Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America.
Department of Health Services Policy and Practice, and International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, United States of America.
PLoS One. 2023 Dec 22;18(12):e0295845. doi: 10.1371/journal.pone.0295845. eCollection 2023.
In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
在萨摩亚，成年人 2 型糖尿病的患病率在过去 30 年中有所增加。患者对护理的偏好是已知会影响治疗依从性的因素，与降低疾病进展和严重程度有关。然而，一般来说，患者对糖尿病护理的偏好研究不足，其他以患者为中心的因素，如对糖尿病治疗的支付意愿 (WTP)，在这种情况下从未被探讨过。离散选择实验 (DCE) 是一种有用的工具，可以引出对医疗保健的偏好和 WTP。DCE 向患者呈现由一系列多选择配置文件组成的假设场景，这些配置文件由属性和水平组成。患者根据可能对他们更有利的属性和水平选择一个配置文件，从而对本地相关的以患者为中心的偏好进行量化和识别。本文介绍了在萨摩亚设计、试点和实施 DCE 以确定患者对糖尿病护理偏好的方案。采用探索性顺序混合方法设计，从文献综述和对 20 名萨摩亚成年 2 型糖尿病患者的半结构式访谈中获取形成性数据，用于设计最佳最佳 DCE 工具。实验设计程序用于减少选择集的数量并平衡工具。试点测试后，正在向 450 名萨摩亚成年糖尿病患者发放 DCE 以及相关问卷和人体测量学数据。随后，我们还将评估随着时间的推移护理偏好如何变化。数据将使用渐进式混合秩次逻辑模型进行分析。结果将确定哪些糖尿病护理属性对患者重要 (p < 0.05)，研究参与者特征与偏好之间的关联，阐明参与者愿意做出的权衡以及特定属性和水平的吸收率和 WTP。这项研究的结果将提供有用的基础数据，用于设计和调整这种情况下有效的糖尿病干预和治疗方法。
