Preferences For Attributes Research Articles

Farmers’ preferences for rice bean production traits in western Kenya

Rice bean (Vigna umbellata) is an important legume for food and nutritional security. However, the level of its cultivation in western Kenya, where there is a serious malnutrition challenge, is still low due to a lack of insights into its attributes. Hence, to bridge this knowledge gap, this study analyzed smallholder farmers' preferences for production traits. We collected data from 204 farmers through a choice experiment (CE) approach in upper and lower midland agro-ecological zones. Subsequently, we used the random parameter logit (RPL) model to analyze the data. Results showed that farmers preferred all attribute levels presented except 61% or more pest resistance. The lower midland farmers preferred compensation of Kenya shillings (Ksh) 34.93 for yields of 9 or more bags per acre; Ksh 52.22 for 61 to 79 maturity days and; Ksh 20.24 for 40% to 60% pest resistance level. In comparison, upper midland farmers preferred compensation of Ksh 66.44 for 6 to 8 bags per acre; Ksh 53.82 for 9 or more bags per acre; no compensation for 50 to 60 maturity days; and Ksh 132.98 for 40% to 60% pest resistance. However, farmers preferred no compensation for intact pods. The observed differences in farmers’ preferences for rice bean attributes are explained by heterogeneity in the agroecological conditions, farmers’ socio-economic characteristics, and risk perceptions. The findings should inform targeted extension and breeding programs that fit farmers’ diverse environments and resource endowments.

Are local policy attitudes distinct?

Abstract Scholars disagree as to whether Americans’ attitudes toward local issues are structured ideologically and whether these are related to national policy ideology. We use two surveys of American adults to assess whether and to what extent Americans' local policy attitudes exhibit a similar structure as do national policy attitudes. We find that items asking about local policy are just as likely to reflect a latent dimension of policy preferences as those asking about national policy. Additionally, when local and national items are scaled separately, those scales are highly correlated. Our findings indicate that attitudes toward many local issues are aligned with national ideology. A smaller subset of attitudes about local issues appears distinctively local and possibly structured by non-ideological cleavages.

Children's friendship stability in the United States, China, and Indonesia: Associations with individual attributes and dyadic similarity.

Predictors of friendship stability from individual attributes and dyadic similarities were assessed using cross-classified multilevel analyses in this 6- to 8-month longitudinal study of 10-year-old US (White, Black, Asian, other; n = 477, 50% girls), Chinese (n = 467, 59% girls), and Indonesian (Sudanese, Javanese, other; n = 419, 45% girls) children with complete participation and reciprocated baseline friendships. Across countries, individual attributes of social preference, popularity, and academic achievement and dyadic social preference similarity positively predicted friendship stability. Dyadic similarity of popularity, academic achievement, and aggression respectively predicted friendship stabilities of US, Chinese, and Indonesian children. Both individual attributes and dyadic similarity predicted friendship stability, with results that varied across countries consistent with attributes' reputational salience.

Identifying central dimensions of quality of life including life-related values, preferences and functional health in older patients with cancer: a scoping review protocol

BackgroundOlder patients with cancer already represent the largest proportion of cancer survivors which will further increase in the upcoming years. However, older patients are highly underrepresented in clinical research, leading to a detrimental knowledge gap. Research on important aspects of quality of life (QoL) and associated factors for older patients with cancer is insufficient to date.AimThe objective of this scoping review therefore is to investigate the dimensions of QoL including functional health, life-relevant values and preferences in older adults with cancer across all tumor entities and health care settings. It will further identify medical, sociodemographic, psychosocial and geriatric aspects associated with QoL in the elderly and compare these with younger cancer patients and older non-cancer cases.MethodsPublished articles investigating QoL dimensions and associated factors in older patients with cancer, i.e., exclusively patients ≥65 years or mean/median age ≥ 70 years for age-mixed samples, or that compare results of older with younger cancer patients or with older non-cancer cases will be considered for this scoping review. Older patients with cancer across all tumor entities, disease stages and health care setting will be included. PubMed and PsychINFO databases will be searched for relevant articles. Abstracts and titles will be screened for basic inclusion, and two independent reviewers will conduct a full text screening to evaluate the age criteria and decide on the final inclusion of the study. Data on study and participant characteristics, QoL dimensions and geriatric factors will be extracted using a data extraction sheet. Results will be summarized descriptively to address the objectives of this review.DiscussionThe findings of this scoping review will provide valuable insights into central dimensions of QoL, including values, preferences and functional health in older adults with cancer, and help to improve targeted interventions and healthcare planning.

COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment.

Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers. We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines. Participants in the 2019nCoV-408 study were aged ≥18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants' backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an "opt-out" option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non-high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options. The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8% vs 30.6%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7% vs 8.2%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non-high-risk subgroups were protection against severe COVID-19 (38.2% vs 31.5%; P<.000), avoiding common vaccine side effects (12% vs 20.5%; P<.000), and avoiding serious vaccine side effects (9.7% vs 7.5%; P=.002). This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor.

Disaster risk reduction measures and farmers choices: a discrete choice experiment in Uganda

ABSTRACT Climate change induces high and erratic rainfall which triggers landslides and floods. With the increasing population and food needs, households in mountainous, densely populated areas turn fragile ecosystems into farms. This exacerbates landslide and flood risks requiring Disaster Risk Reduction (DRR) measures. Tree planting and diversion channels are among the recommended measures for farmers but their adoption remains low. Current studies assessing barriers to adoption ignore farmers’ opinions regarding the kind of trees or diversion channels preferred. We apply a Discrete Choice Experiment to evaluate how information delivered through videos impacts preferences for the DRR measures. Plot-level data were collected from 319 farmers from Kasese, Bundibugyo, Bushenyi and Buhweju in Uganda – districts prone to landslides and floods. The mixed logit model reveals a general preference for risk-reducing attributes of DRR measures. Using the conditional logit model to analyze split samples reveals that information influences preferences for tree planting, while preferences for diversion channels were hardly changed. Plot characteristics did not strongly explain the differences in preferences. Our study indicates that information specific to DRR measures in extension programmes would increase the adoption of such measures.

Preferences for processed tomato products’ attributes: an explorative analysis of Italian consumers using a large sample

IntroductionPrice competition in the tomato market may lead Italian processing companies to adopt product differentiation strategies to attract consumers and raise revenues. Exploring consumers’ preferences for processed tomato products’ attributes can support companies in implementing product differentiation strategies and succeed in the market.MethodsThis study used a convenience sample of 602 Italian consumers to identify consumers’ preferences for processed tomato products’ attributes selected through a literature review and tested by the Best Worst Scaling (BWS) method. Also, a two-step cluster analysis was used to identify and size consumer groups with common preferences for tested product’s attributes.ResultsOverall, our results showed that Italian consumers of processed tomato products strongly preferred attributes such as Country of origin, Organic, and Social and economic sustainability labels. In addition, the analysis shows the existence of three distinct consumer segments such as “traditional,” “price-sensitive,” and “sustainable” consumers. The largest one was price-sensitive consumers followed by sustainable and traditional ones.DiscussionOur findings have practical implications for producers and policymakers. Producers may use claims about the product’s origin jointly with an organic production logo and ethical label to differentiate their products and raise revenues. Likewise, policymakers should enhance monitoring and control measures to ensure with environmental, social, and economic sustainable standards compliance. This will support building consumer trust for those credence attributes. Overall, this study adds valuable insights to the existing literature on consumer preferences for processed tomato products, providing results with high external validity using a large convenience sample.

Patient preferences for the provision of NHS medicines helpline services: a discrete choice experiment.

Patient medicines helpline services (PMHS) can reduce harm and improve medicines adherence and patient satisfaction after hospital discharge. There is little evidence of which PMHS attributes are most important to patients. This would enable PMHS providers to prioritise their limited resources to maximise patient benefit. Patient preferences for PMHS attributes were measured using a discrete choice experiment. Seven attributes were identified from past research, documentary analysis and stakeholder consultation. These were used to produce a D-efficient design with two blocks of ten choice sets incorporated into an online survey. Adults in the UK who took more than one medicine were eligible to complete the survey and were recruited via the Research for the Future database. Preferences were estimated using conditional logistic regression. Associations between participant characteristics and preferences were investigated with latent class models. 460 participants completed the survey. The most valued attributes were weekend opening (willingness-to-pay, WTP: £11.20), evening opening (WTP: £8.89), and receiving an answer on the same day (WTP: £9.27). Alternative contact methods, immediate contact with a pharmacist and helpline location were valued less. Female gender and full-time work were associated with variation in preferences. For one latent class containing 27% of participants, PMHS location at the patient's hospital was the most valued attribute. PMHS providers should prioritise extended opening hours and answering questions on the same day. Limitations include a non-representative sample in terms of ethnicity, education and geography, and the exclusion of people without internet access.

Extensive Exploration of The Preference Correlations Between Architectural Features and Musical Attributes

This study investigates the correlations between empirically-based preferences for architectural features and self-reported preferences for musical attributes. Altogether, 16 architectural attributes related to architectural complexity, indentation, symmetry, rhythm, pattern, and stress and 36 musical attributes of genres, perceived psychological attributes, Five Factors of Music, and 3-Factors are considered in the study, and their correlations are examined across 61 different demographic classes. In short, after gathering the data, Pearson’s correlation coefficient analysis examined the existence of correlation, and Bonferroni correction screened the most reliable ones. Then, categorization and K-mean clustering methods summarized the outcomes to provide a holistic understanding of the discovered correlations. The former reflected a higher number of correlations within genre and FFM in music, and indentation, complexity, and symmetry in architecture. The latter presented interesting correlation trends, including between complicated music and complicated architecture, rap music and the existence of pattern in architecture, and mellow music and simple architectural forms.

Nurses' preferences for working in Uber-style ‘Internet plus’ nursing services: A discrete choice experiment

BackgroundChina's ‘Internet Plus’ nursing services, which are Uber-style home care services with an ‘online application, offline service’ approach, have been evolving over the past five years. Registered nurses' preference for these Uber-style Internet Plus nursing services are crucial for improving human resource management and service efficiency, yet research in this area remains scarce. ObjectiveThis study aimed to explore registered nurses' preferences for Uber-style Internet Plus nursing services and provide optimization recommendations from a supply-side perspective. DesignA cross-sectional study utilising a discrete choice experiment. Setting(s)Two public tertiary hospitals located in Tianjin, China, which have implemented Internet Plus nursing services. Participants211 registered nurses who participated in Internet Plus nursing services. MethodsThe survey was conducted anonymously using an online survey platform. Respondents were presented with choices between two alternatives, based on five key attributes: income, safety and security, patient and family cooperation, commute time, and service type. Mixed logit models estimated the stated preferences for attributes. Relative importance scores, willingness-to-pay estimates, and simulations of service-type uptake rates were calculated. Subgroup analysis and seemingly unrelated regression estimation were performed to examine heterogeneity in preferences. ResultsA total of 3202 choice observations were generated. When sorted by the strength of preference, the five attributes related to registered nurses' choice of Uber-style Internet Plus nursing services, measured by their relative importance scores, are as follows: safety and security (30.89 %), income (27.41 %), patient and family cooperation (18.47 %), service type (11.96 %), and commuting time (11.27 %). Elevating safety and security from low to high levels has the same utility as a 31.81 % increase in monthly income, equivalent to 2586.14 yuan. Subgroup analysis showed that senior nurses place more value on safety and security than junior nurses (β = 1.421 vs.β = 0.725; P = 0.011), and unmarried nurses had a stronger preference for family and caregiver cooperation (β = 1.105 vs.β = 0.314; P = 0.023). ConclusionsThe strength and heterogeneity of registered nurses' preferences should be highlighted in the dispatch algorithms model of Uber-style Internet Plus nursing services, thereby enhancing the efficiency and humanity of Uber-style Internet Plus nursing services. Tweetable abstractRegistered nurses prioritise safety and security, acknowledging heterogeneous preferences in Uber-style Internet Plus nursing services.

Patient Preferences for Attributes of Androgen Deprivation Therapies in Prostate Cancer: A Discrete Choice Experiment with Latent Class Analysis.

Medical androgen deprivation therapy (ADT) options have expanded for patients with advanced prostate cancer (PC). Historically, ADT was primarily available in long-acting injectable formulations. In 2020, the first oral formulation was US Food and Drug Administration-approved for adults with advanced PC. This study's aim was to assess patient preferences for attributes of medical ADT, including mode of administration, side effects, impact on sexual interest, and out-of-pocket (OOP) costs, and to segment respondents into distinct groups based on their treatment choice patterns. A cross-sectional survey was conducted among US residents aged > 40years with PC, employing a discrete choice experiment to assess preferences for ADT attributes. For each choice task, respondents were asked to select the hypothetical treatment profile that they preferred out of two presented. Latent class analysis (LCA) was conducted to estimate attribute-level preference weights and calculate attribute relative importance for groups of respondents with similar treatment preferences. A total of 304 respondents completed the survey (mean age 64.4years). LCA identified four preference groups, named according to the attribute each group considered most important: Sexual interest, Cost-sensitive, Favors daily pill, and Favors injection. Most respondents in the Sexual interest group were < 65years, while the Cost-sensitive group was mostly ≥ 65years. Favors daily pill had the highest proportion of ADT-naïve individuals. On average, respondents in these groups preferred an oral medication. Favors injection, which had the highest proportion of ADT-experienced individuals, preferred infrequent intramuscular injections, lower chance of post-ADT testosterone recovery, and lower OOP cost. Respondents differed in their preferences regarding ADT attributes, highlighting the need for patient involvement in their treatment decisions. Effective communication between healthcare providers and patients about the benefits and risks of available therapies should be encouraged to ensure that patients receive the PC treatment that best meets their needs.

The role of ethical orientation in animal welfare choice behaviour: A segmentation study

Consumers are becoming more and more conscious about their consumption choices, demanding more sustainable, healthy and fair options. Meat consumption especially is under scrutiny for environmental as well as ethical reasons. We develop a set of items to measure ethical orientation and apply it to consumers’ choices of meat products with 3000 consumers across six European countries (Denmark, Germany, Spain, Poland, Netherlands, Italy). We find consumer preferences to be similar across countries, with two thirds of consumers showing a preference for animal welfare attributes, especially outdoor access. Consumer segments can be differentiated based on their degree of ethical orientation, environmental concern, level of trust in the food system and price sensitivity. Ethical orientation differentiates between consumers’ self-reported welfare meat purchases. Our results contribute to the literature on consumer behavior regarding farm animal welfare across different meat product and countries.

Physical attributes and nutritional composition of meat from dual purpose (Sasso C431 and TR51) broiler breeds in Ntabazinduna, Zimbabwe.

The growing animal welfare concerns regarding poultry production have led to the rearing of slow-growing meat type chickens also known as free-range chickens. In Zimbabwe these slow-growing chickens are gaining popularity as an alternative to the commercial broiler chickens owing to their preferred sensory attributes comparatively. Little is known regarding the quality of the meat versus that of the conventional broilers. We evaluated the physical characteristics and nutritional composition of meat from dual purpose slow-growing hybrids, Sasso C431 and TR51 in comparison with the commercial broiler breed Ross 308, under intensive feeding conditions. Birds were fed the standard commercial chicken feed produced by Hamara, a local chicken and chicken feed producing company. Birds were slaughtered on days 42, 56 and 70 of life where carcass and breast yield were measured. The pH, drip loss and cooking losses were determined for all carcasses. Proximate composition (dry matter, ash, protein, fat, carbohydrate) and mineral composition (iron, zinc and phosphorus) were determined for all the meat samples. The fast-growing broiler breed had a higher breast yield; than the slower-growing breeds, Sasso C431 and TR51 breeds (P&lt;0.05). The highest cooking and drip loss were observed in the faster growing breed Ross 308 and the lowest ones for Sasso C431 and TR51 breeds (P&lt;0.05). Shear texture values were higher in the Sasso C431 and TR51 than the Ross 308 breed (P&lt;0.05). The Sasso C431 and TR51 breeds can produce more meat with a lower fat and a higher protein compared to the Ross breeds.

Stackelberg game analysis of the energy performance contracting considering altruistic preferences

The Stackelberg game analysis of an Energy Performance Contracting(EPC) is established to correctly analyze the impact of altruistic preference behaviors on the decision-makers, energy service companies(ESCOs) and energy-consuming units(EUs). Its motivation comes from the fact that, to achieve a win-win situation, EUs usually engage in altruistic behaviors, but the implementation results of the EPC are always contrary to their expectations. Using nonlinear optimization theory, analyzed the decisions of the Stackelberg models under different altruistic preference attributes, and then compared the impacts of altruistic preferences on decisions and profits. Results reveal: (1)compared to a situation lacking altruistic preference, when the leader, the EU, has an altruistic preference, the EU only needs to transfer a small part of its own interests to significantly increase the ESCO's profit and ultimately improve the overall EPC profit; (2) the altruistic preference of the ESCO functions akin to a "poison," engrossing the company in the satisfaction derived from the increased revenue of the energy-consuming entity and gradually eroding its own profits; and (3)the altruistic preference behavior of both parties is a kind of “benefit transfer behavior,” which is conducive to stable operation and long-term development of EPC industry. The research results can provide a theoretical reference to enhance the development of energy-saving service industry.

Segmentation of Chinese consumer preference for wine extrinsic attributes based on stratification and weighted clustering algorithm

Chinese consumers are unfamiliar with the sensory attributes of wine and often pay more attention to the extrinsic attributes of wine that can most directly present information. Therefore, it is crucial to study consumer preferences for extrinsic attributes. This paper proposes a consumer segmentation method based on stratification and weighted clustering algorithm, leveraging data from an anonymous online survey (N = 3179). The AFR model is constructed based on the RFM model to segment wine consumers from the perspective of customer value. This model removes Monetary indicator and adds a new indicator Amount to eliminate multicollinearity caused by the Frequency and Monetary indicators of RFM model. In addition, factor analysis is used to assign weights to clustering indicators, addressing the problems of unequal weighting and strong correlation among the indicators. This allows for a simple, efficient, and precise segmentation of wine consumers at different levels. The method proposed in this article segments consumers into two layers and six categories: the potential layer includes product-oriented type, amorphous type, and cheap-fine type, while the mature layer comprises the rational type, reputation-price type and random type. This research will provide wine producers and distributors with a simple and efficient basis for production and marketing decision-making. Additionally, it can serve as a reference for consumer segmentation in food and other fields.

Stated preferences of adolescents and young adults for sexual and reproductive health services in Africa: a systematic review protocol

BackgroundAdolescence and young adulthood are critical life stages with varied healthcare needs. Adolescents and young adults (AYAs) are often confronted with challenges in their sexual and reproductive health (SRH) and...

Preferences for attributes of oral antipsychotic treatments: results from a discrete-choice experiment in respondents with schizophrenia or bipolar I disorder

BackgroundAntipsychotic medications are effective treatments for schizophrenia (SZ) and bipolar I disorder (BD-I), but when presented with different treatment options, there are tradeoffs that individuals make between clinical improvement and adverse effects. As new options become available, understanding the attributes of antipsychotic medications that are valued and the tradeoffs that individuals consider when choosing among them is important.MethodsA discrete-choice experiment (DCE) was administered online to elicit preferences across 5 attributes of oral antipsychotics: treatment efficacy (i.e., improvement in symptom severity), weight gain over 6 months, sexual dysfunction, sedation, and akathisia. Eligible respondents were aged 18–64 years with a self-reported clinician diagnosis of SZ or BD-I.ResultsIn total, 144 respondents with SZ and 152 with BD-I completed the DCE. Of those with SZ, 50% identified themselves as female and 69.4% as White, with a mean (SD) age of 41.0 (10.1) years. Of those with BD-I, most identified themselves as female (69.7%) and as White (77.6%), with a mean (SD) age of 40.0 (10.7) years. In both cohorts, respondents preferred oral antipsychotics with better efficacy, less weight gain, no sexual dysfunction or akathisia, and lower risk of sedation. Treatment efficacy was the most important attribute, with a conditional relative importance (CRI) of 31.4% for respondents with SZ and 31.0% for those with BD-I. Weight gain (CRI = 21.3% and 23.1%, respectively) and sexual dysfunction (CRI = 23.4% and 19.2%, respectively) were adverse effects in this study that respondents most wanted to avoid. Respondents with SZ were willing to accept 9.8 lb of weight gain or > 25% risk of sedation for symptom improvement; those with BD-I were willing to accept 8.5 lb of weight gain or a > 25% risk of sedation.ConclusionsIn this DCE, treatment efficacy was the most important attribute of oral antipsychotic medications among respondents with SZ and BD-I. Weight gain and sexual dysfunction were the adverse effects respondents most wanted to avoid; however, both cohorts were willing to accept some weight gain or sedation to obtain better efficacy. These results highlight features that patients value in antipsychotic medications and how they balance benefits and risks when choosing among treatments.

Exploring heterogeneous differences between Chinese and Western customer preferences for restaurant attributes from online reviews

Exploring heterogeneous differences between Chinese and Western customer preferences for restaurant attributes from online reviews

Preferences for coordinated care for rare diseases: discrete choice experiment

BackgroundEvidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models.ResultsValid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals’ preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place.ConclusionsThe findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases.

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: a convergent mixed-methods secondary analysis of data from the decision analysis in shared decision making for thromboprophylaxis during pregnancy (DASH-TOP) study

BackgroundVenous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals’ preferences towards the use of daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals’ preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy.MethodsDesign: Convergent mixed-methods.Participants: Pregnant women or those planning a pregnancy with VTE recurrence risk.Intervention: A SDM intervention about thromboprophylaxis with LMWH in pregnancy.Analysis: Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke’s pentad of motives framework: act (what needs to be done), scene (patient’s context), agent (perspectives and influence of people involved in the decision), agency (aspects of the medication), and purpose (patient’s goals). We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance.ResultsWe comprehensively determined preferences for using LMWH by pregnant individuals at risk of VTE: through value elicitation exercises we found that the least valued health state was to experience a pulmonary embolism (PE), followed by major obstetrical bleeding (MOB), deep vein thrombosis (DVT), and using daily injections of LMWH (valued as closest to a ‘healthy pregnancy’); through interviews we found that: previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks were described (agency). For participants, the main goal of using LMWH was avoiding any risks in pregnancy (purpose). Side-by-side comparisons revealed concordance and discordance between health states and motives.ConclusionsMixed-methods provide a nuanced understanding of LMWH preferences, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care around preference-sensitive decisions in thromboprophylaxis during pregnancy.