Universität zu Köln

Abiiro, Gilbert Abotisem ORCID: 0000-0002-3809-2671, Leppert, Gerald, Mbera, Grace Bongololo, Robyn, Paul J. and De Allegri, Manuela (2014). Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi. BMC Health Serv. Res., 14. LONDON: BMC. ISSN 1472-6963

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Abstract

Background: Discrete choice experiments (DCEs) are attribute-driven experimental techniques used to elicit stakeholders' preferences to support the design and implementation of policy interventions. The validity of a DCE, therefore, depends on the appropriate specification of the attributes and their levels. There have been recent calls for greater rigor in implementing and reporting on the processes of developing attributes and attribute-levels for discrete choice experiments (DCEs). This paper responds to such calls by carefully reporting a systematic process of developing micro health insurance attributes and attribute-levels for the design of a DCE in rural Malawi. Methods: Conceptual attributes and attribute-levels were initially derived from a literature review which informed the design of qualitative data collection tools to identify context specific attributes and attribute-levels. Qualitative data was collected in August-September 2012 from 12 focus group discussions with community residents and 8 in-depth interviews with health workers. All participants were selected according to stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three researchers to identify context-specific attributes and attribute-levels. Expert opinion was used to scale down the attributes and levels. A pilot study confirmed the appropriateness of the selected attributes and levels for a DCE. Results: First, a consensus, emerging from an individual level analysis of the qualitative transcripts, identified 10 candidate attributes. Levels were assigned to all attributes based on data from transcripts and knowledge of the Malawian context, derived from literature. Second, through further discussions with experts, four attributes were discarded based on multiple criteria. The 6 remaining attributes were: premium level, unit of enrollment, management structure, health service benefit package, transportation coverage and copayment levels. A final step of revision and piloting confirmed that the retained attributes satisfied the credibility criteria of DCE attributes. Conclusion: This detailed description makes our attribute development process transparent, and provides the reader with a basis to assess the rigor of this stage of constructing the DCE. This paper contributes empirical evidence to the limited methodological literature on attributes and levels development for DCE, thereby providing further empirical guidance on the matter, specifically within rural communities of low-and middle-income countries.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Abiiro, Gilbert Abotisem UNSPECIFIED orcid.org/0000-0002-3809-2671 UNSPECIFIED Leppert, Gerald UNSPECIFIED UNSPECIFIED UNSPECIFIED Mbera, Grace Bongololo UNSPECIFIED UNSPECIFIED UNSPECIFIED Robyn, Paul J. UNSPECIFIED UNSPECIFIED UNSPECIFIED De Allegri, Manuela UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-437764
DOI:	10.1186/1472-6963-14-235
Journal or Publication Title:	BMC Health Serv. Res.
Volume:	14
Date:	2014
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1472-6963
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SUB-SAHARAN AFRICA; CONJOINT-ANALYSIS; PREFERENCES; CARE; ENROLLMENT; DECISION; PERCEPTIONS; COVERAGE; FEATURES; DESIGN Multiple languages Health Care Sciences & Services Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43776