; Future Health System, Singapore General Hospital, Singapore
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Loy JK, Kimmig C, Klos S, Wunram HL, Langer T, Breitinger E, Bender S. Influence parental- and child-related factors on the acceptance of SARS-CoV-2 test methods in schools and daycare facilities. Front Public Health 2024; 12:1264019. [PMID: 39091535 PMCID: PMC11291219 DOI: 10.3389/fpubh.2024.1264019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Rapid testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections was an essential step in reducing the spread of the virus and monitoring pandemic development. Most mandatory standard pandemic testing in Germany has been performed in schools and daycare facilities. We investigated the influence of behavioral and attitudinal characteristics of children and caregivers on their acceptance of (i) antigen-based nasal swab rapid and (ii) oral saliva-based pooled Polymerase Chain Reaction (PCR) tests. Methods Conducted through a cross-sectional survey between November and December 2021, with 1962 caregivers and 581 children/adolescents participating, the study evaluated the acceptability of each testing method on a six-point scale. Participants scored one test method conducted on their child at one of six levels with 1 and 6 denoting "excellent" (1) and "inadequate" (6), respectively. We considered demographic variables, vaccination status, child mental health (measured by the SDQ-questionnaire), and facility type (kindergarten, primary school, secondary school) as covariates. Results Results reveal a preference for saliva-based PCR tests over nasal swabs by about one grade, particularly among parents of unvaccinated children, especially if their child expressed future vaccination reluctance. Testing acceptance was lower among children with mental health issues, primary school-aged, and those with less-educated parents. Perception of test accuracy and convenience influenced attitudes, favoring saliva-based PCR tests. Moreover, children with mental health issues felt less secure during testing. Discussion To our knowledge, this is the first study to investigate the influence of different testing methods on testing acceptance for SARS-CoV-2 in children and caregivers. Our study identifies predictors of lower acceptance of public health surveillance measures and enables the development of educational programs on testing and vaccination tailored to the needs of specific target groups. Moreover, we demonstrate that test acceptance in vulnerable groups can be enhanced by careful choice of an appropriate testing method.
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Affiliation(s)
- Johanna K. Loy
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Christian Kimmig
- Department of Pediatrics, University of Freiburg, Freiburg, Germany
| | - Simon Klos
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Heidrun Lioba Wunram
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Köln, Germany
| | - Thorsten Langer
- Department of Pediatrics, University of Freiburg, Freiburg, Germany
| | - Eva Breitinger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Stephan Bender
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
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Mouter N, Geijsen T, Munyasya A, Hernandez JI, Korthals D, Stok M, Uiters E, de Bruin M. Preferences for the Societal Impacts of a Pandemic when it Transitions into an Endemic: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00701-x. [PMID: 38980645 DOI: 10.1007/s40271-024-00701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The stage of the pandemic significantly affects people's preferences for (the societal impacts of) COVID-19 policies. No discrete choice experiments were conducted when the COVID-19 pandemic was in a transition phase. OBJECTIVES This is the first study to empirically investigate how citizens weigh the key societal impacts of pandemic policies when the COVID-19 pandemic transitions into an endemic. METHODS We performed two discrete choice experiments among 2181 Dutch adults that included six attributes: COVID-19 deaths, physical health problems, mental health problems, financial problems, surgery delays and the degree to which individual liberties are restricted. We used latent class choice models to identify heterogeneous preferences for the impacts of COVID-19 measures across different groups of respondents. RESULTS A large majority of the participants in this study was willing to accept deaths to avoid that citizens experience physical complaints, mental health issues, financial problems and the postponement of surgeries. The willingness to tolerate COVID-19 deaths to avoid these societal impacts differed substantially between participants. When participants were provided with information about the stringency of COVID-19 measures, they assigned relatively less value to preventing the postponement of non-urgent surgeries for 1-3 months across all classes. CONCLUSIONS Having gone through a pandemic, most Dutch citizens clearly prefer pandemic policies that consider citizens' financial situations, physical problems, mental health problems and individual liberties, alongside the effects on excess mortality and pressure on healthcare.
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Affiliation(s)
- Niek Mouter
- Transport and Logistics Group, Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
- Populytics, Research Agency, Leiden, The Netherlands.
| | - Tom Geijsen
- Populytics, Research Agency, Leiden, The Netherlands
| | | | - Jose Ignacio Hernandez
- Center of Economics for Sustainable Development (CEDES), Faculty of Economics and Government, Universidad San Sebastián, San Sebastián, Chile
| | - Daniel Korthals
- Transport and Logistics Group, Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
- Populytics, Research Agency, Leiden, The Netherlands
| | - Marijn Stok
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ellen Uiters
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marijn de Bruin
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Institute of Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Kemper S, de Vries M, de Weger E, Bongers M, Kupper F, Timen A. The public's considerations about implementing non-pharmaceutical interventions to manage a novel COVID-19 epidemic. Heliyon 2024; 10:e30390. [PMID: 38737250 PMCID: PMC11088335 DOI: 10.1016/j.heliyon.2024.e30390] [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: 01/04/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
In the future, new variants of the SARS-CoV-2 virus might emerge and cause outbreaks. If this occurs, the implementation of non-pharmaceutical interventions (NPIs) can be reconsidered. Consideration of the potential benefits and harms of implementing NPIs, and ultimately deciding about implementing NPIs, is currently mainly executed by experts and governments. However, general literature on public engagement suggests that integrating public perspectives into decision-making can enhance the quality of decisions and foster greater public understanding of them. In this study, a deliberative mini-public was conducted to integrate this public perspective. The aim was to elicit public considerations regarding non-pharmaceutical interventions by asking a diverse group of citizens to participate as decision-makers and convene, learn and deliberate about implementing non-pharmaceutical interventions during a hypothetical outbreak of a new SARS-CoV-2 variant. Participants emphasized the importance of early implementation during the outbreak, to prevent exceeding healthcare capacity, long-term mental health issues, educational deficits, and bankruptcies. Additionally, participants stressed taking public support into account, and shared ideas on maintaining support. Furthermore, participants wanted to give citizens personal responsibility and freedom in making their own assessment regarding adherence to interventions and how much risk of infection they would be willing to accept. Participants also expressed the need for the government to adopt a learning attitude towards improvements in pandemic response, and to generate more focus on long-term strategies. The deliberative mini-public, revealed public considerations that reflected public values and needs. These considerations might be helpful in better aligning epidemic management policies with public perspectives. Regarding the deliberative mini-public, uncertainties remain about the design and impact on a bigger scale.
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Affiliation(s)
- Sophie Kemper
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, the Netherlands
| | - Marion de Vries
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Esther de Weger
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, the Netherlands
| | - Marloes Bongers
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Frank Kupper
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, the Netherlands
| | - Aura Timen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Kemper S, Bongers M, Kupper F, De Vries M, Timen A. Preferences for public engagement in decision-making regarding four COVID-19 non-pharmaceutical interventions in the Netherlands: A survey study. PLoS One 2023; 18:e0292119. [PMID: 37796885 PMCID: PMC10553365 DOI: 10.1371/journal.pone.0292119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Worldwide, non-pharmaceutical interventions (NPIs) were implemented during the COVID-19 crisis, which heavily impacted the daily lives of citizens. This study considers public perspectives on whether and how public engagement (PE) can contribute to future decision-making about NPIs. METHODS An online survey was conducted among a representative sample of the public in the Netherlands from 27 October to 9 November 2021. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 were collected. Preferences regarding four NPIs were studied: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of elementary schools and daycares (CED); and physical distancing (1.5M). Engagement was surveyed based on the five participation modes of the IAP2 Spectrum of Public Participation, namely inform, consult, advice, collaborate and empower. RESULTS Of the 4981 respondents, 25% expressed a desire to engage in decision-making, as they thought engagement could improve their understanding and the quality of NPIs, as well as increase their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage and provide their perspective on trade-offs in values (e.g. opening up society versus division in society by vaccination status). Respondents agreed that the main responsibility in decision-making should stay with experts and policy-makers. 50% of respondents did not want to engage, as they felt no need to engage or considered themselves insufficiently knowledgeable. Inform was deemed the most preferred mode of engagement, and empower the least preferred mode of engagement. CONCLUSION We reveal large variations in public preferences regarding engagement in NPI decision-making. With 25% of respondents expressing an explicit desire to engage, and considering the benefit of PE in other areas of (public) health, opportunities for PE in NPI decision-making might have been overlooked during the COVID-19 pandemic. Our results provide guidance into when and how to execute PE in future outbreaks.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Frank Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marion De Vries
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
- Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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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.
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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
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Kemper S, van den Broek R, van Hameren S, Kupper JFH, Bongers MEJ, de Weger E, de Vries M, Timen A. Voices of society: the emergence of civil-society practices aiming to engage in the management of the COVID-19 pandemic in the Netherlands. BMJ Glob Health 2023; 8:e012875. [PMID: 37607772 PMCID: PMC10445389 DOI: 10.1136/bmjgh-2023-012875] [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: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
During the COVID-19 pandemic, public groups mobilised themselves in civil-society engagement practices (CSEPs) aiming to improve or suggest alternative epidemic management. This study explores the motivation to establish CSEPs and their perceived contributions to epidemic management, to gain insight whether integrating views of CSEPs could add value. A systematic online search was executed to identify CSEPs focused on COVID-19 management between January 2020 and January 2022 in the Netherlands. In order to create a comprehensible overview of the identified CSEPs, relevant characteristics were gathered and mapped, for example, local or national scope, subject of action and goals. A selection of CSEPs was interviewed between April and June 2022 to study their motivators to start the CSEPs and perceived contributions to management. The search resulted in the identification of 22 CSEPs, of which members of 14 CSEPs were interviewed. These members indicated several issues that motivated the start of their CSEP, namely; shortage of equipment, sense of solidarity, and a perceived lack of governmental action, lack of democratic values and lack in diversity of perspectives in epidemic management. All respondents believed to have contributed to policy or society, by influencing opinions, and occasionally by altering policy. However, respondents encountered obstacles in their attempts to contribute such as inability to establish contact with authorities, feeling unheard or undermined, and complications due to the interplay of political interests. In conclusion, CSEPs have fulfilled various roles such as providing alternative management policies, producing equipment, representing the needs of vulnerable populations, and supporting citizens and providing citizens with other viewpoints and information. The identified motivators to establish CSEPs in this study uncover room for improvements in policy. These insights, together with the identified perceived barriers of CSEPs, can be used to improve the connection between (future) epidemic management and public priorities and interests.
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Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Renate van den Broek
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sarah van Hameren
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - J Frank H Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes E J Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Esther de Weger
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marion de Vries
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Veldwijk J, van Exel J, de Bekker-Grob EW, Mouter N. Public Preferences for Introducing a COVID-19 Certificate: A Discrete Choice Experiment in the Netherlands. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:603-614. [PMID: 37155007 PMCID: PMC10165281 DOI: 10.1007/s40258-023-00808-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Here we investigate public preferences for coronavirus disease 2019 (COVID-19) certificates in the Netherlands, and whether these preferences differ between subgroups in the population. METHODS A survey including a discrete choice experiment was administered to 1500 members of the adult population of the Netherlands. Each participant was asked to choose between hypothetical COVID-19 certificates that differed in seven attributes: the starting date, and whether the certificate allowed gathering with multiple people, shopping without appointment, visiting bars and restaurants, visiting cinemas and theatres, attending events, and practising indoor sports. Latent class models (LCMs) were used to determine the attribute relative importance and predicted acceptance rate of hypothetical certificates. RESULTS Three classes of preference patterns were identified in the LCM. One class a priori opposed a certificate (only two attributes influencing preferences), another class was relatively neutral and included all attributes in their decision making, and the final class was positive towards a certificate. Respondents aged > 65 years and those who plan to get vaccinated were more likely to belong to the latter two classes. Being allowed to shop without appointment and to visit bars and restaurants was most important to all respondents, increasing predicted acceptance rate by 12 percentage points. CONCLUSIONS Preferences for introduction of a COVID-19 certificate are mixed. A certificate that allows for shopping without appointment and visiting bars and restaurants is likely to increase acceptance. The support of younger citizens and those who plan to get vaccinated seems most sensitive to the specific freedoms granted by a COVID-19 certificate.
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Affiliation(s)
- J Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - J van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - E W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - N Mouter
- Faculty of Technology, Policy and Management, Transport and Logistics Group, Delft University of Technology, Delft, The Netherlands
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Sicsic J, Blondel S, Chyderiotis S, Langot F, Mueller JE. Preferences for COVID-19 epidemic control measures among French adults: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:81-98. [PMID: 35305178 PMCID: PMC8934018 DOI: 10.1007/s10198-022-01454-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/21/2022] [Indexed: 06/04/2023]
Abstract
In this stated preferences study, we describe for the first time French citizens' preferences for various epidemic control measures, to inform longer-term strategies and future epidemics. We used a discrete choice experiment in a representative sample of 908 adults in November 2020 (before vaccination was available) to quantify the trade-off they were willing to make between restrictions on the social, cultural, and economic life, school closing, targeted lockdown of high-incidence areas, constraints to directly protect vulnerable persons (e.g., self-isolation), and measures to overcome the risk of hospital overload. The estimation of mixed logit models with correlated random effects shows that some trade-offs exist to avoid overload of hospitals and intensive care units, at the expense of stricter control measures with the potential to reduce individuals' welfare. The willingness to accept restrictions was shared to a large extent across subgroups according to age, gender, education, vulnerability to the COVID-19 epidemic, and other socio-demographic or economic variables. However, individuals who felt at greater risk from COVID-19, and individuals expressing high confidence in the governmental management of the health and economic crisis, more easily accepted all these restrictions. Finally, we compared the welfare impact of alternative strategies combining different epidemic control measures. Our results suggest that policies close to a targeted lockdown or with medically prescribed self-isolation were those satisfying the largest share of the population and achieving high gain in average welfare, while average welfare was maximized by the combination of all highly restrictive measures. This illustrates the difficulty in making preference-based decisions on restrictions.
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Affiliation(s)
- Jonathan Sicsic
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
| | - Serge Blondel
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
- Université d’Angers, GRANEM, SFR Confluences, F-49000 Angers, France
| | | | - François Langot
- Le Mans Université (GAINS-TEPP and IRA), IUF, PSE, Cepremap, Le Mans, France
- IZA, Bonn, Germany
| | - Judith E. Mueller
- EHESP French School of Public Health, Rennes and Institut Pasteur, Paris, France
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Stepping into the shoes of the policy maker: Results of a Participatory Value Evaluation for the Dutch long term COVID-19 strategy. Soc Sci Med 2022; 314:115430. [PMID: 36279793 PMCID: PMC9556804 DOI: 10.1016/j.socscimed.2022.115430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 outbreak early 2020 was followed by an unprecedented package of measures. The relative calmness of the pandemic early 2022 provides a momentum to prepare for various scenarios. OBJECTIVES As acceptance of COVID-19 measures is key for public support we investigated citizens' preferences towards imposing measures in four scenarios: 1) spring/summer scenario with few hospitalizations; 2) autumn/winter scenario with many hospitalizations; 3) a new contagious variant, the impact on hospitalizations is unclear; 4) a new contagious variant, hospitalizations will substantially increase. METHODS Study 1 comprised a Participatory Value Evaluation (PVE) in which 2011 respondents advised their government on which measures to impose in the four scenarios. Respondents received information regarding the impact of each measure on the risk that the health system would be overloaded. To triangulate the results, 2958 respondents in Study 2 evaluated the acceptability of the measures in each scenario. RESULTS Measures were ranked similarly by respondents in Study 1 and 2: 1) the majority of respondents thought that hygiene measures should be upheld, even in the spring/summer; 2) the majority supported booster vaccination, working from home, encouraging self-testing, and mandatory face masks from scenario 2 onwards; 3) even in scenario 4, lockdown measures were not supported by the majority. Young respondents were willing to accept more risks for the health system than older respondents. CONCLUSION The results suggest that policies that focus on prevention (through advising low-impact hygiene measures) and early response to moderate threats (by scaling up to moderately restrictive measures and boostering) can count on substantial support. There is low support for lockdown measures even under high-risk conditions, which further emphasizes the importance of prevention and a timely response to new threats. Our results imply that young citizens' concerns, in particular, should be addressed when restrictive COVID-19 measures are to be implemented.
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Wolfe D, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Suschinsky K, Skidmore B, Bartram M, Cohen K, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Porath A, Thavorn K. Service-level barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use: protocol for a scoping review. BMJ Open 2022; 12:e064578. [PMID: 36410826 PMCID: PMC9680171 DOI: 10.1136/bmjopen-2022-064578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, substance use health services for treatment of alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and challenging to access. The pandemic magnified system weaknesses, often resulting in disruptions of treatment as alcohol use during the pandemic rose. When treatment services were available, utilisation was often low for various reasons. Virtual care was implemented to offset the drop in in-person care, however accessibility was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will perform a scoping review that will identify characteristics of services for treatment of AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of these groups. METHODS AND ANALYSIS We will follow scoping review methodological guidance from the Joanna Briggs Institute. Using the OVID platform, we will search Ovid MEDLINE including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, APA PsychInfo, Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews and CINAHL (Ebsco Platform). Multiple reviewers will screen citations. We will seek studies reporting data collected from individuals with AUD/PAU or providers of treatment for AUD/PAU on service-level factors affecting access to care. We will map barriers to and facilitators of access to AUD/PAU treatment services identified in the relevant studies, stratified by service type and key measures of inequity across service users. ETHICS AND DISSEMINATION This research will enhance awareness of existing evidence regarding barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use. Findings will be disseminated through publications, conference presentations and a stakeholder meeting. As this is a scoping review of published literature, no ethics approval was required.
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Affiliation(s)
- Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberly Corace
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | | | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alyssa Grant
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, Ontario, Canada
| | - Karen Cohen
- Canadian Psychological Association, Ottawa, Ontario, Canada
| | - Gord Garner
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | - Sarah Konefal
- Research, Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Amy Porath
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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12
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Ferreira S, Amorim M, Lobo A, Kern M, Fanderl N, Couto A. Travel mode preferences among German commuters over the course of COVID-19 pandemic. TRANSPORT POLICY 2022; 126:55-64. [PMID: 35874046 PMCID: PMC9287019 DOI: 10.1016/j.tranpol.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 05/10/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has changed the way how the people live, work and move, and naturally the transport sector became one of the most affected by this global crisis. Beyond the sudden fall of mobility at the beginning of the pandemic, it is important to understand how people are regaining trust in travelling, even if it is still unpredictable if and when the transport sector will recover to the pre-pandemic levels. This study focuses on the analysis of commuting trips and the changes of travel mode preferences over the first eight months of the pandemic in Germany. A survey with an orthogonal design based on sets of cards containing different transport mode alternatives and attributes was conducted in three waves (April, June, and October 2020). The individual characteristics and the preferences of around 4800 commuters were collected through the survey and modelled using a conditional logit approach. The results show that commuters have regained some trust on public transport since the April-May 2020 lockdown, but this has occurred at a slow pace. The reduction of public transport ticket fares can be the most effective strategy to recover some of the users lost to other modes.
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Affiliation(s)
- Sara Ferreira
- Faculty of Engineering of the University of Porto, Research Centre for Territory, Transports and Environment, Rua Dr. Roberto Frias, s/n, 4200-465, Portugal
| | - Marco Amorim
- Fraunhofer IAO, Fraunhofer Institute for Industrial Engineering IAO, Nobelstraße 12, 70569, Stuttgart, Germany
| | - António Lobo
- Faculty of Engineering of the University of Porto, Research Centre for Territory, Transports and Environment, Rua Dr. Roberto Frias, s/n, 4200-465, Portugal
| | - Mira Kern
- University of Stuttgart, Institute of Human Factors and Technology Management (IAT), Nobelstraße 12, 70569, Stuttgart, Germany
| | - Nora Fanderl
- Fraunhofer IAO, Fraunhofer Institute for Industrial Engineering IAO, Nobelstraße 12, 70569, Stuttgart, Germany
| | - António Couto
- Faculty of Engineering of the University of Porto, Research Centre for Territory, Transports and Environment, Rua Dr. Roberto Frias, s/n, 4200-465, Portugal
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13
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Haghani M, Bliemer MCJ, de Bekker-Grob EW. Applications of discrete choice experiments in COVID-19 research: Disparity in survey qualities between health and transport fields. JOURNAL OF CHOICE MODELLING 2022; 44:100371. [PMID: 35880141 PMCID: PMC9301170 DOI: 10.1016/j.jocm.2022.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Published choice experiments linked to various aspects of the COVID-19 pandemic are analysed in a rapid review. The aim is to (i) document the diversity of topics as well as their temporal and geographical patterns of emergence, (ii) compare various elements of design quality across different sectors of applied economics, and (iii) identify potential signs of convergent validity across findings of comparable experiments. Of the N = 43 published choice experiments during the first two years of the pandemic, the majority identifies with health applications (n = 30), followed by transport-related applications (n = 10). Nearly 100,000 people across the world responded to pandemic-related discrete choice surveys. Within health applications, while the dominant theme, up until June 2020, was lockdown relaxation and tracing measures, the focus shifted abruptly to vaccine preference since then. Geographical origins of the health surveys were not diverse. Nearly 50% of all health surveys were conducted in only three countries, namely US, China and The Netherlands. Health applications exhibited stronger pre-testing and larger sample sizes compared to transport applications. Limited signs of convergent validity were identifiable. Within some applications, issues of temporal instability as well as hypothetical bias attributable to social desirability, protest response or policy consequentiality seemed likely to have affected the findings. Nevertheless, very few of the experiments implemented measures of hypothetical bias mitigation and those were limited to health studies. Our main conclusion is that swift administration of pandemic-related choice experiments has overall resulted in certain degrees of compromise in study quality, but this has been more so the case in relation to transport topics than health topics.
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Affiliation(s)
- Milad Haghani
- Research Centre for Integrated Transport Innovation (rCITI), School of Civil and Environmental Engineering, The University of New South Wales, UNSW Sydney, Australia
| | - Michiel C J Bliemer
- Institute of Transport and Logistics Studies (ITLS), The University of Sydney Business School, Sydney, Australia
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14
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Zhang Y, Liu T, He Z, Chan SN, Akinwunmi B, Huang J, Wong TH, Zhang CJP, Ming WK. The Preferences for Attributes of Initial COVID-19 Diagnosis in the US and China during the Pandemic: A Discrete Choice Experiment with Propensity Score Matching. JMIR Public Health Surveill 2022; 8:e37422. [PMID: 35759683 PMCID: PMC9384860 DOI: 10.2196/37422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/14/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights. Objective We aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States. Methods We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test. Results A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred. Conclusions Improvements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance.
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Affiliation(s)
- Yimin Zhang
- School of Medicine, Jinan University, Guangzhou, CN
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, HK
| | - Zonglin He
- Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, HK
| | - Sze Ngai Chan
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Jinan University, First Affiliated Hospital of Jinan University, Guangzhou, CN
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Boston, US.,Center for Genomic Medicine (CGM), Massachusetts General Hospital, Harvard Medical School Harvard University, Boston, US
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, SG
| | - Tak-Hap Wong
- Department of Obstetrics and Gynecology, The first Affiliated Hospital of Jinan University, Guangzhou, CN
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, HK
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, HK
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15
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Rübsamen N, Garcia Voges B, Castell S, Klett-Tammen CJ, Oppliger J, Krütli P, Smieszek T, Mikolajczyk R, Karch A. Providing laypeople with results from dynamic infectious disease modelling studies affects their allocation preference for scarce medical resources-a factorial experiment. BMC Public Health 2022; 22:572. [PMID: 35321669 PMCID: PMC8940588 DOI: 10.1186/s12889-022-13000-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Allocation of scarce medical resources can be based on different principles. It has not yet been investigated which allocation schemes are preferred by medical laypeople in a particular situation of medical scarcity like an emerging infectious disease and how the choices are affected by providing information about expected population-level effects of the allocation scheme based on modelling studies. We investigated the potential benefit of strategic communication of infectious disease modelling results. METHODS In a two-way factorial experiment (n = 878 participants), we investigated if prognosis of the disease or information about expected effects on mortality at population-level (based on dynamic infectious disease modelling studies) influenced the choice of preferred allocation schemes for prevention and treatment of an unspecified sexually transmitted infection. A qualitative analysis of the reasons for choosing specific allocation schemes supplements our results. RESULTS Presence of the factor "information about the population-level effects of the allocation scheme" substantially increased the probability of choosing a resource allocation system that minimized overall harm among the population, while prognosis did not affect allocation choices. The main reasons for choosing an allocation scheme differed among schemes, but did not differ among those who received additional model-based information on expected population-level effects and those who did not. CONCLUSIONS Providing information on the expected population-level effects from dynamic infectious disease modelling studies resulted in a substantially different choice of allocation schemes. This finding supports the importance of incorporating model-based information in decision-making processes and communication strategies.
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Affiliation(s)
- Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. .,Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.
| | - Benno Garcia Voges
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | | | - Jérôme Oppliger
- Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland
| | - Pius Krütli
- Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland
| | - Timo Smieszek
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK.,Modelling and Economics Unit, Statistics, Modelling, and Economics Department, Public Health England, London, UK
| | - Rafael Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
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16
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Misra M, Joshi H, Sarwal R, Rao KD. Exit strategies from lockdowns due to COVID-19: a scoping review. BMC Public Health 2022; 22:488. [PMID: 35279102 PMCID: PMC8917328 DOI: 10.1186/s12889-022-12845-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In response to the ongoing COVID-19 pandemic, countries have adopted various degrees of restrictive measures on people to reduce COVID-19 transmission. These measures have had significant social and economic costs. In the absence of therapeutics, and low vaccination coverage, strategies for a safe exit plan from a lockdown are required to mitigate the transmission and simultaneously re-open societies. Most countries have outlined or have implemented lockdown exit plans. The objective of this scoping review is to (a) identify and map the different strategies for exit from lockdowns, (b) document the effects of these exit strategies, and (c) discuss features of successful exit strategies based on the evidence. METHODS A five-step approach was used in this scoping review: (a) identifying the research question and inclusion/exclusion criteria; (b) searching the literature using keywords within PubMed and WHO databases; (c) study selection; (d) data extraction; (e) collating results and qualitative synthesis of findings. RESULTS Of the 406 unique studies found, 107 were kept for full-text review. Studies suggest the post-peak period as optimal timing for an exit, supplemented by other triggers such as sufficient health system capacity, and increased testing rate. A controlled and step-wise exit plan which is flexible and guided by information from surveillance systems is optimal. Studies recommend continued use of non-pharmaceutical interventions such as physical distancing, use of facemasks, and hygiene measures, in different combinations when exiting from a lockdown, even after optimal vaccination coverage has been attained. CONCLUSION Reviewed studies have suggested adopting a multi-pronged strategy consisting of different approaches depending on the context. Among the different exit strategies reviewed (phase-wise exit, hard exit, and constant cyclic patterns of lockdown), phase-wise exit appears to be the optimal exit strategy.
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Affiliation(s)
- Madhavi Misra
- Johns Hopkins India Private Ltd, Flat 57, India International Centre, 40, Max Muller Marg, New Delhi, 110003, India.
| | - Harsha Joshi
- Johns Hopkins India Private Ltd, Flat 57, India International Centre, 40, Max Muller Marg, New Delhi, 110003, India
| | - Rakesh Sarwal
- National Institution for Transforming India Aayog, Delhi, India
| | - Krishna D Rao
- Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, USA
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17
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McPhedran R, Gold N, Bemand C, Weston D, Rosen R, Scott R, Chadborn T, Amlôt R, Mawby M, Toombs B. Location, location, location: a discrete choice experiment to inform COVID-19 vaccination programme delivery in the UK. BMC Public Health 2022; 22:431. [PMID: 35246082 PMCID: PMC8894545 DOI: 10.1186/s12889-022-12823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK's vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18-29-year-olds regarding key delivery characteristics and assess the influence of these on intentions to get vaccinated, to inform planning for this cohort. METHODS From 25 March to 2 April 2021, an online sample of 2012 UK adults aged 18-29 years participated in a Discrete Choice Experiment. Participants made six choices, each involving two SMS invitations to book a vaccination appointment and an opt-out. Invitations had four attributes (1 × 5 levels, 3 × 3 levels): delivery mode, appointment timing, proximity, and sender. These were systematically varied according to a d-optimal design. Responses were analysed using a mixed logit model. RESULTS The main effects logit model revealed a large alternative-specific constant (β = 1.385, SE = 0.067, p < 0.001), indicating a strong preference for 'opting in' to appointment invitations. Pharmacies were dispreferred to the local vaccination centre (β = - 0.256, SE = 0.072, p < 0.001), appointments in locations that were 30-45 min travel time from one's premises were dispreferred to locations that were less than 15 min away (β = - 0.408, SE = 0.054, p < 0.001), and, compared to invitations from the NHS, SMSs forwarded by 'a friend' were dispreferred (β = - 0.615, SE = 0.056, p < 0.001) but invitations from the General Practitioner were preferred (β = 0.105, SE = 0.048, p = 0.028). CONCLUSIONS The results indicated that the existing configuration of the UK's vaccination programme was well-placed to deliver vaccines to 18-29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0-15 min from one's premises) was not necessary; and either the 'NHS' or 'Your GP' would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens' preferences, requirements and predicted behaviours regarding COVID-19.
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Affiliation(s)
- Robert McPhedran
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK.
| | - Natalie Gold
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK.,Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.,Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Charlotte Bemand
- Solent NHS Trust, NHS England, Highpoint Venue, Bursledon Rd, Southampton, Hampshire, SO19 8BR, UK
| | - Dale Weston
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - Rachel Rosen
- Economics and Strategic Analysis Team, NHS England and NHS Improvement, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Robert Scott
- Economics and Strategic Analysis Team, NHS England and NHS Improvement, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Richard Amlôt
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - Max Mawby
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK
| | - Ben Toombs
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK
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