Stakeholder Preferences Research Articles

Assessing whether decisions are more sensitive to preference or prediction uncertainty with a value of information approach

In many decisions, we are not only uncertain about the predicted outcomes of decision alternatives but also about stakeholder preferences regarding these outcomes. Further information collection may reduce uncertainties, but is costly. We present and apply a framework to identify the most decisive uncertainties and prioritize data collection efforts based on value of information (VoI) sensitivity analysis. Preference uncertainty is usually not explicitly considered in VoI analysis or in standard utility theory. Based on the expected expected utility (EEU) concept, we consider uncertain predictions and preferences jointly in decisions and subsequent VoI analysis. We focus on the expected value of partially perfect information (EVPPI) and adapt a fast, given-data algorithm for estimating this metric. The framework is motivated by complex environmental decision problems and we apply it to a hypothetical multi-criteria decision regarding coral reef management with conflicting stakeholder perspectives. The results show that better understanding of stakeholder positions can be as relevant as improving system understanding. For one perspective, preference model parameters had the highest EVPPI, while for another predictive uncertainties of the reef system attributes were more relevant. For two perspectives, the decision was largely insensitive. By considering predictive and preferential uncertainty on an equal footing in VoI analysis, we open up possibilities to design data collection for decision support processes more efficiently.

Anchoring tools to communities: insights into perceptions of flood informational tools from a flood-prone community in Louisiana, USA

The lack of community-relevant flood informational resources and tools often results in inadequate and divergent understandings of flood risk and can impede communities' ability to function cohesively in the face of increasing flood threats. The current study reports on a set of workshops that the authors conducted with various groups (citizens, city engineers and planners, realtors and builders, and media representatives) within a flood prone community to evaluate how novel hydroinformatic tools that include hydrodynamic modeling, geospatial visualization, and socioeconomic analysis can enhance understanding of flood risk and engagement in flood risk mitigation among diverse community members. The workshops were designed to help identify stakeholder preferences regarding key functionality needed for integrated hydroinformatic technologies and socioeconomic analyses for flood risk reduction. Workshop participants were asked to use and comment on examples of prototype flood risk informational tools, such as: (1) flood damage estimation tool, (2) drivability and emergency accessibility tool, and (3) community-scale social and economic metrics tool. Data gathered from workshops were analyzed using qualitative analysis based on a grounded-theory approach. Data were coded by hand based on themes identified by the research team and incorporated deviant case analysis to ensure minority opinions was represented. The study results are focused on the following main themes and how flood tools can address them: (1) improving the understanding of flood risk and engagement in flood risk mitigation, (2) reducing the gap between individual and community risk, (3) challenges in communicating flood risk information, (4) enhancing relevance to and engagement of the community, and (5) enabling actionable information. Our research demonstrates the need for community-anchored tools and technologies that can illustrate local context, include local historical and simulated events at multiple levels of community impact, enable analyses by flood professionals while also providing simplified tools of use by citizens, and allow individuals to expand their knowledge beyond their homes, businesses, and places of work.

Texas hunters' attitudes toward wild pigs (Sus scrofa) and their management: an applied approach for wildlife managers

AbstractChoosing and executing a wild pig management strategy is often a considerable challenge for wildlife managers due to the wide variety of potential strategies and stakeholder preferences. Our research aims to understand management preferences for and tolerance of wild pigs among Texas resident hunters within 8 managerial districts of Texas. We applied the Potential for Conflict Index (PCI2) to estimate potential management preference conflicts within each district. From 24,201 questionnaires completed in 2019, we found that, on average, 74% of respondents across all management actions in each district were found to be acceptable. Resident respondents were overall intolerant of wild pigs and were least tolerant in the San Angelo district. Study findings are useful in informing socially acceptable and contextually appropriate wild pig management plans. Our research serves as an approach that matches the units of analysis with the units of management for decision‐making.

Robust assessment of energy scenarios from stakeholders' perspectives

Using scenarios is vital in identifying and specifying measures for successfully transforming the energy system. Such transformations can be particularly challenging and require the support of a broader set of stakeholders. Otherwise, there will be opposition in the form of reluctance to adopt the necessary technologies. Usually, processes for considering stakeholders' perspectives are very time-consuming and costly. In particular, there are uncertainties about how to deal with modifications in the scenarios. In principle, new consulting processes will be required. In our study, we show how multi-criteria decision analysis can be used to analyze stakeholders' attitudes toward transition paths. Since stakeholders differ regarding their preferences and time horizons, we employ a multi-criteria decision analysis approach to identify which stakeholders will support or oppose a transition path. We provide a flexible template for analyzing stakeholder preferences toward transition paths. This flexibility comes from the fact that our multi-criteria decision analysis-based approach does not involve intensive empirical work with stakeholders. Instead, it involves subjecting assumptions to robustness analysis, which can help identify options to influence stakeholders' attitudes toward transitions.

An integrative strategy for Venezuela's electricity sector (VES), from an analysis of stakeholder perspectives

This work aims to determine the most important aspects of an integrative strategy to end the stagnation of Venezuela's energy sector (VES). The first step is to extract the various stakeholders' perspectives on policies needed to improve VES. Q methodology combines qualitative and quantitative approaches to learn the subjective opinions of a group of individuals on a specific topic to determine the different perspectives at hand. Using Q methodology we analyzed the preferences of VES-involved stakeholders regarding the structure of the industry, its services, the infrastructure framework, and, finally, energy governance design. Analyzing commonalities and disagreements between perspectives resulted in three perspectives or mindsets: i) a partial vertical restructuring of the industry, ii) the development of hydroelectricity and large-scale renewable energies, and iii) the improvement of control mechanisms to increase the sector's efficiency.

Evaluating collaborative scenarios for short food supply chains: a case study on high‐level processing technology

SummaryThis study examined three collaborative scenarios for the implementation of a high‐level aseptic filling machine in small‐scale food processing for improved food safety in short food supply chains. A two‐stage research design was implemented, based on an exploration and evaluation phase. Two workshops were organised to conceptualise the following scenarios: mobile packaging, cooperative and individual ownership. A novel approach to the strengths, weaknesses, opportunities and threats‐analytical hierarchy process methodology was used to compare stakeholder perceptions and preferences for different scenarios within one case study. Financial benefits played a key role in each collaborative scenario. The most suitable scenario was found to be the mobile packaging, offering flexibility and no initial investment cost while enabling collaborations. The cooperative scenario has the potential for centralised logistics and marketing while being conscious of its organisational structure. Individual ownership should also focus on centralised logistics and marketing while considering food safety and flexibility limitations.

Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England.

Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England's National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences using an additive function. Uncertainty was estimated by probabilistic sensitivity analysis using 1,000 Monte Carlo Simulation iterations. The most important criteria influencing what interventions were preferred was whether they addressed "patient needs" (17.6%)' and their financial "cost (11.5%)". The interventions' total scores (unweighted score out of 30 | weighted out of 100%) were: Computerised Interface (25 | 83.8%), Built Environment (24 | 79.6%), Written Communication (22 | 71.6%), and Face-to-Face (22 | 67.8%). The probabilistic sensitivity analysis revealed that the Computerised Interface would be the most preferred intervention over various degrees of uncertainty. An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was the Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggests that successfully implementing lower-ranked interventions may require more conversations that acknowledge stakeholder concerns.

Optimizing desalination for regional water systems: Integrating uncertainty, quality, and sustainability

Regional water supply systems in arid regions worldwide face growing challenges due to increasing demands under conditions of water scarcity. For coastal regions, the addition of seawater desalination as an alternative water source can hedge against uncertainty stemming from demands placed on the system and hydrological inputs to the natural resources. In order to effectively integrate desalination into a water supply system, water managers utilize optimization models that solve for the optimal mix of desalination and natural resources to meet consumer demands at a sufficient water quality while maintaining sustainable levels in the natural resources. The complexity of managing both quantity and quality for a water supply system facing uncertainties is increased by contractual limitations between desalination plant owners and water managers that dictate the desalination production decisions to occur at the start of the year before the uncertainties have been revealed. To incorporate the misalignment between decision timelines and the order in which the uncertainty is revealed, a two-stage optimization approach is utilized where management decisions are split into implementable decisions representing the desalination production volumes, and recourse decisions representing supply volumes from the remaining sources and water allocations in the supply network. An iterative process is then undertaken in which in the first stage the implementable decisions are solved for potential uncertain scenarios, and then introduced to the second stage as inputs where the recourse decisions are iteratively solved for new uncertain scenarios. This framework is applied to the Israeli national water supply system, where the unique challenges of managing mixed salinity sources and asynchronous decision timelines in the face of uncertainty are addressed. A multicriteria decision analysis method is then applied where tradeoffs are found between the upfront investment in desalination and the expected system operational cost and robustness to failure. The inclusion of multicriteria decision analysis to analyze the multiple desalination production alternatives allows for including stakeholders preferences in model-based decision-making.

Protocol for the formative phase of a trial (SHE-CAN) to test co-designed implementation strategies for HPV-based cervical screening among vulnerable women in two diverse settings in India

BackgroundIn view of the WHO’s call for the elimination of cervical cancer as a public health problem, and current low screening coverage, Indian policy makers need evidence on how to effectively implement cervical screening programmes, ensuring equity in access.Our study will follow the INSPIRE implementation framework to co-design and test HPV-based screening approaches in two states of India with different health system organisation, based on understanding the status of screening as currently implemented, readiness and challenges to transition to HPV-based screening, and preferences of key stakeholders. Here, we describe our protocol for the formative phase of the study (SHE-CAN).MethodsThe study population includes women from vulnerable populations, defined as residents of tribal areas, rural villages, and urban slums, in the states of Mizoram and Tamil Nadu. The baseline assessment will use mixed methods research, with desktop reviews, qualitative studies, and surveys. A capacity assessment survey of screening and treatment facilities will be done, followed by interviews with healthcare providers, programme managers, and community health workers. Interviews will be conducted with previously screened women and focus group discussions with under and never-screened women and community members. Stakeholder workshops will be held in each state to co-design the approaches to delivering HPV-based screening among 30–49-year-old women.DiscussionThe quality and outcomes of existing screening services, readiness to transition to HPV-based screening, challenges in providing and participating in the cervical cancer care continuum, and acceptability of screening and treatment approaches will be examined. The knowledge gained about the current system, as well as recognition of actions to be taken, will inform a stakeholder workshop to co-design and evaluate implementation approaches for HPV-based screening through a cluster randomised implementation trial.

Exploring stakeholder preferences and spatial heterogeneity in policy scenario analysis for vulnerable ecosystems: A choice experiment approach

The importance of understanding people's preferences and the well-being of river systems cannot be overstated when it comes to the effective restoration and long-term management of these systems. This study aimed to determine the preferences of people in the Hei River Basin of China regarding the conservation, restoration, and development of ecological systems and their associated services. The research utilized a combination of random parameter logit models for distance decay. The study collected data using a choice experiment method and separated the study area into three distance-based groups: group I (within 25 km), group II (25 to 50 km), and group III (beyond 50 km). The findings showed that there was spatial heterogeneity among the people, with a higher willingness to pay for high-quality agricultural production and the lowest willingness to pay for oasis. The results revealed a complex pattern of spatial heterogeneity and indicated the need for increased awareness programs, environmental education, and the promotion of social responsibility towards environmental protection. It is essential to implement environmental policies, restore properties, and preserve ecological systems to achieve sustainable development and a sustainable environment. The findings highlight the importance of considering spatial heterogeneity and the need for increased environmental awareness, education, and policy implementation. This research can contribute to developing effective strategies for the preservation of river systems and ensuring sustainable development and a sustainable environment.

Socio-economic or environmental benefits from pondscapes? Deriving stakeholder preferences using analytic hierarchy process and compositional data analysis

Ponds occupy a large share of standing water worldwide and play an important role in providing various ecosystem services. There are concerted efforts of the European Union either to create new ponds, or to restore and preserve existing ponds as nature-based solutions to provide benefits to ecosystem and human well-being. As part of the EU PONDERFUL project, selected pondscapes (i.e. landscapes of ponds) in eight different countries – hereafter “demo-sites”, are studied to comprehensively understand their characteristics and their efficiency to provide ecosystem services. In addition, the needs and knowledge of stakeholders who own, work, research, or benefit from the pondscapes are also important, because of their capabilities to create, manage and develop the pondscapes. Therefore, we established connection with stakeholders to study their preferences and visions on the pondscapes. Using the analytic hierarchy process, this study shows that in general stakeholders in the European and Turkish demo-sites prefer environmental benefits to economic benefits, while stakeholders in the Uruguayan demo-sites rank the economic benefits higher. More specifically, in the European and Turkish demo-sites, the biodiversity benefits, i.e. life-cycle maintenance, habitat and gene pool protection, receive the highest ranking among all groups. On the other hand, stakeholders at the Uruguayan demo-sites rank provisioning benefits as the most important, because many ponds in Uruguayan demo-sites are being used for agricultural purposes. Understanding those preferences helps policy makers to address the needs of stakeholders more correctly, when considering any action or policy for the pondscapes.

Preferences on Policy Options for Ensuring the Financial Sustainability of Healthcare Services in the Kingdom of Saudi Arabia.

Escalating global health expenditures pose a threat to healthcare financing sustainability, requiring the exploration of alternative financing policies and resource allocation strategies to curb their adverse effects. The aim of this study was to gather insight into the preferences of healthcare workers, including physicians, nurses, allied healthcare professionals, and healthcare administrators, as well as academics in the field of healthcare management and health sciences in Saudi universities, regarding policy options that can secure the financial sustainability of healthcare services in Saudi Arabia. A cross-sectional research design was employed, and data were collected through an online self-administered survey from August 2022 to December 2022 in Saudi Arabia. The survey garnered responses from 513 participants hailing from all 13 administrative regions in Saudi Arabia. Analyses were performed using non-parametric statistical tests, specifically the two-sample Mann-Whitney U-test and Kruskal-Wallis test, to determine the statistical significance of differences in the policy ranking and policy feasibility options. The study findings reveal a consensus among stakeholders on the most and least preferred policies. All stakeholders expressed opposition to financing healthcare by diverting resources from defence, social protection, and education, while they favoured policies that entail imposing penalties on health-related issues such as waste management and pollution. Nevertheless, variations among stakeholders were evident in regard to the rankings for specific policies, particularly between healthcare workers and academics. Moreover, the results highlight that tax-based policies are the most feasible approach to generating healthcare funds, despite ranking lower in terms of preferred policies. This study provides a framework for understanding stakeholder preferences on healthcare financing sustainability by ranking 26 policy options according to stakeholder groups. The appropriate mixture of financing mechanisms should be informed by evidence-based and data-driven approaches that consider relevant stakeholder preferences.

Clinical Stakeholder Preferences for Paediatric Cardiac Surgery Outcome Reporting in Australia and New Zealand

This study aimed to examine stakeholder preferences for the content, format, and dissemination of outcomes and benchmarking of paediatric cardiac surgery in Australia and New Zealand.

PCR191 A Review of the Influence of Stakeholder Preference Research on the EtR Framework

The Evidence to Recommendation (EtR) framework was adopted by the Center for Disease Control’s Advisory Committee on Immunization Practices (ACIP) in 2018 to supplement the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for developing evidence-based vaccination recommendation. While preference information is not required, two domains (values and acceptability) allow for the incorporation of quantitative stated preference (SP) information in the framework. We reviewed published EtR frameworks to describe how often and what type of SP information is included.

Structured decision making to navigate trade‐offs between multiple conservation values in threatened grasslands

AbstractManaging biodiversity often requires making difficult trade‐offs, especially when threatened species and ecosystems overlap in their distributions, and management actions to promote their persistence varies between them. Trade‐offs reflect preferences and how much decision makers are willing to give up in benefits for one objective in exchange for gains in other objectives. Despite the increase of tools for exploring trade‐offs, decisions are often made without clear specification of preferences among objectives, reducing transparency and limiting clear communication of the rationale behind decisions. We used structured decision making to navigate trade‐offs between ecological objectives and management costs across three conservation reserves of protected grasslands in Victoria, Australia. The objectives included four nationally listed threatened species, two nationally listed threatened ecosystems, a group of locally threatened and rare non‐listed species and management costs. Alternative management strategies included various combinations of fire management and weed control. The consequences of alternatives were estimated using stochastic models, empirical data and expert judgment. Context dependent preferences were elicited using swing weighting from nine decision makers and stakeholders. While all species and ecosystems are valued, how they are weighted, and the resulting preferred management strategy is context dependent. Weights were variable across participants for all objectives. There was stronger alignment of weights for one of the ecosystems, Natural Temperate Grasslands, than other objectives. One of the threatened species, striped legless lizard, tended to be weighted higher than other ecological objectives, while management costs had the lowest weights. Stakeholder's weightings for objectives varied, however the influence on the rank order of management strategies was minimal. The structured approach to navigate trade‐offs identified management strategies that best address stakeholder preferences across multiple objectives. This approach offers improvements in evidence‐based decision making and provides a transparent and defensible rationale for selecting management interventions that considers all relevant objectives.

Stakeholder preferences for pangolin conservation interventions in south‐east Nigeria

Abstract The overexploitation of biological resources severely threatens many species, requiring urgent and effective conservation interventions. Such interventions sometimes require governance structures that incorporate pluralist perspectives and collaborative decision‐making, especially in complex, multi‐faceted and multi‐scale issues like the illegal trade in pangolins. We used Q‐methodology to provide evidence to inform interventions for pangolin conservation in south‐east Nigeria. We sampled stakeholder groups associated with pangolin use and protection, including hunters, wild meat traders and Nigeria Customs Service employees, to elicit their opinion and knowledge on the use and perceptions of pangolins and their preferences for interventions to reduce pangolin decline. We found that the local consumption of pangolin meat as food is the primary driver of poaching in the region. This contradicts popular opinions that pangolins are specifically targeted for international trade, revealing an opportunity for site‐level behaviour change interventions. The different stakeholder groups identified awareness‐raising campaigns, law enforcement, community stewardship programs and ecotourism as preferred interventions, whose effectiveness we attempted to assess using reported case studies. We observed different perspectives between people associated with pangolin poaching and use (predominantly those living around pangolin habitats, including hunters and wild meat traders) and those working to protect them (such as conservation organisations and Nigeria Customs Service employees). For example, the first group supported community stewardship programs, while the latter preferred awareness‐raising and law enforcement efforts. This divergence in perspectives underpins the need for a combination of targeted interventions at the site level to engage different stakeholders while highlighting the potential challenges to collaborative decision‐making for species threatened by illegal wildlife trade. Policy implications. Our results stress the importance of targeted and context‐specific conservation interventions. Read the free Plain Language Summary for this article on the Journal blog.

Reverse engineering of stakeholder preferences – A multi-criteria assessment of the German passenger car sector

Germany is a frontrunner in setting frameworks for the transition to a low-carbon system. The mobility sector plays a significant role in this shift, affecting different people and groups on multiple levels. Without acceptance from these stakeholders, emission targets are out of reach. This research analyzes how the heterogeneous preferences of various stakeholders align with the transformation of the mobility sector, looking at the extent to which the German transformation paths are supported and where stakeholders are located.Under the research objective of comparing stakeholders' preferences to identify which car segments require additional support for a successful climate transition, a status quo of stakeholders and car performance criteria is the foundation for the analysis. Stakeholders' hidden preferences hinder the derivation of criteria weightings from stakeholders; therefore, a ranking from observed preferences is used. This study's inverse multi-criteria decision analysis means that weightings can be predicted and used together with a recalibrated performance matrix to explore future preferences toward car segments.Results show that stakeholders prefer medium-sized cars, with the trend pointing towards the increased potential for alternative propulsion technologies and electrified vehicles. These insights can guide the improved targeting of policy supporting the energy and mobility transformation. Additionally, the method proposed in this work can fully handle subjective approaches while incorporating a priori information. A software implementation of the proposed method completes this work and is made publicly available.

Development of a Choice-framework for Covid vaccines in India using a multi-criteria decision analysis approach

BackgroundVaccines were crucial in controlling the Covid-19 pandemic. As more vaccines receive regulatory approval, stakeholders will be faced with several options and must make an appropriate choice for themselves. We proposed a multi-criteria decision analysis (MCDA) framework to guide decision-makers in comparing vaccines for the Indian context. MethodsWe adhered to the ISPOR guidance for the MCDA process. Seven vaccine options were compared under ten criteria. Through three virtual workshops, we obtained opinions and weights from citizens, private-sector hospitals, and public health organisations. Available evidence was rescaled and incorporated into the performance matrix. The final score for each vaccine was calculated for the different groups. We performed different sensitivity analyses to assess the consistency of the rank list. ResultsThe cost, efficacy and operational score of the vaccines had the highest weights among the stakeholders. From the six scenario groups, Janssen had the highest score in four. This was driven by the advantage of having a single dose of vaccination. In the probabilistic sensitivity analysis for the overall group, Covaxin, Janssen, and Sputnik were the first three options. The participants expressed that availability, WHO approvals and safety, among others, would be crucial when considering vaccines. ConclusionsThe MCDA process has not been capitalised on in healthcare decision-making in India and LMICs. Considering the available data and stakeholder preference at the time of the study, Covaxin, Janssen, and Sputnik were preferred options. The choice framework with the dynamic performance matrix is a valuable tool that could be adapted to different population groups and extended based on increasing vaccine options and emerging evidence.*ISPOR – The Professional Society for Health Economics and Outcomes Research.

The association between corporate social responsibility activity and tax avoidance: a classical economic perspective

ABSTRACT This study empirically examines why firms engage in corporate social responsibility (CSR) activities based on the classical economic perspective, which is shareholder value maximization. Using the CSR index evaluated by the Korean government, we find that firms with a high score on the index are more likely to engage in tax avoidance practices to mitigate potential costs. This finding suggests that firms aiming to maximize profits strategically employ CSR activities under social pressure to accommodate heterogeneous preferences of shareholders and stakeholders.

Patient and researcher stakeholder preferences for use of electronic health record data: a qualitative study to guide the design and development of a platform to honor patient preferences.

This qualitative study aimed to understand patient and researcher perspectives regarding consent and data-sharing preferences for research and a patient-centered system to manage consent and data-sharing preferences. We conducted focus groups with patient and researcher participants recruited from three academic health centers via snowball sampling. Discussions focused on perspectives on the use of electronic health record (EHR) data for research. Themes were identified through consensus coding, starting from an exploratory framework. We held two focus groups with patients (n = 12 patients) and two with researchers (n = 8 researchers). We identified two patient themes (1-2), one theme common to patients and researchers (3), and two researcher themes (4-5). Themes included (1) motivations for sharing EHR data, (2) perspectives on the importance of data-sharing transparency, (3) individual control of personal EHR data sharing, (4) how EHR data benefits research, and (5) challenges researchers face using EHR data. Patients expressed a tension between the benefits of their data being used in studies to benefit themselves/others and avoiding risk by limiting data access. Patients resolved this tension by acknowledging they would often share their data but wanted greater transparency on its use. Researchers expressed concern about incorporating bias into datasets if patients opted out. A research consent and data-sharing platform must consider two competing goals: empowering patients to have more control over their data and maintaining the integrity of secondary data sources. Health systems and researchers should increase trust-building efforts with patients to engender trust in data access and use.