Open-ended Follow-up Question Research Articles

INADEQUATE CARE OF HYPERTENSION AND OTHER NON-COMMUNICABLE DISEASES DURING THE COVID-19 PANDEMIC IN SOUTH AFRICA

Objective: In the setting of an already overburdened healthcare system, South Africa has a high burden of hypertension and other non-communicable diseases (NCDs), and the country experienced a high COVID-19 caseload. The aim of this study was to examine the perceptions and experiences of 1) healthcare professionals (HPs) on the preparedness of health systems to provide NCD care and of NCD management during the COVID-19 pandemic, and 2) people living with NCDs (PLWNCDs) on the care they received for hypertension and other NCDs during the COVID-19 pandemic in South Africa. Design and method: Across the country, we recruited a convenience sample of 1) HPs who worked in healthcare management i.e., public health officials and healthcare workers who provided care and engaged with patients in any healthcare capacity, and 2) PLWNCDs with at least 1 NCD. Questionnaires included quantitative and open-ended follow-up questions. Quantitative analyses were conducted using SPSS. The qualitative open-ended questions were evaluated using content analysis with inductive reasoning. Results: There were 31 HPs and 79 PLWNCDs (59 with hypertension) included in this cross-sectional study. HPs perceived COVID-19 care to be adequate, while NCD care was poor during the pandemic. There were service disruptions including for emergency and specialised NCDs care. Strategies for the care of non-COVID-19 illnesses during the pandemic were absent. This would have serious long-term consequences for PLWNCDs and the healthcare system. Perceptions of inadequate hypertension and other NCD care were reiterated by PLWNCDs; 49% felt they received ’very little’ or no adequate care. 18% had a scheduled appointment cancelled. Additionally, many PLWNCDs (52%) felt anxious, lonely, or frightened during the pandemic and 15% felt their mental health had deteriorated. The utility of digital health in future was positively perceived by both HPs and PLWNCDs and may be able to improve health provision during crises. Conclusions: Policies are required 1) so that NCD care will not be overlooked during future crises and 2) to encourage PLWNCDs to timeously access healthcare services during such periods. Such strategies may incorporate digital health apps to improve care and target the mental healthcare needs of PLWNCDs.

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S.

Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

Factors contributing to U.S. parents’ decisions to administer melatonin to children

ObjectivePediatric melatonin use is increasingly prevalent in the U.S. despite limited research on its efficacy and long-term safety. The current study investigated factors contributing to parents’ decisions whether to give children melatonin. MethodsParents of children 1.0–13.9 years completed an online questionnaire on children's health, sleep, and melatonin use. Parents who reported giving melatonin to their child were asked open-ended follow-up questions on why their child takes melatonin and why they stopped (if applicable). Responses were assigned to categories through thematic coding. ResultsData were analyzed on 212 children who either consumed melatonin in the past 30 days (n = 131) or took melatonin previously (n = 81). Among children who recently took melatonin, 51.1 % exhibited bedtime resistance and 46.2 % had trouble falling asleep. Parents most commonly gave children melatonin to: help them fall asleep (49.3 %), wind down before bedtime (22.7 %), facilitate changes in their sleep routine (17.5 %), and/or change their circadian rhythm (11.4 %). Parents stopped giving melatonin because their child did not need it anymore (32.0 %), experienced negative side effects (9.3 %), and/or concerns about health and safety (13.3 %). Finally, parents initiated melatonin use on their own (50.0 %), were encouraged by a friend or family member (27.4 %), and/or followed the recommendation of a health provider (48.1 %). ConclusionsParents administered melatonin to children for a number of reasons and discontinued melatonin based on their own observations of a variety of effects. Parents frequently initiated use without the recommendation of a medical professional. Further research on indications and efficacy of melatonin and wider dissemination of guidelines are needed to help parents make informed decisions regarding children's sleep health.

FC5: The Maintain Your Brain online multidomain intervention for dementia risk reduction: qualitative exploration of lifestyle changes made, continued, or declined, and why

Objective:Explore end-user evaluations and feedback focused on lifestyle change in a large-scale multidomain online intervention targeting modifiable risk factors for dementia.Methods:Online survey and semi-structured interviews at conclusion of the Maintain Your Brain (MYB) randomized controlled trial. Participants were 55-77 years of age at baseline, and had engaged in assessments, brain training, nutrition and physical activity, and mental health modules over three years. Of 5,260 participants invited, 2,386 completed online surveys and 1,589 of these respondents provided free text comments. Nearly 250 survey respondents agreed to be contacted for additional interviews; 70 of these were invited, 40 interviewed. Survey respondents and interview completers endorsed whether they had made lifestyle changes because of MYB participation and whether they would continue healthy lifestyle changes going forward. Interview participants endorsed whether they thought similar programs can be useful in delaying or preventing dementia, whether their views regarding this type of program had changed over time, answered open-ended follow-up questions and provided additional feedback. Data were summarized using descriptive statistics and explored using multiple qualitative methods.Results:Of survey respondents, 90.5% endorsed intention to continue a healthier lifestyle; 63.2% endorsed that lifestyle changes had occurred. Interview participants thought similar programs could be useful in delaying or preventing dementia, but some were unsure. Trial participation had not changed many individuals’ views about online lifestyle programs. Survey free-text and interview comments indicated diversity in pre-intervention knowledge, lifestyle and health-related behavior. Many respondents reported improved knowledge and awareness, some detailed relevant and continued lifestyle change. Those who were already well informed and/or leading healthy lifestyles explained that trial participation had confirmed their existing practices. Trial characteristics, personal characteristics, social relationships and significant events impacted whether respondents had made and/or continued changes. More flexible, adaptive individually tailored goals and timely feedback were requested to better support change.Conclusion:Surveyed participants who engaged in the 3-year MYB online multidomain dementia risk reduction program reported lifestyle changes and intention to continue having a healthier lifestyle. Older adults in this study suggested that similar online programs need to provide flexible, individualized guidance and feedback to support lifestyle change.

Factors Affecting Parent and Child Play Experiences During the COVID-19 Spread and Initial Social Distancing Efforts

ABSTRACT The present study sought to understand parents’ perspectives on the ease with which they felt they could play with their children during the initial period of social distancing. Seven hundred and five participants answered a 48-item questionnaire. This manuscript is focused on one Likert-type scale question and an open-ended follow-up question. Almost two thirds of participants indicated they felt indifference or that it was difficult to play with their children during social distancing. Five hundred and nine participants provided feedback for their answers. Thematic analysis was used to code and categorize these comments. Participants provided varied reasons for how they viewed playing with their children during social distancing, which were used to create five themes: Work and Professional Role, Mental & Physical Health, Time, Access to Resources, and Parenting Factors. The researchers offer implications for promoting play during times of social distancing.

GA Pilot Perceptions of Speech Systems to Transcribe and Submit PIREPs

Flying into hazardous weather can be a cause of aviation incidents and accidents. Accidents involving general aviation (GA) pilots who are not instrument rated who fly into instrument meteorological conditions (IMC) are often fatal. Pilot weather reports (PIREPs) can increase the accuracy and timeliness of current and forecasted weather conditions. They are an essential tool used by pilots to avoid flying into hazardous weather as well as meteorologists to develop and update aviation forecasts. Thus, a large number of accurate PIREPs with the best source of current weather coming from pilots and air traffic controllers are needed. Pilots are often unable to make PIREPs because of workload in the cockpit or because it is cumbersome to leave the air traffic control (ATC) frequency to contact flight the flight service station (FSS). Currently, air traffic controllers must solicit and disseminate PIREPs. However, air traffic controllers’ primary obligation is to provide traffic separation and traffic alerts. During poor weather, when PIREPs are needed the most, controllers are often too busy to solicit and disseminate PIREPs (NTSB, 2017a). This study administered a descriptive survey to inquire about how likely pilots would be to use a speech recognition system (SRS) to transcribe and submit PIREPs automatically while flying in three distinct flight regimes: instrument flight rules (IFR), visual flight rules (VFR) with flight following, and VFR without flight following. The survey employed cross-section design and included Likert scale questions. For each flight regime, additional information was obtained through an open-ended follow-up question. The Likert scale responses indicated that pilots were neutral about using a SRS to transcribe and submit PIREPs in each flight regime.Spradley’s (1979) domain analysis was used to identify common themes and patterns from the open-ended responses. Major findings from flying IFR were that pilots found it easier to speak directly to air traffic control, or pilots were too busy to submit PIREPs while flying IFR. Major findings from flying VFR with flight following were that pilots thought it was easier to report PIREPs directly to air traffic control or to a flight service station, and it was more accurate to report PIREPs directly to an aviation professional. However, they were willing to try a SRS. Major findings from flying VFR without flight following were that pilots wanted the opportunity to review a PIREP submission for accuracy and were willing to try the system. Significant differences were determined by making a comparison between the three groups.

Covid-19 and Collective Memory Among Malaysians: Does Generation Matter?

The present study aims to understand the impact of Covid-19 on the collective memory among Malaysian generational cohorts. Our research draws on a nationwide survey conducted from July-September 2020 during the second pandemic wave in Malaysia. Respondents were asked to report “the national or world events or changes over the past 60 years” that seemed to them especially important and explain the reasons for their choices. As expected, the result indicated Covid-19 as the most frequently mentioned event. Despite the primacy and recency of the event, we found significant cohort effects on the collective memory of Covid-19, with lower recall recorded among the older generation as compared to the younger generation, which provided stronger support to the Critical Years Hypothesis. Interesting cohort experiences emerge in the meaning attached to Covid-19 across different generational cohorts through open-ended follow-up questions.

The Economic Valuation of Urban Green Parks: The Application of Contingent Valuation Method

This study analyzes the total economic values of urban green areas conserved at Bahir Dar city. Contingent Valuation Method (CVM) was employed to obtain estimates of Willingness to Pay (WTP) for improving the endangered and overlooked environmental assets, urban green areas to sustain them & generate benefits to current and future generations. In this contingent valuation survey, the researcher adopted a dichotomous choice with follow-up debriefing questions and scenario description, as well as open-ended follow-up question to model individual’s WTP. The study used purposive sampling method to select the parks under study followed by simple random sampling to select 200 sample respondents. The study result revealed that almost all the respondents have a positive attitude towards the conservation of urban green parks but uncertain about the sustainability of the area’s that leads them not to take care of the areas. Besides, the study results show that the mean monthly WTP of the individuals was between 0.047 -0.16 USD and the Total Economic Value (TEV) of improved urban green areas per month was about 4656.75- 15,704.14 USD calculated from the double bounded elicitation format and open ended elicitation format respectively. Keywords: Bahir Dar , CVM, Logistic Regression, Urban Green Parks, WTP. DOI: 10.7176/JESD/12-23-01 Publication date: December 31 st 2021

Rural Residents' Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews.

BackgroundCompared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities.ObjectiveThis study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program—Make Better Choices 2—consists of personalized health coaching, accelerometer use, and financial incentives.MethodsWe convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis.ResultsWe identified 3 main themes regarding Appalachian residents’ perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program.ConclusionsBlending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents.

Patients' Willingness and Perspectives Toward Chimeric Antigen Receptor T-Regulatory Cell Therapy for Inflammatory Bowel Diseases.

Inflammatory bowel disease is a life-changing disease resulting from recurrent intestinal inflammation. Current therapies (eg, steroids and biologics) are associated with mild to severe side effects, and none provide a cure. Recent research has focused on genetically engineering gut-specific anti-inflammatory T-regulatory cells (CAR-Tregs) to control intestinal inflammation, a logistically and conceptually complex approach. The purpose of our study was to understand patients' willingness to try CAR-Treg given 2 hypothetical scenarios-in a clinical trial or as a new treatment. We surveyed people living with inflammatory bowel disease about their willingness to try CAR-Treg. The online survey was developed using patient focus groups and associated literature. We recruited participants through email and social media. We used descriptive and inferential statistics to analyze closed-ended questions and inductive thematic analysis to analyze open-ended follow-up questions. Survey participants indicated high willingness to try CAR-Treg therapy in both a clinical trial and as a new treatment. Willingness to try was not correlated with disease state or medication history. Women were less likely than men to indicate willingness to participate in a clinical trial. Participants' reasons for being willing to try CAR-Treg therapy included the wish to change their current treatment and the calling to participate in research. Participants that were not willing to try CAR-Treg mentioned the lack of long-term data and the success of their current therapy. This is the first study to our knowledge to investigate patient willingness to try CAR-Treg therapy. Our results demonstrate the promise of moving this therapy into clinical practice as most patients indicated willingness to try.

Perceived Social Standing in Assisted Living Communities: A Mixed-Methods Study of Social Hierarchies Among Residents.

The purpose of this mixed-methods study was to measure perceived social standing within an assisted living (PSS-AL), and to identify individual determinants and empirical correlates of this construct. The sample consisted of 200 residents of 21 assisted livings (ALs). A self-anchoring ladder measured PSS-AL (M = 6.95, SD = 2.04) and an open-ended follow-up question assessed individual determinants of PSS-AL ratings. In a multiple regression, mental health (β = .27, p = .001), intimate staff-resident relationships (β = .22, p = .024), and extraversion (β = .27, p < .001) were significant predictors of PSS-AL. Qualitative findings revealed that inter-personal factors, prosocial behaviors, and health were key determinants of PSS-AL. Results highlight the social demands of AL and associated implications for residents with varying social abilities, skills, and interests. Findings also suggest that staff-resident relationships may shape and-or reinforce resident social hierarchies. The authors discuss implications for research and practice.

Households’ willingness to pay for soil conservation on communal lands: application of the contingent valuation method in north eastern Ethiopia

Currently, soil erosion is one of the most serious environmental problems in Ethiopia. Therefore, this study was initiated with the objective of examining the determinants of households’ willingness to pay (WTP) for soil conservation practice on communal lands and to estimate the aggregate welfare gain of the proposed conservation program in the study area. A multi-stage sampling technique was employed to select the target respondents. A double bounded contingent valuation survey with an open-ended follow-up question was conducted on 245 randomly selected rural households. A Bivariate probit model was used. The results show that factors such as the size of total livestock holding, perception, credit, extension contact and farm size near to communal land have a positive and statistically significant effect on households’ WTP, while dependency ratio, migration, and initial starting bid have a negative and significant effect. The aggregate benefit was estimated to be 2,262,386.83 labor days (135,743,209.8 Birr) per annum.

Physical activity programs for children diagnosed with cancer: an international environmental scan

Physical activity programs for children diagnosed with cancer may enhance health and quality of life. However, it is unknown where and in what capacity such programs are being offered internationally. To identify physical activity programs for children diagnosed with cancer and summarize program characteristics. Five data sources were searched to identify physical activity programs offered to children diagnosed with cancer. Following confirmation of eligibility, correspondents were sent a series of open-ended questions via email. Data were extracted from responses and summarized descriptively and narratively. Of the 140 unique correspondents contacted, 46 programs, in 10 countries, met eligibility criteria. Responses to open-ended follow-up questions were obtained from 36 programs and were subsequently included in the content analysis. Internationally, the majority of programs are being offered to children in Europe, with mixed cancer types, at different stages of the cancer trajectory. There is relatively equal distribution with regard to the setting in which programs are offered (i.e., community, hospital, combination). All correspondents reported that their program is professionally supervised, and most require that children obtain medical clearance prior to participating. There is considerable variability in terms of other key program (e.g., funding) and physical activity characteristics (e.g., frequency). Findings from this environmental scan highlight where and in what capacity physical activity programs are being offered, providing guidance for those seeking to develop/implement physical activity programs themselves. Moreover, results highlight the current state of practice, underscoring the necessity of international networks, multi-site collaborations, and public relations to ensure all children diagnosed with cancer have access to physical activity programs.

"I Feel Permanently Traumatized By It": Physical and Emotional Impacts Reported by Men Forced to Penetrate Women in the United Kingdom.

This article reports findings from the first empirical study in the United Kingdom on forced-to-penetrate cases, where a man is forced to penetrate a woman either orally, vaginally, or anally with his penis and without his consent. Using an online survey, data were collected in relation to the physical and emotional impacts experienced by 154 men following their most recent forced-to-penetrate experience. Quantitative and qualitative data were collected through the use of closed and open-ended survey questions, where participants were asked about the context and circumstances of their most recent experience and whether they had suffered any physical injuries. A unipolar scale was used to measure the emotional impact on participants, with an open-ended follow-up question gathering qualitative data. The majority of participants did not report suffering physical injuries, but those that did suffered injuries to their genitalia and upper bodies. Participants most frequently indicated that their most recent forced-to-penetrate experience had had a severe negative emotional impact on them. Negative emotional impacts disclosed by participants were complex, ranging from anxiety and depression, to self-harm and suicidal thoughts and attempts. Quantitative analysis highlighted that when certain variables were present, participants more frequently reported physical injuries, as well as higher average levels of emotional harm. The findings from the study challenge existing understandings of masculinity and rigid sex and gender roles, which assume that men will always consent to sexual activity with a woman and that they cannot or do not experience emotional or physical harms at the hands of a woman. The findings are also considered in relation their implications for law and legal discourse, where evidence of harm is used as a justification for the criminalisation of certain behaviors and the severity of the legal response through sentencing.

Farmers' Willingness to Pay for 2-Wheel Tractor Hiring Services in Northwestern Ethiopia: A Contingent Valuation Study

This study sought to determine farmers’ willingness to pay (WTP) for 2-wheel tractor hiring services in Northwestern Ethiopia. Survey questionnaire related to CVM was designed and face-to face interview were made to collect the data. Moreover, focus group discussion used to generate qualitative information on household characteristics. Both purposive and stratified sampling techniques were used based on gender, wealth class and soil type of the sampled households. For the study, a total of 144 farm households were considered using double bounded contingent valuation methods approach with an open-ended follow-up question. The study result indicated that the mean amount of money farmers is willing to pay was 1121.026 ETB (56.05 USD) per hectare. Econometric results confirm that the education level of households, land size of households, male labor availability and soil type were the factors that affecting the farmers’ level of willingness to pay positively. However, age of households and tropical livestock unit (TLU) were the factors that affected the same negatively. About 80% of the sampled farmers were willing to use 2-wheel THS. The finding of this study showed that farmers demand for improved 2-wheel THS is high. Hence, there is a need to consider the above factors to introduce 2-wheel tractor hiring service for cultivation practice in the study area.Â

A101 - Primary Care Physician Approaches to Severe Obesity Treatment and Bariatric Surgery: A Qualitative Study

Background: Bariatric surgery is the most cost-effective treatment for severe obesity, yet less than 1% of U.S. adults undergo bariatric surgery annually. Reasons for low utilization are unclear although previous investigators have found that the most powerful predictor of whether a patient would consider bariatric surgery was if the primary care physician (PCP) recommended it. To better understand how PCPs prioritize the care they provide to their severely obese patients – who often have multiple comorbidities we conducted focus groups with PCPs in Wisconsin. Specifically, we investigated how PCPs approach bariatric surgery as a treatment option and explored the challenges they encounter while providing care. Methods: We conducted three 90-minute focus groups with PCPs in a rural setting (Mauston), mid-sized city (Madison), and large city (Milwaukee) in Wisconsin. PCPs were eligible to participate if they managed adult patients (450% of their practice) and had seen at least five severely obese patients (BMI 435 or higher) in their clinic over the past 6 months. During the focus groups, participants were given a clinical vignette of a severely obese patient with multiple comorbidities and were asked a variety of questions about how they would prioritize treatment. All questions were guided by a focus group script, and the moderator used open-ended follow-up questions to pursue emerging themes. Participants completed a demographic questionnaire prior to completion of the focus group. Sessions were audio-recorded and transcribed. Data were analyzed using a directed approach to content analysis, in which emergent themes were identified and finalized through a process of consensus among three coders. Results: Participants in the three focus groups (n1⁄416) had a mean age of 46 (SD 11), 50% were female, and 94% were white. We identified four general approaches that PCPs use when prioritizing treatment for severely obese patients with multiple comorbidities: 1) Treat the disease that is the “easiest” to address, which is often hypertension or diabetes; 2) Treat the disease that is perceived as the most dangerous; 3) Let the patient set the agenda; 4) Address obesity first because it is the “common denominator” underlying many of the comorbid conditions. Challenges to implementing the plan included patient characteristics (low socioeconomic status, prior weight loss failures, being in denial about their obesity), provider factors (feeling ineffective in their ability to help patients lose weight), and systemic factors, particularly uncertainty regarding insurance coverage for obesity-related services. PCPs rarely – if ever – brought up the idea of bariatric surgery with their patients. This hesitancy stemmed from five main concerns: 1) Wanting to “do no harm”; 2) Questioning the long-term effectiveness of bariatric surgery; 3) Having limited knowledge about bariatric surgery; 4) Not wanting to recommend bariatric surgery “too early”; 5) Not knowing if the patient’s insurance would cover it. Once the PCP and patient agreed to pursue bariatric surgery, challenges to executing the plan during the pre-operative, operative and post-operative phases included meeting the preoperative requirements, living far from a bariatric surgery program, and the need for PCPs to be involved in post-operative care. Conclusions: PCP approaches to prioritizing care are pragmatic and mostly derived from previous experiences with patients. Three of the four prioritization approaches typically place the treatment emphasis on health conditions other than obesity. The five main concerns that PCPs have about bariatric surgery referral can be effectively addressed by provider and patient education, research, policy change, and publicity to highlight the literature regarding safety and effectiveness of bariatric surgery. Given that obesity often underlies many patient comorbidities, future research should focus on providing effective weight management options for PCPs in clinic and health system re-design that supports comprehensive weight management treatment. *This research was conducted as part of a 2014 ASMBS Research Grant award to Dr. Funk

On Scope Effects in Contingent Valuation: Does the Statistical Distributional Assumption Matter?

In this paper, we test for scope effects in Contingent Valuation applying different distributional assumptions for WTP, a non-parametric estimation and an estimation based on an open-ended format. Mean WTP is sensitive to the distributional assumption, but so is the scope effect. The nonparametric model, without conditions on the distribution, is the best able to identify scope effects. More sophisticated models, such as the spike model, and open-ended follow-up question give more information about individual WTP and are thus more powerful in revealing scope effects. For small sample size, a non-parametric analysis, a spike model or an open-ended format may therefore be better than the classical parametric dichotomous choice analysis to identify scope effects.

Would you let your family stay here?

Despite its flaws, the Friends and Family Test allows patients to give valuable feedback, writes Erin Dean

The influence of cheap talk on willingness-to-pay ranges: some empirical evidence from a contingent valuation study

Different instruments have been developed to mitigate the hypothetical bias in contingent valuation surveys. One, labelled ‘cheap talk’, warns participants about the hypothetical bias phenomenon prior to the valuation question. This paper investigates the effects of cheap talk on willingness-to-pay ranges, in a case study on remote mountain lakes. An open-ended follow-up question is added to a payment ladder to elicit the maximum amount an individual would definitely pay and the minimum amount above which they would definitely refuse to pay. The main conclusion is that cheap talk has no influence on the width of people’s willingness-to-pay range, but is effective at lowering the mean willingness-to-pay.

Using econometric analysis of willingness-to-pay to investigate economic efficiency and equity of domestic water services in the West Bank

The paper is aimed at providing evidence on economic efficiency, and equity of distribution of domestic water services in the West Bank. The study utilizes the CVM as a means of monetizing public preferences and households’ WTP. In the CVM questionnaire, the dichotomous choice with follow-up debriefing questions format is followed by an open-ended follow-up question was undertaken. A second questionnaire survey was directed to employees from water institutions, which was mainly designed to investigate the reasons behind the full absence of private sector in the provision of water supply. The two samples were selected to ensure a representative samples in accordance with the Palestinian case. The main findings of this paper gauged the WTP with key socioeconomic variables suggested by economic theory and previous CVM studies. These results provide information on economic efficiency and equity of water distribution. The results will allow decision makers to develop new policies that can achieve more efficient and equitable domestic water services.