Abstract
BackgroundAn increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parents’ preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA).MethodsA discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parents’ monetary valuation of health and service improvements.ResultsEvery attribute in the DCE was statistically significant (p < 0.01) except that of cost (p = 0.118), suggesting that all attributes, except cost, have an impact on parents’ preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parents’ estimated mean annual WTP for a multidisciplinary foot care service was £1,119.05.ConclusionsIn terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parents’ preferences.
Highlights
An increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery
This randomised controlled trial (RCT) was registered with the International Standard Randomised Controlled Trial Number (ISRCTN) register
At present very little is known about the provision of foot care in juvenile idiopathic arthritis (JIA) [2,14], and there is little evidence on parents’ views and opinions of foot care, from those who have had no experience of foot care services
Summary
An increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. Paediatric patient adherence to rehabilitative strategies is often poor and non-compliance may limit the potential for benefits in outcomes following therapy [7,8]. As such children with JIA may respond poorly to intervention resulting in sustained physical impairment, which may contribute negatively to the economic impact of JIA [9,10]. An increased awareness of patients’ and parents’ care preferences is desirable from a clinical perspective as such information may be utilised to optimise care delivery [12,13]. A limitation of qualitative research is that it does not permit the ranking of preferences to provide information regarding the importance of different aspects of care
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