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Using a discrete choice experiment to value a community pharmacy service : how valid are the findings?

Introduction: Expanding the role of community pharmacists within primary care has become an important policy agenda in the UK. To ensure that pharmacy services are delivered to their full potential, services need to be better tailored to consumers' needs and preferences. The discrete choice experiment (DCE), a technique rooted in economic theory, has been used extensively to elicit consumers' preferences and values in healthcare. However, despite its popularity, there is limited empirical evidence on the external validity of DCEs. Aims: The aim of this thesis was to assess consumers' preferences for a community pharmacyled health check using a DCE with a methodological focus to investigate the external validity of DCE. Method: This thesis employed a four-phased mixed methods study design. In Phase I, a convenience sample of participants was recruited from within a community pharmacy, a colocated dental practice and nearby public spaces and invited to complete a DCE questionnaire to assess preferences for a community pharmacy-led health-check. The DCE comprised twelve choices examining preferences for six attributes of the health check. Additionally, the questionnaire included post-choice certainty questions and attitudinal measures developed from the Theory of Planned Behaviour (TPB). Four weeks later, these participants were offered a real choice between two actual health-checks (Phase II). Their actual choices were compared with DCE-predicted choices; if these differed, participants were invited to an in-depth, face-toface interview (Phase III). In Phase IV, leaflets promoting the service were handed out to the local population and uptake was compared with that predicted by the DCE. Results: The DCE was completed by 423 individuals; 133 (31.4%) were contactable in Phase II and 10 were interviewed in Phase III. The DCE suggested that consumers preferred a healthcheck that was: cheaper; delivered by experienced personnel; with follow-up; available by appointment; lasted 30-minutes; with weekend availability. The estimated value of the health check was £49. The DCE correctly predicted 42.1% of participants' actual choices in Phase II. Calibration of the DCE with certainty questions and incorporation of the TPB into DCE improved DCE-prediction. From the interviews in Phase III, reasons for discrepancies in stated choice and actual behaviour included differences in decision-making processes in DCE and real life, attitudinal and other contextual factors (e.g. timing, location). Discussion & Conclusion: Consumers valued the role of community pharmacists in providing public health services targeted at disease prevention. This finding supports government policies to increase community pharmacists' contribution to public health. Whilst the results raised questions about the external validity of DCE in this study context, different choice modelling approaches (i.e. incorporation of TPB and certainty calibration) improved external validity of DCE. Qualitative findings provided deeper insights into why participants did not do as they said and do not necessarily invalidate DCE findings. The findings from this study should not act as a deterrent to future use of DCEs but more to raise awareness of the need to take into account how choices are made in real life. Ideally the development of DCE and the modelling of choice responses should mimic as closely as possible the decision-making process individuals face in reality.
Date January 2017
CreatorsChua, Gin Nie
PublisherUniversity of Aberdeen
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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