Abstract
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.
Highlights
Complex health interventions must incorporate user preferences to maximize their potential effectiveness
Use of antiretroviral (ART)-based vaginal and oral pre-exposure prophylaxis (PrEP) was effective in five of eight randomized controlled trials (RCTs) [1,2,3,4,5,6,7,8], with the differing results largely attributed to sub-optimal adherence rather than a lack of product efficacy [9, 10]
The purpose of this study is to describe how the Discrete choice experiment (DCE) methodology can be used to inform the development of complex interventions
Summary
Complex health interventions must incorporate user preferences to maximize their potential effectiveness. DCEs are a survey-based approach to eliciting user preferences They allow the estimation of user values in the absence of observable markets, where services are provided for free or have not yet been introduced. They can measure the strength of preferences between service attributes, for example, valuing waiting times, prices and provider gender, independently. They can identify where preferences differ between individuals, which is useful when complex interventions include targeting specific user groups
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