Combining service design and discrete choice experiments for intervention design: An application to weather index insurance
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SUBMITTER: Dehmel N
PROVIDER: S-EPMC8563645 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundComplex health interventions must incorporate user preferences to maximize their potential effectiveness. Discrete choice experiments (DCEs) quantify the strength of user preferences and identify preference heterogeneity across users. We present the process of using a DCE to supplement conventional qualitative formative research in the design of a demand creation intervention for voluntary medical male circumcision (VMMC) to prevent HIV in Tanzania.MethodsThe VMMC intervention was designed within a 3-month formative phase. In-depth interviews (n = 30) and participatory group discussions (n = 20) sought to identify broad setting-specific barriers to and facilitators of VMMC among adult men. Qualitative results informed the DCE development, identifying the role of female partners, service providers' attitudes and social stigma. A DCE among 325 men in Njombe and Tabora, Tanzania, subsequently measured preferences for modifiable VMMC service characteristics. The final VMMC demand creation intervention design drew jointly on the qualitative and DCE findings.ResultsWhile the qualitative research informed the community mobilization intervention, the DCE guided the specific VMMC service configuration. The significant positive utilities (u) for availability of partner counselling (u = 0.43, p < 0.01) and age-separated waiting areas (u = 0.21, p < 0.05) led to the provision of community information booths for partners and provision of age-separated waiting areas. The strong disutility of female healthcare providers (u = - 0.24, p < 0.01) led to re-training all providers on client-friendliness.ConclusionThis is, to our knowledge, the first study documenting how user preferences from DCEs can directly inform the design of a complex intervention. The use of DCEs as formative research may help increase user uptake and adherence to complex interventions.
| S-EPMC6399844 | biostudies-literature
Project description:ObjectivesThis study reviews simulation studies of discrete choice experiments to determine (i) how survey design features affect statistical efficiency, (ii) and to appraise their reporting quality.OutcomesStatistical efficiency was measured using relative design (D-) efficiency, D-optimality, or D-error.MethodsFor this systematic survey, we searched Journal Storage (JSTOR), Since Direct, PubMed, and OVID which included a search within EMBASE. Searches were conducted up to year 2016 for simulation studies investigating the impact of DCE design features on statistical efficiency. Studies were screened and data were extracted independently and in duplicate. Results for each included study were summarized by design characteristic. Previously developed criteria for reporting quality of simulation studies were also adapted and applied to each included study.ResultsOf 371 potentially relevant studies, 9 were found to be eligible, with several varying in study objectives. Statistical efficiency improved when increasing the number of choice tasks or alternatives; decreasing the number of attributes, attribute levels; using an unrestricted continuous "manipulator" attribute; using model-based approaches with covariates incorporating response behaviour; using sampling approaches that incorporate previous knowledge of response behaviour; incorporating heterogeneity in a model-based design; correctly specifying Bayesian priors; minimizing parameter prior variances; and using an appropriate method to create the DCE design for the research question. The simulation studies performed well in terms of reporting quality. Improvement is needed in regards to clearly specifying study objectives, number of failures, random number generators, starting seeds, and the software used.ConclusionThese results identify the best approaches to structure a DCE. An investigator can manipulate design characteristics to help reduce response burden and increase statistical efficiency. Since studies varied in their objectives, conclusions were made on several design characteristics, however, the validity of each conclusion was limited. Further research should be conducted to explore all conclusions in various design settings and scenarios. Additional reviews to explore other statistical efficiency outcomes and databases can also be performed to enhance the conclusions identified from this review.
| S-EPMC5898574 | biostudies-literature
Project description:IntroductionDespite the recognised importance of participant understanding for valid and reliable discrete choice experiment (DCE) results, there has been limited assessment of whether, and how, people understand DCEs, and how 'understanding' is conceptualised in DCEs applied to a health context.ObjectivesOur aim was to identify how participant understanding is conceptualised in the DCE literature in a health context. Our research questions addressed how participant understanding is defined, measured, and used.MethodsSearches were conducted (June 2019) in the MEDLINE, EMBASE, PsychINFO and Econlit databases, as well as hand searching. Search terms were based on previous DCE systematic reviews, with additional understanding keywords used in a proximity-based search strategy. Eligible studies were peer-reviewed journal articles in the field of health, related to DCE or best-worst scaling type 3 (BWS3) studies, and reporting some consideration or assessment of participant understanding. A descriptive analytical approach was used to chart relevant data from each study, including publication year, country, clinical area, subject group, sample size, study design, numbers of attributes, levels and choice sets, definition of understanding, how understanding was tested, results of the understanding tests, and how the information about understanding was used. Each study was categorised based on how understanding was conceptualised and used within the study.ResultsOf 306 potentially eligible articles identified, 31 were excluded based on titles and abstracts, and 200 were excluded on full-text review, resulting in 75 included studies. Three categories of study were identified: applied DCEs (n = 52), pretesting studies (n = 7) and studies of understanding (n = 16). Typically, understanding was defined in relation to either the choice context, such as attribute terminology, or the concept of choosing. Very few studies considered respondents' engagement as a component of understanding. Understanding was measured primarily through qualitative pretesting, rationality or validity tests included in the survey, and participant self-report, however reporting and use of the results of these methods was inconsistent.ConclusionsThose conducting or using health DCEs should carefully select, justify, and report the measurement and potential impact of participant understanding in their specific choice context. There remains scope for research into the different components of participant understanding, particularly related to engagement, the impact of participant understanding on DCE validity and reliability, the best measures of understanding, and methods to maximise participant understanding.
| S-EPMC7794102 | biostudies-literature
Project description:ObjectivesDiscrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges.MethodsA systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated.ResultsOf the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels.ConclusionsThe use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
| S-EPMC6386055 | biostudies-literature
Project description:BackgroundThe use of qualitative research (QR) methods is recommended as good practice in discrete choice experiments (DCEs). This study investigated the use and reporting of QR to inform the design and/or interpretation of healthcare-related DCEs and explored the perceived usefulness of such methods.MethodsDCEs were identified from a systematic search of the MEDLINE database. Studies were classified by the quantity of QR reported (none, basic, or extensive). Authors ( n = 91) of papers reporting the use of QR were invited to complete an online survey eliciting their views about using the methods.ResultsA total of 254 healthcare DCEs were included in the review; of these, 111 (44%) did not report using any qualitative methods; 114 (45%) reported "basic" information; and 29 (11%) reported or cited "extensive" use of qualitative methods. Studies reporting the use of qualitative methods used them to select attributes and/or levels ( n = 95; 66%) and/or pilot the DCE survey ( n = 26; 18%). Popular qualitative methods included focus groups ( n = 63; 44%) and interviews ( n = 109; 76%). Forty-four studies (31%) reported the analytical approach, with content ( n = 10; 7%) and framework analysis ( n = 5; 4%) most commonly reported. The survey identified that all responding authors ( n = 50; 100%) found that qualitative methods added value to their DCE study, but many ( n = 22; 44%) reported that journals were uninterested in the reporting of QR results.ConclusionsDespite recommendations that QR methods be used alongside DCEs, the use of QR methods is not consistently reported. The lack of reporting risks the inference that QR methods are of little use in DCE research, contradicting practitioners' assessments. Explicit guidelines would enable more clarity and consistency in reporting, and journals should facilitate such reporting via online supplementary materials.
| S-EPMC5367554 | biostudies-literature
Project description:Experience across many countries shows that, without large premium subsidies, crop insurance uptake rates are generally low. In this article, we propose to use the cumulative prospect theory to design weather insurance products for situations in which farmers frame insurance narrowly as a stand-alone investment. To this end, we introduce what we call "behavioral weather insurance" whereby insurance contract parameters are adjusted to correspond more closely with farmers' preferences. Depending on farmers' preferences, we find that a stochastic multiyear premium increases the prospect value of weather insurance, while a zero deductible design does not. We suggest that insurance contracts should be tailored precisely to serve farmers' needs. This offers potential benefits for both the insurer and the insured.
| S-EPMC7194365 | biostudies-literature
Project description:BACKGROUND:The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016. METHODS:A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models. RESULTS:The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P<.001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P=.485) disutility (OR=0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P<.001) the highest for the private hospitals' benefits (OR=2.82) followed by public hospitals' benefits (OR=2.02) and outpatient benefits (OR=1.75), and the premium revealed statistically significant (P<.001) disutility (OR=0.96). CONCLUSION:Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals' utility from the insurance benefits packages.
| S-EPMC6706965 | biostudies-other
Project description:Discrete-choice experiments (DCEs) have become a commonly used instrument in health economics and patient-preference analysis, addressing a wide range of policy questions. An important question when setting up a DCE is the size of the sample needed to answer the research question of interest. Although theory exists as to the calculation of sample size requirements for stated choice data, it does not address the issue of minimum sample size requirements in terms of the statistical power of hypothesis tests on the estimated coefficients. The purpose of this paper is threefold: (1) to provide insight into whether and how researchers have dealt with sample size calculations for healthcare-related DCE studies; (2) to introduce and explain the required sample size for parameter estimates in DCEs; and (3) to provide a step-by-step guide for the calculation of the minimum sample size requirements for DCEs in health care.
| S-EPMC4575371 | biostudies-literature
Project description:Several disciplines, among them health, sociology, and economics, provide strong evidence that social context is important to individual choices. It is therefore surprising that relatively little research has been focused on integrating the effect of social influence into choice models, especially given the importance of such choices in healthcare. This study developed and empirically tested a choice model that accounts for social network influences in a discrete choice experiment (DCE). We focused on maternal choices for childhood vaccination in Australia, and used an econometric choice model that explicitly 1) incorporated vaccine schedule characteristics, benefits and costs, and 2) represented up to ten different identifiable key influencer types (e.g., partner, parents, friends, healthcare professionals, inter alia), allowing for the attribution of directional importance of each influencer on the gravid woman's decision to adhere to or reject childhood vaccination. Pregnant women (N = 604) aged 18 years and older recruited from an online panel completed a survey, including a DCE and questions about key influencers. A two-class ordered latent class model was conducted to analyse the DCE data, which assumes that the underlying latent driver (in our case the WHO vaccine hesitancy scale) is ordered, to give a practical interpretation of the meaning of the classes. When the choice model considered both childhood vaccination attributes and key influencers, a very high model fit was reached. The impact of key influencers on maternal choice for childhood vaccination was massive compared to the impact of childhood vaccination attributes. The marginal impact differed between key influencers. Our DCE study showed that the maternal decision for childhood vaccination was essentially almost completely socially driven, suggesting that the potential impact of social network influences can and should be considered in health-related DCEs, particular those where there are likely to be strong underlying social norms dictating decision maker behaviour.
| S-EPMC9581381 | biostudies-literature
Project description:BackgroundVaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide.ObjectiveWe aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments.MethodsA literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist.ResultsThe search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes.ConclusionsOur review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time.Trial registrationPROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7.
| S-EPMC11319885 | biostudies-literature