Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina

BMC Health Services Research

Stephanie B Wheeler⁵  Florence KL Tangka⁴  Lisa C Richardson⁴  Kristen Hassmiller Lich⁵  Carmen L Lewis⁸  Jane L Laping⁷  Sarah T Hawley²  Paul M Brown⁶  Trisha M Crutchfield³  Michael P Pignone¹ 

[1] Division of General Internal Medicine, University of North Carolina at Chapel Hill, School of Medicine, 5045 Old Clinic Building, CB#7110, Chapel Hill 27599, NC, USA;Division of General Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor 48109, MI, USA;University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill 27599-7426, NC, USA;Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta 30333, GA, USA;University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill 27599-7411, NC, USA;University of California - Merced, Health Sciences Research Institute, 5200 North Lake Road, Merced 95343, CA, USA;University of North Carolina at Chapel Hill, Translational and Clinical Sciences Institute, 160 N. Medical Drive Brinkhous-Bullit, 2nd Floor CB#7064, Chapel Hill, USA;Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Mail Stop B180 Academic Office 1, Room 8415 12631 E. 17th Ave, Aurora 80045, CO, USA

关键词: Health policy;    Questionnaires;    Behavioral;    Economics;    Decision making;    Choice behavior;    Rural population;    Vulnerable populations;    Colorectal neoplasms;    Early detection of cancer;   

Others  :  1090362
DOI  :  10.1186/s12913-014-0611-4

 received in 2014-04-29, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Screening for colorectal cancer (CRC) is suboptimal, particularly for vulnerable populations. Effective intervention programs are needed to increase screening rates. We used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs.

Methods

We enrolled English-speaking adults ages 50–75 at average risk of CRC from rural North Carolina communities with low rates of CRC screening, targeting those with public or no insurance and low incomes. Participants received basic information about CRC screening and potential program features, then completed a 16 task DCE and survey questions that examined preferences for four attributes of screening programs: testing options available; travel time required; money paid for screening or rewards for completing screening; and the portion of the cost of follow-up care paid out of pocket. We used Hierarchical Bayesian methods to calculate individual-level utilities for the 4 attributes’ levels and individual-level attribute importance scores. For each individual, the attribute with the highest importance score was considered the most important attribute. Individual utilities were then aggregated to produce mean utilities for each attribute. We also compared DCE-based results with those from direct questions in a post-DCE survey.

Results

We enrolled 150 adults. Mean age was 57.8 (range 50–74); 55% were women; 76% White and 19% African-American; 87% annual household income under $30,000; and 51% were uninsured. Individuals preferred shorter travel; rewards or small copayments compared with large copayments; programs that included stool testing as an option; and greater coverage of follow-up costs. Follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47%); followed by test reward/copayment (33%). From the survey, proportion of follow-up costs paid was most frequently cited as most important (42% of participants), followed by testing options (32%). There was moderate agreement (45%) in attribute importance between the DCE and the single question in the post-DCE survey.

Conclusions

Screening test copayments and follow-up care coverage costs are important program characteristics in this vulnerable, rural population.

【 授权许可】

   
2014 Pignone et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

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