Preferences of patients with chronic low back pain about nonsurgical treatments: Results of a discrete choice experiment

INTRODUCTION

This study aimed to assess patients' preferences of nonsurgical treatments for chronic low back pain (CLBP).

METHOD

We conducted a discrete choice experiment (DCE) in Quebec, Canada, in 2018. Seven attributes were included: treatment modality, pain reduction, the onset of treatment efficacy, duration effectiveness, difficulties with daily activities, sleep problems, and knowledge of the patient's body and pain location. Treatment modalities were corticosteroid injections, supervised body-mind physical activities, supervised sports physical activities, physical manipulations, self-management courses, and psychotherapy. Utility levels were estimated using a logit model, a latent class model and a Bayesian hierarchical model.

RESULTS

Analyses were conducted on 424 $424$ individuals. According to the Bayesian hierarchical model, the conditional relative importance weights of attributes were as follows: (1) treatment modality (34.79%), (2) pain reduction (18.73%), (3) difficulties with daily activities (11.71%), (4) duration effectiveness (10.06%), (5) sleep problems (10.05%), (6) onset of treatment efficacy (8.60%) and (7) knowledge of the patient's body and pain location (6.06%). According to the latent class model that found six classes of respondents with different behaviours (using Akaike and Bayesian criteria), the treatment modality was the most important attribute for all classes, except for class 4 for which pain reduction was the most important. In addition, classes 2 and 5 refused corticosteroid injections, while psychotherapy was preferred only in class 3.

CONCLUSION

Given the preference heterogeneity found in the analysis, it is important that patient preferences are discussed and considered by the physicians. This will help to improve the patient care pathway in a context of a patient-centred model for a disease with growing prevalence.

PATIENT OR PUBLIC CONTRIBUTION

A small group of patients was involved in the conception, design and interpretation of data. Participants in the DCE were all CLBP patients.

Public Preferences for a COVID-19 Vaccination Program in Quebec: A Discrete Choice Experiment

OBJECTIVES

We aimed to elicit preferences of the French-speaking Quebec population regarding a COVID-19 vaccination program and to characterize individuals with respect to their vaccination behaviors.

METHODS

A discrete choice experiment was conducted in Autumn 2020 via a web-based survey. Its design included seven attributes: vaccine origin, vaccine effectiveness, side effects, protection duration, priority population, waiting time to get vaccinated, and recommender of the vaccine. Utilities were estimated using a mixed-logit model and a latent class logit model.

RESULTS

Our sample included 1599 individuals. From this total, 119 always chose the opt-out option (7.4%). According to the mixed-logit model, the relative weights of attributes were as follows: effectiveness (28.48%), side effects (23.68%), protection duration (17.41%), vaccine origin (12.75%), recommender (11.96%), waiting time to get vaccinated (3.62%), and priority population (2.11%). Five classes were derived from the latent class logit model. Class 1 (9.13%) wanted to get vaccinated as fast as possible and was composed of uncertain and more vulnerable individuals. Class 5 (25.14%) was similar to the full sample, mostly favoring vaccination. Classes 2 (7.69%) and 4 (15.82%) included "vaccine hesitant and demanding" individuals but were different in their sociodemographic profiles. Finally, "anti-vaccine" and other "vaccine hesitant" individuals were in class 3 (42.21%).

CONCLUSIONS

This study showed the vaccine characteristics that are likely to improve vaccine uptake, which may more easily lead to herd immunity. Different profiles of respondents also showed various levels of acceptance toward a COVID-19 vaccination program, which may help to better understand vaccine hesitancy behaviors.

Predictors of Vaccine Acceptance, Confidence, and Hesitancy in General, and COVID-19 Vaccination Refusal in the Province of Quebec, Canada

INTRODUCTION

A surge of COVID-19 variants is a major concern, and literatures that support developing an optimum level of herd immunity are meaningful. This study aimed to examine the factors associated with vaccine acceptance, confidence, and hesitancy in general, and COVID-19 vaccination refusal in the general population of Quebec, Canada.

METHODS

A web-based cross-sectional survey was conducted in October and November 2020 among French-speaking participants above 18 years of age employing quota sampling technique. The questionnaire included socio-demographic and attitudinal variables towards vaccination. Logistic regression analyses were conducted to examine the association between independent and outcome variables.

RESULTS

Of total 1599 participants, 88.9%, 87.5%, 78.5%, and 18.2%, respectively, indicated vaccine acceptance, high level of vaccine confidence, low level of vaccine hesitancy, and COVID-19 vaccination refusals. Participants having higher education, income, and fear of COVID-19 (FCV-19S) were more likely to get vaccinated, while smokers were less likely to get vaccinated. Similarly, age groups (40-59, and ≥60 years), higher education, income, permanent resident in Canada, country of parents from Canada, ever faced acute disease in the family, higher sense of coherence, and FCV-19S scores were predictors of high levels of vaccine confidence. Higher education, income, sense of coherence and FCV-19S scores, and higher health-related quality of life (CORE-6D) produced lower levels of vaccine hesitancy. Conversely, those acting as caretaker, other essential worker, smoker, and those with financial losses were more likely to have higher vaccine hesitancy. Additionally, ≥60 years of age, higher education and income, country of parents from Canada, higher scores of willingness to take risk and FCV-19S were less likely to have high level of COVID-19 vaccination refusal.

CONCLUSION

Over three quarters of the participants indicated positive attitudes toward vaccination. Some socio-demographic and health-related quality of life factors were associated with the outcome variables, and these should be sought while designing interventions to improve COVID-19 vaccination rates.