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Exploring what lies behind public preferences for avoiding health losses caused by lapses in healthcare safety and patient lifestyle choices

Exploring what lies behind public preferences for avoiding health losses caused by lapses in healthcare safety and patient lifestyle choices
Exploring what lies behind public preferences for avoiding health losses caused by lapses in healthcare safety and patient lifestyle choices
Background: although many studies have identified public preferences for prioritising health care interventions based on characteristics of recipient or care, very few of them have examined the reasons for the stated preferences. We conducted an on-line person trade-off (PTO) study (N=1030) to investigate whether the public attach a premium to the avoidance of ill health associated with alternative types of responsibilities: lapses in healthcare safety, those caused by individual action or lifestyle choice; or genetic conditions. We found that the public gave higher priority to prevention of harm in a hospital setting such as preventing hospital associated infections than genetic disorder but drug administration errors were valued similar to genetic disorders. Prevention of staff injuries, lifestyle diseases and sports injuries, were given lower priority. In this paper we aim to understand the reasoning behind the responses by analysing comments provided by respondents to the PTO questions.

Method: a majority of the respondents who participated in the survey provided brief comments explaining preferences in free text responses following PTO questions. This qualitative data was transformed into explicit codes conveying similar meanings. An overall coding framework was developed and a reliability test was carried out. Recurrent patterns were identified in each preference group. Comments which challenged the assumptions of hypothetical scenarios were also investigated.

Results: NHS causation of illness and a duty of care were the most cited reasons to prioritise lapses in healthcare safety. Personal responsibility dominated responses for lifestyle related contexts, and many respondents mentioned that health loss was the result of the individual’s choice to engage in risky behaviour. A small proportion of responses questioned the assumptions underlying the PTO questions. However excluding these from the main analysis did not affect the conclusions.

Conclusion: although some responses indicated misunderstanding or rejection of assumptions we put forward, the results were still robust. The reasons put forward for responses differed between comparisons but responsibility was the most frequently cited. Most preference elicitation studies only focus on eliciting numerical valuations but allowing for qualitative data can augment understanding of preferences as well as verifying results
health care safety, stated preferences, hypothetical scenarios, priority setting
1472-6963
249
Singh, J.
b3066746-23cb-4292-87c6-be4656fd0561
Longworth, L.
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Baine, A.
ecea8df1-2531-4d33-985e-e11d026dd81d
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Orr, S.
46e0a107-cd27-4a23-93f0-5dd6bbfa96e2
Buxton, M.
2496fce8-7812-477d-bd26-0e30c1969613
Singh, J.
b3066746-23cb-4292-87c6-be4656fd0561
Longworth, L.
f72c0d0a-625e-4e97-a0e8-b89792bb0cae
Baine, A.
ecea8df1-2531-4d33-985e-e11d026dd81d
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Orr, S.
46e0a107-cd27-4a23-93f0-5dd6bbfa96e2
Buxton, M.
2496fce8-7812-477d-bd26-0e30c1969613

Singh, J., Longworth, L., Baine, A., Lord, J., Orr, S. and Buxton, M. (2013) Exploring what lies behind public preferences for avoiding health losses caused by lapses in healthcare safety and patient lifestyle choices. BMC Health Services Research, 13 (249), 249. (doi:10.1186/1472-6963-13-249). (PMID:23819651)

Record type: Article

Abstract

Background: although many studies have identified public preferences for prioritising health care interventions based on characteristics of recipient or care, very few of them have examined the reasons for the stated preferences. We conducted an on-line person trade-off (PTO) study (N=1030) to investigate whether the public attach a premium to the avoidance of ill health associated with alternative types of responsibilities: lapses in healthcare safety, those caused by individual action or lifestyle choice; or genetic conditions. We found that the public gave higher priority to prevention of harm in a hospital setting such as preventing hospital associated infections than genetic disorder but drug administration errors were valued similar to genetic disorders. Prevention of staff injuries, lifestyle diseases and sports injuries, were given lower priority. In this paper we aim to understand the reasoning behind the responses by analysing comments provided by respondents to the PTO questions.

Method: a majority of the respondents who participated in the survey provided brief comments explaining preferences in free text responses following PTO questions. This qualitative data was transformed into explicit codes conveying similar meanings. An overall coding framework was developed and a reliability test was carried out. Recurrent patterns were identified in each preference group. Comments which challenged the assumptions of hypothetical scenarios were also investigated.

Results: NHS causation of illness and a duty of care were the most cited reasons to prioritise lapses in healthcare safety. Personal responsibility dominated responses for lifestyle related contexts, and many respondents mentioned that health loss was the result of the individual’s choice to engage in risky behaviour. A small proportion of responses questioned the assumptions underlying the PTO questions. However excluding these from the main analysis did not affect the conclusions.

Conclusion: although some responses indicated misunderstanding or rejection of assumptions we put forward, the results were still robust. The reasons put forward for responses differed between comparisons but responsibility was the most frequently cited. Most preference elicitation studies only focus on eliciting numerical valuations but allowing for qualitative data can augment understanding of preferences as well as verifying results

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Accepted/In Press date: 28 June 2013
Published date: 2 July 2013
Keywords: health care safety, stated preferences, hypothetical scenarios, priority setting
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 382212
URI: https://eprints.soton.ac.uk/id/eprint/382212
ISSN: 1472-6963
PURE UUID: 6c626e2e-07ca-476c-81ae-4cad45db082d
ORCID for J. Lord: ORCID iD orcid.org/0000-0003-1086-1624

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Date deposited: 22 Oct 2015 12:31
Last modified: 20 Jul 2019 00:34

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