Cheung Kei Long, Evers Silvia M A A, Hiligsmann Mickaël, Vokó Zoltán, Pokhrel Subhash, Jones Teresa, Muñoz Celia, Wolfenstetter Silke B, Józwiak-Hagymásy Judit, de Vries Hein
Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, GT Maastricht, 6229, The Netherlands.
Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Duboisdomein 30, GT Maastricht, 6229, The Netherlands.
Health Policy. 2016 Jan;120(1):46-54. doi: 10.1016/j.healthpol.2015.11.004. Epub 2015 Nov 28.
Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understanding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e., the Return on Investment tool.
Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA's were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool.
Ninety-three stakeholders participated. Significant differences in beliefs were found between non-intenders and intenders: risk perception, attitude, social support, and self-efficacy towards using the tool. Regression showed that demographics, pre-motivational, and motivational factors explained 69% of the variation in intention.
This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies.
尽管对烟草控制干预措施的经济评估数量有所增加，但利益相关者对其的采用率仍然有限。因此，了解利益相关者采用此类经济决策支持工具的潜在机制很重要。通过应用行为改变模型，本研究旨在确定哪些因素决定了经济决策支持工具（即投资回报率工具）的潜在采用情况。
在五个国家对利益相关者（决策者、服务/药品购买者、专业人员/服务提供者、证据生成者和健康促进倡导者）进行了访谈，使用基于行为改变模型的问卷。进行多变量方差分析以评估有意采用者和无意采用者在信念方面的差异。进行多元回归分析以确定使用经济决策支持工具意图的主要解释变量。
93名利益相关者参与了研究。在无意采用者和有意采用者之间发现了信念上的显著差异：对使用该工具的风险认知、态度、社会支持和自我效能感。回归分析表明，人口统计学、动机前和动机因素解释了意图差异的69%。
本研究首次提供了一个理论框架，以理解有意或无意使用经济决策支持工具的利益相关者在信念上的差异，并通过实证证实了该框架。这有助于我们理解采用这些研究的促进因素和障碍。
