Predicting Health Programme Participation: A Gravity-Based, Hierarchical Modelling Approach

Abstract

SummaryStatistical analyses of health programme participation seek to address a number of objectives that are compatible with the evaluation of demand for current resources. In this spirit, a spatial hierarchical model is developed for disentangling patterns in participation at the small area level, as a function of population-based demand and additional variation. For the former, a constrained gravity model is proposed to quantify factors associated with spatial choice and to account for competition effects, for programmes delivered by multiple clinics. The implications of gravity model misspecification within a mixed effects framework are also explored. The model proposed is applied to participation data from a no-fee mammography programme in Brisbane, Australia. Attention is paid to the interpretation of various model outputs and their relevance for public health policy.