To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates.

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Background and Objectives: Understanding patient and public values and preferences is essential to healthcare and policy decision making. Discrete choice experiments (DCEs) are a common tool used to capture and quantify these preferences. Recent technological advances allow for a variety of approaches to create and analyze DCEs. However, there is no optimal DCE design, nor analysis method. Our objectives were to (i) survey DCE simulation studies to determine what design features affect statistical efficiency, and assess their reporting, (ii) further investigate these findings with a de novo simulation study, and (iii) explore the sensitivity of individuals’ preference of attributes to several methods of analysis. Methods: We conducted a systematic survey of simulation studies within the health literature, created a DCE simulation study of 3204 designs, and performed two empirical comparison studies. In one empirical comparison study, we determined addiction agency employees’ preferences on knowledge translation attributes using four models, and in the second, we determined elementary school children’s choice of bullying prevention programs using nine models. Results and Conclusions: In our evaluation of DCE designs, we identified six design features that impact the statistical efficiency of a DCE, several of which were further investigated in our simulation study. The reporting quality of these studies requires improvement to ensure that appropriate inferences can be made, and that they are reproducible. In our empirical comparison of statistical models to explore the sensitivity of individuals preferences of attributes, we found similar rankings in the relative importance measures of attributes’ mean part-worth utility estimates, which differed when using latent class models. Understanding the impact of design features on statistical efficiency are useful for designing optimal DCEs. Incorporating heterogeneity in the analysis of DCEs may be important to make appropriate inferences about individuals’ preferences of attributes within a population. / Thesis / Doctor of Philosophy (PhD) / This thesis focuses on the design and analysis of preference surveys, which are referred to as discrete choice experiments. These surveys are used to capture and quantify individuals’ preferences on various characteristics describing a product or service. They are applied in various health settings to better understand a population. For example, clinicians may want to further understand a patient population’s preferences in regards to multiple treatment alternatives. Currently, there is no optimal approach for designing or analyzing preference surveys. We investigated what factors help improve the design of a preference survey by exploring the literature and conducting our own simulation study. We also investigated how sensitive the results of a preference survey were based on the statistical model used. Overall, we found that (i) increasing the amount of information presented and reducing the number of variables to explore will maximize the statistical optimality of the survey; and (ii) analyzing the data with different statistical models will yield similar results in the ranking of individuals’ preferences of the variables explored.

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Yes / Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations. / Department of Health, Project 016/0108. NIHR, CDF/01/2008/009.

Die vier Beiträge der vorliegenden Dissertationsschrift untersuchen das Entscheidungsverhalten von Landwirten in unterschiedlichen Entscheidungssituationen. Das übergeordnete Ziel ist es, die Präferenzstruktur und Zahlungsbereitschaft von Landwirten in den untersuchten Entscheidungssituationen zu analysieren, um so die Informationsgrundlage als Entscheidungsbasis für Politiker und Berater sowie der Landwirte selbst zu erweitern. Hierzu findet die Methode der Discrete Choice Experimente in allen vier Beiträgen Anwendung. Im Einzelnen werden in den Beiträgen folgende Forschungsfragen untersucht: Der erste Beitrag prüft welche Faktoren die Entscheidung von Landwirten beeinflussen, den Preis für ihr Erntegut ex ante abzusichern. Im zweiten Beitrag werden die Präferenzen von Landwirten für das Eingehen einer Kooperation unter expliziter Berücksichtigung von nicht-monetären Faktoren analysiert. Der dritte Beitrag geht der Frage nach, welche Rolle die finanzielle Flexibilität in Investitionsentscheidungen von Landwirten spielt. Wie Anbauverträge für Biogas-Zuckerrüben aus Sicht der anbauenden Landwirte ausgestaltet sein müssen, wird im vierten Beitrag geklärt.

The research utilizes a Discrete Choice Experiment to assess consumer preferences and determine blockchain-based food traceability's relative importance and utility in the food purchasing process. The study specifically tests five selected attributes of olive oil, including price, organic label, olive oil type, country of origin, and blockchain traceability. Additionally, a survey is conducted to evaluate Swedish consumers' knowledge levels concerning blockchain technology and its application in the food system to improve transparency. The study also explores consumer evaluations of safety and sustainability information and their willingness to pay price premiums for food products verified for safety and environmental claims. The findings indicate that while Swedish consumers possess moderate knowledge of blockchain technology, their understanding of its specific application in food traceability is limited. Nevertheless, consumers highly value access to accurate information about the safety and sustainability of their food purchases. A considerable portion of respondents express a willingness to pay a premium for products verified for safety, authenticity, and sustainability. The choice experiment results reveal that blockchain-based food traceability ranks lower in relative importance than the price and organic label but higher than olive oil type and country of origin. The findings of this study contribute to bridging the existing gap in the understanding of blockchain-based food traceability technology among Swedish consumers.

Natural disasters are increasing in frequency and intensity and have devastating impacts on individuals, both humanitarian and economic, particularly in developing countries. Microinsurance is seen as one promising instrument of disaster risk management, however the level of demand for respective projects remains low. Using behavioural games and a discrete choice experiment, this paper analyses the demand for hypothetical microinsurance products in rural Cambodia and contributes significant household level evidence to the current research. A general preference for microinsurance can be found, with demand significantly affected by price, provider, requirements for prevention and combinations with credit. Furthermore, financial literacy, risk aversion, levels of trust and previous disaster experience impact the individual demand for flood insurance in rural Cambodia.

<p> </p> <p>This dissertation consists of three essays that examine the response of small businesses to disruptions in their environment. The first two essays focused on small non-farm businesses in the United States and how they deal with natural disasters. The last essay examined smallholder farm households in Malawi, and how their household labor allocation decisions are affected by land allocation to estates in their communities. The individual essays are summarized as follows:</p> <p>Essay 1: <em>A Conditional Process Approach to Understanding the Role of Adjustment Strategies and Disaster Experience in Racial Disparities in Small Business Performance. </em>Considering that most minority owned businesses have limited access to formal systems, this essay explored how race could indirectly affect business performance (measured as percentage revenue growth) through the adoption of three informal strategies: customer base expansion, supplier base expansion and family adjustment strategies. It also explored whether these indirect effects are moderated by experience with natural disaster. The results showed that being a racial minority was positively associated with revenue growth such that on average, minority business owners experienced 29% higher revenue growth than white-owned businesses (p<0.05) on business performance. It also showed a modest indirect effect of race on revenue growth through each mediating strategy (p<0.5). However, the results did not support a moderating role for disaster experience. </p> <p>Essay 2: <em>Willingness to Pay for Comprehensive Cyclone Insurance Coverage by Small Business Owners: Evidence from the Coastal States of the United States</em>. Small businesses in the coastal United States are usually uninsured or underinsured for cyclone events. The underinsuring of these businesses could be a result of limited insurance coverage as well as individual characteristics of small business owners. Using a discrete choice experiment, this essay used a hypothetical comprehensive cyclone insurance to understand what insurance attributes are important to small business owners. It also examined the role of previous disaster experience, charity hazard as well as temporal orientation on the willingness to pay for the disaster insurance. This study used a discrete choice experiment to elicit insurance preferences from small coastal businesses which employed less than 100 employees. A mixed logit model was used to analyze the data. The results showed that business owners exhibited positive marginal utilities from policies that covered flood, windstorm, and business interruption regardless of the combination. Notably, the mixed logit model showed that on average, business owners were willing to pay up to 450%, 472%, and 482% more than their total monthly business insurance premium payment for insurance that covers flood and business interruption, windstorm and business interruption, and flood, windstorm and business interruption respectively. Ordinary Least Squares (OLS) regression showed that respondents who had previously experienced cyclones were more willing to pay for the presented insurance policies than those who have not. Future orientation was also found to be positively associated with the marginal willingness to pay for the insurance policies.</p> <p>Essay 3: <em>Estates and Small-Holder Agricultural Labor Dynamics in Sub-Saharan Africa:</em> <em>A Case Study of Malawi. </em>Estates are larger than the average farm holdings, which mostly grow one crop, require large capital investment, are centrally managed and rely a lot on hired labor. With such large investments in agricultural land, the labor decisions of smallholder households in Africa will likely be altered. This essay therefore examined the role of estate farms on smallholders’ allocation of labor between on-farm, and off-farm demand and supply of casual labor using the <em>ganyu</em> system of Malawi as a case-study. Using the Malawi Integrated Household Panel survey covering the years 2010, 2013, 2016, and 2019, we estimated the effect of estates on the participation of smallholders on these labor decisions as well as the number of days spent in each activity. We also investigated the effect of these estates on community agricultural labor (<em>ganyu) </em>wage rates and the share of income accruable to ganyu and crop production. Linear probability (LPM), as well as tobit-correlated random effects (CRE) regressions were used to test these effects. Both models showed that the share of estates had a negative correlation with <em>ganyu </em>demand. The Tobit CRE regression showed that on average a 1% increase in the percentage share of agricultural land occupied by estates was associated with a modest 0.04% (p<0.01) decrease in the number of days <em>ganyu </em>labor was demanded, and a 0.02% increase in the number of days household members spent on their own farms. Further results showed that households in communities with higher shares of estates participated in less non-crop farming activities especially wage employment. We also found that the negative relationship between estates and <em>ganyu </em>demand was accentuated among households with higher levels of assets, and farm income. Finally, we found a modest negative relationship between share of estates and community <em>ganyu </em>wage rates </p>