Hierarchical Bayes Estimation Research Articles

Residents’ preferences for tourism development in a protected area: a choice experiment

Purpose This study aims to reveal residents’ individual perceptions of nature-based destination development and preferences for infrastructure and tourism superstructure development among communities that rely heavily on wildlife tourism. Design/methodology/approach A discrete choice experiment (DCE) was used among the Maasai community based in the villages and towns near the Maasai Mara National Reserve in Kenya. The attributes included type of tourism accommodation, location of tourism accommodations, types of access roads (tarmac or marram), tourist numbers and desired land-use options (between tourism development, livestock grazing and agriculture). A DCE analysis with hierarchical Bayes estimation was performed. Findings It revealed that the introduction to land-use restrictions and the location of tourism accommodations were the most important attributes for the respondents, with average importance values of 30.36% and 24.02%, respectively. A significant less important attribute was the types of access roads with an average importance of just 8.38%. Cluster analysis revealed widespread heterogeneity in preferences. Research limitations/implications The survey-based DCE was conducted in the Maasai Mara National Reserve, Kenya, and therefore may not be relevant in other contexts. The focus was also only on the residents’ preferences. The findings broaden the knowledge on tourism developments and residents’ support for development and management of protected areas. Practical implications For policymakers, conservation practitioners and tourism businesses, this study provides a source of reference for understanding the development preferences of the Maasai community. In general, the study contributes to a better understanding of local communities in relations to tourism development and residents’ support for developments and management of protected areas (PAs). Originality/value This study fills the gap in the literature on tourism development and residents’ support for developments in PAs by presenting some limits of acceptable and desirable use of PAs among a community that has a complex coexistence with a wildlife tourism destination. It provides an alternative perspective for future research by examining residents’ choice towards destination development and preferences for infrastructure and tourism superstructure development using an experimental approach.

The Global Impact of Diversifying PrEP Options: Results of an International Discrete Choice Experiment of Existing and Potential PrEP Strategies with Gay and Bisexual Men and Physicians.

To improve current and future use of existing (oral, injectable) and potential future (implants, douches) pre-exposure prophylaxis (PrEP) products, we must understand product preferences relative to one another, among gay and bisexual men (GBM), and physicians who prescribe PrEP. We completed an online discrete choice experiment (DCE) with separate groups of GBM and/or physicians from the United States, South Africa, Spain, and Thailand. Participants were presented information on PrEP products, including daily pills, event-driven pills (2-1-1 regimen), injections, subdermal implants (dissolvable, removable), and rectal douches. Next, they completed a choice exercise in which they were shown 10 screens, each presenting 3 of the aforementioned products at a time with 11 attributes for physicians and 10 attributes for GBM. For the attributes that were not constant, one level was shown per screen for each product. Participants selected the product they preferred most and rated their likelihood to select (GBM) or recommend (physicians) that product. Data were modeled using hierarchical Bayes estimation; resulting model coefficients were used to develop attribute importance measures and product preferences. For GBM across all countries, if all aforementioned PrEP products were on the market at the same time, over 90% of GBM would use some form of PrEP; 100% of physicians would recommend at least one of the PrEP products. There were variations in product preference by country. GBM in the United States and Thailand preferred the injection (21.7%, 22.9%, respectively), while the dissolvable implant was preferred in South Africa and Spain (19.9%, 19.8%, respectively). In the United States, South Africa, and Spain (where physician data were available), physicians were most likely to recommend the dissolvable implant (37.2%, 40.6%, 38.3%, respectively).

Getting midwives back to hospitals: A discrete choice experiment

BackgroundThere is a severe global shortage of midwives, and the situation worsens when qualified professionals leave their jobs because of inadequate working conditions. Hospitals have increasing difficulties in filling vacancies for midwives. In the case of Germany, midwives tend to give up birth assistance after an average of seven years working in delivery rooms, which are usually led by physicians. ObjectiveWe aim to provide concrete recommendations on encouraging qualified professionals to work in maternity wards by examining the job preferences of midwives who currently do not provide such services. These insights shall help policy makers and hospital managers to fill vacancies more quickly and provide adequate care to more women. DesignDiscrete choice experiment. Setting(s)Online survey promoted through email and social media to midwives in Germany. Participants415 midwives participated; we examine the subgroup of 241 midwives who do not offer birth assistance. MethodsWe obtain individual parameter estimates through a multinominal logit analysis with hierarchical Bayes estimation techniques, calculate importance weights, and simulate uptake probabilities of different hypothetical job offers that include birth assistance. ResultsParticipants want to provide birth assistance but fiercely reject doing so under physicians' supervision. With a 15 % increase in income, however, 16 % would accept this least preferred setting. Forty-four percent, however, would choose to offer birth assistance if they could work in a midwife-led unit. An additional increase in income of 5 % (15 %) could even lead to uptake probabilities of 67 % (77 %). ConclusionsThere is a common understanding that midwife-led care is a safe and effective option for healthy women. Policy makers are advised to further extend their initial support for such units to fill vacancies quicker and enable comprehensive healthcare for more childbearing women. Tweetable abstractMidwife-led units help counter shortages: Midwives want to provide birth assistance but reject doing so under physicians' supervision.

HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis.

Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.

Competitive Effects of Fixed Wireless Access on Wireline Broadband Technologies

Abstract In this paper, we investigate the potential consumer savings to U.S. home broadband consumers in cable modem monopoly markets, should fixed wireless access technologies become available as a competitive alternative. We use a Choice-Based Conjoint survey and Hierarchical Bayes estimation to calculate the proportion of home broadband consumers that would switch to a fixed wireless access option if it was made available in a cable modem monopoly market. We then utilize a monopoly pricing model to estimate the downward pricing pressure this competition would place on incumbent cable modem monopoly prices. We find that fixed wireless entry at current prices would convert 18 percent of cable-only households and lead to a 37 percent reduction in the price of cable modem service. We also find entry into non-monopoly markets where a fiber-optic broadband alternative already exists, and find muted conversion rates and price reductions. Our results indicate that the deployment of fixed-wireless access would generate substantial consumer savings in cable modem monopoly markets, which constitute 30 precent all cable modem subscribers in the United States.

Patient preferences in treatment options of ulcerative colitis: a discrete choice experiment

Introduction Since the number of medical treatment options for Ulcerative Colitis (UC) has expanded over the last decades, patients and physicians face challenges regarding decisions about the medication options. We aimed to identify patients’ preferences about their UC treatment options in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment. Methods We conducted a web-based, multicenter, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical medicinal treatment options. The choice tasks were based on administration route, administration location, chance of symptom reduction (on short and long term) and chances on infection and other adverse events. Data were analyzed by using Hierarchical Bayes estimation. Results A total of 172 UC patients participated in the DCE. More than half were anti-TNF experienced (52.9%). The chance of symptom reduction after one year (relative importance (RI) 27.7 (95% CI 26.0–29.4)) was most important in choosing between medicinal treatments, followed by the chance of infection (RI 22.3 (21.4 − 23.3)) and chance of symptom reduction after eight weeks (RI 19.5 (18.3 − 20.6)). Considering surgical treatment, nineteen patients (14.3%) would not even consider surgery after failing eight treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. Conclusion We found that symptom reduction after one year was the most important attribute in choosing between treatments in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.

Using Auxiliary Item Information in the Item Parameter Estimation of a Graded Response Model for a Small to Medium Sample Size: Empirical Versus Hierarchical Bayes Estimation.

Marginal maximum likelihood estimation (MMLE) is commonly used for item response theory item parameter estimation. However, sufficiently large sample sizes are not always possible when studying rare populations. In this paper, empirical Bayes and hierarchical Bayes are presented as alternatives to MMLE in small sample sizes, using auxiliary item information to estimate the item parameters of a graded response model with higher accuracy. Empirical Bayes and hierarchical Bayes methods are compared with MMLE to determine under what conditions these Bayes methods can outperform MMLE, and to determine if hierarchical Bayes can act as an acceptable alternative to MMLE in conditions where MMLE is unable to converge. In addition, empirical Bayes and hierarchical Bayes methods are compared to show how hierarchical Bayes can result in estimates of posterior variance with greater accuracy than empirical Bayes by acknowledging the uncertainty of item parameter estimates. The proposed methods were evaluated via a simulation study. Simulation results showed that hierarchical Bayes methods can be acceptable alternatives to MMLE under various testing conditions, and we provide a guideline to indicate which methods would be recommended in different research situations. R functions are provided to implement these proposed methods.

An empirical study of hierarchical Bayes small area estimators using different priors for model variances

In this paper, we study hierarchical Bayes (HB) estimators based on different priors for small area estimation. In particular, we use inverse gamma and flat priors for variance components in the HB small area models of You and Chapman (2006) and You (2021). We evaluate the HB estimators through a simulation study and real data analysis. Our results indicate that using the inverse gamma prior for the variance components in the HB models can be very effective.

Algorithm aversion to mobile clinical decision support among clinicians: a choice-based conjoint analysis

ABSTRACT Artificial intelligence has pervaded clinical decision support systems driven by algorithms. In healthcare, algorithmic decision-making is said to outperform clinicians in their treatment choices and recommendations. Yet, relying on an algorithm outcome for clinical decisions comes with uncertainties resulting from the opacity, inconsistency and inaccuracy usurping the epistemic authority of clinicians and ultimately creating aversion. This study explores latent factors that constitute aversion to using algorithm-augmented mobile clinical decision support (mCDS) applications (apps) by clinicians at the point of care. Given that aversion encompasses a tendency to avoid potential risks, we modelled clinicians’ preferences using choice-based conjoint analysis with Hierarchical Bayes (HB) estimation methods to examine 362 clinicians’ aversion algorithm-augmented mCDS apps. In order of magnitude, the findings indicate that clinicians using mCDS apps are averse to algorithms undermining their epistemic authority with persistently inconsistent results at the point of care. In essence, clinicians will at the point-of-care resist algorithms that restrict them from modifying the result in line with their professional responsibilities. The study has several implications for both research and practice by helping improve potential drawbacks in clinical algorithms while promoting effective frameworks to enhance decision-making in medical practice.

P688 Patient preferences in medication to treat Ulcerative Colitis: a discrete choice experiment

Abstract Background Since the number of treatment options for Ulcerative Colitis (UC) has expanded, patients and physicians face challenges regarding decisions about the medication options. In shared decision making, treating physicians help patients understand the trade-offs and their own preferences. We aimed to identify patients preferences about the relative risks and benefits of UC treatment options in patients with UC in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment. Methods We conducted a web-based, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical treatment options with varying combinations of attribute levels (fig 1). Attributes were based on consecutively a literature search, patient interviews, surveys and a focus group. The six included attributes were: administration route, administration location, chance on symptom reduction (short and long term), chances on infection and on adverse events. A balanced overlap design was used. Patients were recruited via the patient association Crohn & Colitis NL and in two academic hospitals. Data were analyzed by using Hierarchical Bayes estimation. Results A total of 172 patients participated in the DCE. Median disease duration was 8 (IQR 3-16) years. Most patients were anti-TNF experienced (52.9%). Symptom reduction after one year (relative importance (RI) 27.7 (95% CI 25.6-29.7)) was the most important when choosing between treatment options (table 1), followed by the chance of infection (22.3 (21.2 - 23.4)) and chance of symptom reduction after eight weeks (RI 19.5 (18.1 - 20.9)). The location of administration of the treatment and the chance of adverse events were the least important (8.7 (7.7 - 9.79) and 8.5 (7.9 - 9.2), respectively). Patients preferred oral administration over subcutaneous injections. Intravenous route of administration was least favorite. The differences in average utilities of patients previous treated with biologic therapy or small molecules or naïve patients are displayed in table 2. 133 patients filled in the trade off questions regarding surgery. Forty-four patients (33.1%) responded with unknown. Nineteen patients (14.3%) would not even consider surgery after failing all treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. Of the remaining patients, nine (6.8%) would consider surgery after failing six treatment options. Conclusion We found that symptom reduction after one year was the most important treatment attribute in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.

Measuring the Value of Different Types of Product Information in the Electronic Retail of Books

The value of different kinds of book information in electronic retail is measured using best–worst scaling, an approach making the respondent consider several information items simultaneously and choose the most and least preferred among them. Our respondents are both customers using municipal libraries and students. Theory on digital nativity, Hierarchical Bayes estimation and Latent Class analysis are used to study the heterogeneity of the preferences. Customer reviews give the most valuable information on an average. Especially digital immigrants rely more on samples, expert reviews, author presentations, blogs, and friends’ ratings. Preference clusters were identified where the extremes groups were those who highly valued peer information but not expert information and those who valued them vice versa. Customer reviews are appreciated by almost everyone, regardless of their state of digital nativity. The electronic retailer should make all efforts to provide the personalized information when the customer is browsing books online and offer a rich set of customer reviews.

Identifying participants' preferences for modifiable chemotherapy-induced peripheral neuropathy prevention clinical trial factors: an adaptive choice-based conjoint analysis.

There are no recommended treatments for chemotherapy-induced peripheral neuropathy (CIPN) prevention. Recruitment to CIPN prevention clinical trials is challenging because it is difficult to enroll patients between the time of cancer diagnosis and the initiation of neurotoxic chemotherapy. The purpose of this exploratory-sequential mixed-methods study was to determine patients' preferences that could affect the choice to participate in CIPN prevention clinical trials. First, twenty cognitive interviews were conducted with adults who completed less than three neurotoxic chemotherapy infusions to clarify clinical trial attributes and levels thought to be important to patients when deciding whether to enroll in CIPN prevention trials (i.e., type of treatment, clinical tests, reimbursement, survey delivery; length of visits, timing of follow-up, when to begin treatment). Second, another eighty-eight patients completed an adaptive choice-based conjoint analysis survey that incorporated the finalized attributes and levels. Each level was assigned a part-worth utility score using Hierarchical Bayes Estimation. The relative importance of each attribute was calculated. The attributes with the highest relative importance values were type of treatment (27.1%) and length of study visits (20.2%). The preferred levels included non-medicine treatment (53.49%), beginning treatment after experiencing CIPN (60.47%), email surveys (63.95%), assessments that include surveys and clinical exams (39.53%), under 30-min visits (44.19%), $50/week reimbursement (39.53%), and 1-month post-chemotherapy follow-up visits (32.56%). Patients' preferences for participation may be included in the design of future CIPN prevention clinical trials to potentially bolster study enrollment.

Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT): a maximum-difference-scaling analysis

The Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT) project is intended to provide new insights into the relevant utility attributes regarding therapy choices for malignant primary and secondary liver tumors from the perspective of those who are involved in the decision-making process. It addresses the potential value of taking patients’ expectations and preferences into account during the decision-making and, when possible, adapting therapies according to these preferences. Specifically, it is intended to identify the relevant clinical attributes that influence the patients’, medical laymen’s, and medical professionals’ decisions and compare the three groups’ preferences. We conducted maximum difference (MaxDiff) scaling among 261 participants (75 physicians, 97 patients with hepatic malignancies, and 89 medical laymen) to rank the importance of 14 attributes previously identified through a literature review. We evaluated the MaxDiff data using count analysis and hierarchical Bayes estimation (HB). Physicians, patients, and medical laymen assessed the same 7 attributes as the most important: probability (certainty) of a complete removal of the tumor, probability of reoccurrence of the disease, pathological evidence of tumor removal, possible complications during the medical intervention, welfare after the medical intervention, duration and intensity of the pain, and degree of difficulty of the medical intervention. The cumulative relative importance of these 7 attributes was 88.3%. Our results show that the physicians’, patients’, and medical laymen’s preferences were very similar and stable.Trial registration DRKS-ID of the study: DRKS00013304, Date of Registration in DRKS: 2017/11/16.

Medical practitioners’ decision making on quality of online medical information: A consumption values theory analysis

ObjectiveThis study examined how medical practitioners make decisions on what constitutes quality Online Medical Information (OMI). The study seeks to understand the factors that are considered in arriving at a decision to use medical information provided online given the probable consequences if found to be erroneous. MethodsThe study used choice-based conjoint analysis with Hierarchical Bayes (HB) estimation methods, to examine online medical information quality choices of 242 medical practitioners. The methodology was theoretically guided by the Random Utility Theory (RUT) and Consumption Values Theory (CVT) ResultsIn the order of importance, the findings indicate that during online medical information seeking, the source of the information and its up-to-dateness are the most important quality criteria physicians look out for when assessing OMI. In general, the OMI consumption behaviour of medical practitioners can be explained by social, epistemic and functional values. ConclusionMedical practitioners are avid users of OMI and therefore it is important that the decision-making process to determine the quality of OMI is understood. Understanding the decision-making process would help optimize the determination of the quality of OMI for safe usage. There must be regular OMI training and awareness especially on how to assess quality OMI content.

Autonomous agriculture in public perception - German consumer segments’ view of crop robots

Public acceptance of agricultural technologies is an important determinant of their success. In the case of autonomous crop robots, recent research from Germany suggests that societal acceptance of the technology plays an important role for farmer acceptance of crop robots. Yet little research has been conducted so far into how the public perceives autonomous agricultural technologies like crop robots. Investigating the public’s opinion on crop robots will provide answers to one of farmers’ questions in the decision to invest in crop robots. Through consumer segmentation and hypotheses-based characterization, specific consumer groups with differing attitudes towards crop robots are identified. Two discrete choice experiments on digital and autonomous methods of weed management (n = 675) and tractor size and degree of autonomy (n = 645), conducted as part of a larger representative consumer survey in Germany (n = 2,012), are submitted to a Hierarchical Bayes estimation and subsequent latent class analysis. The identified consumer segments are characterized in a hypotheses-based approach with hypotheses centering on consumer attitudes measured as 5-point Likert-type items and as spontaneous image associations. Both subsamples can be segmented into three groups, which are comparable between the experiments in their socio-economic composition. Results suggest that the German public is largely positively inclined towards autonomous agricultural technologies. The method of weed control is considered more important than the vehicle type (i.e., conventional tractor or crop robot) and vehicle size is considered more important than degree of autonomy. Only the respective smallest consumer segments in the two experiments indicate indifference or a more conservative perspective. Participants’ attitude towards environmental preservation appears to have a positive influence on their evaluation of autonomous agricultural technologies. To the authors’ best knowledge, this is the first investigation into the public opinion of crop robots, based on a large sample representative of the German population in four socio-demographic variables. It indicates that the German population is most interested in the reduction of agrochemicals in plant production and will also accept autonomous agricultural technologies to achieve this goal. Policymakers should make use of these insights when communicating about novel technologies in agriculture and extension agents should relay this information to farmers, particularly those already interested in investing in crop robots.

Does the relative importance of the OxCAP-MH’s capability items differ according to mental ill-health experience?

BackgroundSome capability dimensions may be more important than others in determining someone’s well-being, and these preferences might be dependent on ill-health experience. This study aimed to explore the relative preference weights of the 16 items of the German language version of the OxCAP-MH (Oxford Capability questionnaire-Mental Health) capability instrument and their differences across cohorts with alternative levels of mental ill-health experience.MethodsA Best–Worst-Scaling (BWS) survey was conducted in Austria among 1) psychiatric patients (direct mental ill-health experience), 2) (mental) healthcare experts (indirect mental ill-health experience), and 3) primary care patients with no mental ill-health experience. Relative importance scores for each item of the German OxCAP-MH instrument were calculated using Hierarchical Bayes estimation. Rank analysis and multivariable linear regression analysis with robust standard errors were used to explore the relative importance of the OxCAP-MH items across the three cohorts.ResultsThe study included 158 participants with complete cases and acceptable fit statistic. The relative importance scores for the full cohort ranged from 0.76 to 15.72. Findings of the BWS experiment indicated that the items Self-determination and Limitation in daily activities were regarded as the most important for all three cohorts. Freedom of expression was rated significantly less important by psychiatric patients than by the other two cohorts, while Having suitable accommodation appeared significantly less important by the expert cohort. There were no further significant differences in the relative preference weights of OxCAP-MH items between the cohorts or according to gender.ConclusionsOur study indicates significant between-item but limited mental ill-health related heterogeneity in the relative preference weights of the different capability items within the OxCAP-MH. The findings support the future development of preference-based value sets elicited from the general population for comparative economic evaluation purposes.

Measuring country of origin effects in online shopping implicitly: a discrete choice analysis approach

PurposeTo examine whether the country of origin (COO) effect actually exists in an e-commerce context, the authors intend to contribute to the ongoing debate by measuring the COO effect through a series of connected studies.Design/methodology/approachDrawing on cue utilization theory, the authors emphasize the urge to investigate the COO effect in multiple cue settings in order to reveal a more realistic picture of its actual effect size. In contrast to most prior research, which often does not analyze COO using methodological plurality and neglects important contextual factors, the authors employed a four-staged research design in an attempt to trigger and measure the COO’s implicit effect size in today’s pervasive context of online shopping. The importance of brands (inhering the COO) is decompositionally calculated relative to other extrinsic cues by applying a Hierarchical Bayes estimation, with the COO impact being extracted subsequently.FindingsThe results deepen concerns that the COO effect actually does not exist, particularly in the more contemporary context of online shopping. Specifically, preferences for previously favored German products faded when controlling for brand attitude for both high-involvement (p = 0.003) and low-involvement products (p = 0.024).Research limitations/implicationsThe study focused on consumers of Generation Y, as they represent one of the most important segments in online shopping. Findings might be replicated for other consumer generations. The study focused on Chinese consumers, as the Chinese e-commerce market represents the world’s largest one. Future studies might investigate other markets.Practical implicationsAs brands, rather than a COO effect, impacted consumer preferences, companies selling their products to Chinese consumers online need to establish a reputation for quality early on. Chinese companies should emphasize their COO to make use of the ethnocentrism detected. Companies profit from the Best-Worst Scaling investigation revealing which product categories Chinese consumers most preferably buy online from German companies.Originality/valueTo the best of the authors’ knowledge, this study is the first to capture the importance of COO in the contemporary context of ubiquitous online shopping. Moreover, a more realistic and less biased way of measuring the importance of COO is enabled by building upon three pre-connected studies. The findings allow to develop a generalization for both high- and low-involvement products.

Preferences for Long-Acting and Alternative Modalities for PrEP among Military Men Who Have Sex with Men: Segmentation Results of an Adaptive Choice-Based Conjoint Analysis Study

The use of pre-exposure prophylaxis (PrEP) for HIV prevention within the U.S. military is low. Implementing preference-based alternative modalities of PrEP delivery, however, can be an innovative strategy to address the specific barriers to PrEP uptake among military MSM. We sought to identify population-based, segment-specific preferences for longer-acting and alternative PrEP delivery modalities to guide patient-centered strategies to optimize uptake within military-serving healthcare systems. HIV-negative military men who have sex with men (MSM) completed an anonymous, adaptive choice-based conjoint (ACBC) analysis survey consisting of five key attributes of interest (dosing method, provider type, visit location, lab work evaluation location, and dispensing venue). Relative importance and part-worth utility scores were generated using Hierarchical Bayes (HB) estimation, and cluster ensemble analysis grouped participants into “phenotype” segments by preference similarity. The randomized first-choice model was then used to examine changes in program interest rates among segments through market simulation. The 429 participants were segmented into five preference groups. The dosing method attribute was found to be the most important to nearly all segments. Simulations revealed that PrEP program interest among two segments with low interest levels increased when smartphone, civilian-based, and long-acting injectable PrEP options were involved. Findings also suggested a need for clinics to be responsive and sensitive to sexual practices, risk perception, and functional PrEP knowledge. Responsiveness to segment-specific preferences in the design of military PrEP programs and acting on the importance of clinical relationships within the context of PrEP engagement within a military setting may contribute to increasing PrEP uptake.

Patient and physician preferences for non-invasive diagnostic cardiovascular imaging technologies: a discrete choice experiment

PurposeDiagnostic imaging techniques have to be selected for their accuracy, efficiency, cost-efficiency, and impact on outcome. But beyond that, the choice of non-invasive cardiovascular imaging tests for diagnosing coronary artery disease also has to respect patient safety and comfort. In this study, we investigated patient and physician preference in relation to the choice of cardiovascular imaging tests.ResultsA total of 211 subjects (148 cardiac patients and 63 physicians) were enrolled and completed a discrete choice experiment. Tests and modalities were deconstructed into 6 attributes (risks and side effects, diagnostic accuracy, patient out-of-pocket cost, type of procedure, type of scanner and test duration). A Sawtooth software choice-based conjoint analysis with hierarchical Bayes estimation was performed and showed the risks and side effects attribute was assigned the most relative importance (30%) when considering patients’ preference. Patients gave notably high value to tests with milder side effects, while preferring to avoid exposure to ionizing radiation and risks associated the use of pharmacological agents inducing direct coronary arteriolar vasodilation. Physicians allocated more importance to the patient out-of-pocket cost attribute (29%). Both patients and physicians valued tests’ risks and side effects, diagnostic accuracy, patient out-of-pocket cost as the three most important attributes, but in diverging order. A market simulation comparing current cardiovascular imaging tests revealed breathing maneuver-enhanced cardiac magnetic resonance had the highest shares of preference in both patients (59.6%) and physicians (32.7%).ConclusionA patients’ preference for a particular cardiovascular imaging test was most determined by the risks and side effects, while physicians prioritized less costly tests for their patients. In shared decision-making with patients, physicians should therefore focus on a balanced discussion of risks and side effects associated with cardiovascular imaging tests. Both, patients and physicians would prefer a cardiovascular MR imaging test using a vasoactive breathing maneuver instead of currently used alternatives that require intravenous contrast agents, pharmacological stress, or radiation.

Factors Affecting Young Adults' Decision Making to Undergo COVID-19 Vaccination: A Patient Preference Study.

Young adults are a substantial driver of lagging vaccination against COVID-19 worldwide. We aimed to understand what vaccine or vaccination environment attributes may affect young adults’ vaccine inclination. We contacted a convenience sample of 1415 students to recruit a minimum of 150 individuals for a web-based discrete choice experiment. The respondents were asked to choose one of two hypothetical vaccines, defined by six attributes—vaccine efficacy, risk of mild side effects, protection duration, administration route, recommender, and travel time to the vaccination site. Individual preferences were calculated with the Markov chain Monte Carlo hierarchical Bayes estimation. A total of 445 individuals (mean age 24.4 years, 272 (61.1%) women) completed the survey between 22 March and 3 May 2021. Vaccine protection duration (28.3 (95% CI, 27.0–29.6)) and vaccine efficacy in preventing COVID-19 (27.5 (95% CI, 26.3–28.8)) were the most important, followed by the risk of vaccine side effects (17.3 (95% CI, 16.2–18.4)). Individuals reluctant or unsure about vaccination (21.1%) prioritized the potential for mild side effects higher and vaccine efficacy lower than the vaccine-inclined individuals. New vaccination programs that target young adults should emphasize the protection duration, low risk of vaccine side effects, and high efficacy.