David A Katz1,2,3, Kenda R Stewart4, Monica Paez4, Mark W Vander Weg4,5,6, Kathleen M Grant7,8, Christine Hamlin4, Gary Gaeth9. 1. Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System (152), Iowa City, IA, 52246-2208, USA. david-katz@uiowa.edu. 2. Department of Medicine, University of Iowa, Iowa City, IA, USA. david-katz@uiowa.edu. 3. Department of Epidemiology, University of Iowa, Iowa City, IA, USA. david-katz@uiowa.edu. 4. Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System (152), Iowa City, IA, 52246-2208, USA. 5. Department of Medicine, University of Iowa, Iowa City, IA, USA. 6. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA. 7. VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA. 8. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA. 9. Tippie School of Business, University of Iowa, Iowa City, IA, USA.
Abstract
BACKGROUND: Providers often prescribe counseling and/or medications for tobacco cessation without considering patients' treatment preferences. OBJECTIVE: The primary aims of this study are to describe (1) the development of a discrete choice experiment (DCE) questionnaire designed to identify the attributes and levels of tobacco treatment that are most important to veterans; and (2) the decision-making process in choosing between hypothetical tobacco treatments. METHODS: We recruited current smokers who were already scheduled for a primary care appointment within a single Veterans Affairs (VA) healthcare system. Subjects were asked to rate the importance of selected treatment attributes and were interviewed during two rounds of pilot testing of initial DCE instruments. Key attributes and levels of the initial instruments were identified by targeted literature review; the instruments were iteratively revised after each round of pilot testing. Using a 'think aloud' approach, subjects were interviewed while completing DCE choice tasks. Constant comparison techniques were used to characterize the issues raised by subjects. Findings from the cognitive interviews were used to revise the initial DCE instruments. RESULTS: Most subjects completed the DCE questionnaire without difficulty and considered two or more attributes in choosing between treatments. Two common patterns of decision-making emerged during the cognitive interviews: (1) counting 'pros' and 'cons' of each treatment alternative; and (2) using a 'rule-out' strategy to eliminate a given treatment choice if it included an undesirable attribute. Subjects routinely discounted the importance of certain attributes and, in a few cases, focused primarily on a single 'must-have' attribute. CONCLUSION: Cognitive interviews provide valuable insights into the comprehension and interpretation of DCE attributes, the decision processes used by veterans during completion of choice tasks, and underlying reasons for non'-compensatory decision-making.
BACKGROUND: Providers often prescribe counseling and/or medications for tobacco cessation without considering patients' treatment preferences. OBJECTIVE: The primary aims of this study are to describe (1) the development of a discrete choice experiment (DCE) questionnaire designed to identify the attributes and levels of tobacco treatment that are most important to veterans; and (2) the decision-making process in choosing between hypothetical tobacco treatments. METHODS: We recruited current smokers who were already scheduled for a primary care appointment within a single Veterans Affairs (VA) healthcare system. Subjects were asked to rate the importance of selected treatment attributes and were interviewed during two rounds of pilot testing of initial DCE instruments. Key attributes and levels of the initial instruments were identified by targeted literature review; the instruments were iteratively revised after each round of pilot testing. Using a 'think aloud' approach, subjects were interviewed while completing DCE choice tasks. Constant comparison techniques were used to characterize the issues raised by subjects. Findings from the cognitive interviews were used to revise the initial DCE instruments. RESULTS: Most subjects completed the DCE questionnaire without difficulty and considered two or more attributes in choosing between treatments. Two common patterns of decision-making emerged during the cognitive interviews: (1) counting 'pros' and 'cons' of each treatment alternative; and (2) using a 'rule-out' strategy to eliminate a given treatment choice if it included an undesirable attribute. Subjects routinely discounted the importance of certain attributes and, in a few cases, focused primarily on a single 'must-have' attribute. CONCLUSION: Cognitive interviews provide valuable insights into the comprehension and interpretation of DCE attributes, the decision processes used by veterans during completion of choice tasks, and underlying reasons for non'-compensatory decision-making.
Authors: Kathleen Knafl; Janet Deatrick; Agatha Gallo; Gwynne Holcombe; Marie Bakitas; Jane Dixon; Margaret Grey Journal: Res Nurs Health Date: 2007-04 Impact factor: 2.228
Authors: Robert M Anthenelli; Neal L Benowitz; Robert West; Lisa St Aubin; Thomas McRae; David Lawrence; John Ascher; Cristina Russ; Alok Krishen; A Eden Evins Journal: Lancet Date: 2016-04-22 Impact factor: 79.321