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

Details

• Alternative Title:
  BMC Health Serv Res
• Personal Author:
  Pignone, Michael P ; Crutchfield, Trisha M ; Brown, Paul M ; Hawley, Sarah T ; Laping, Jane L ; Lewis, Carmen L ; Lich, Kristen Hassmiller ; Richardson, Lisa C ; Tangka, Florence KL ; Wheeler, Stephanie B
• Description:
  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.
  
  Electronic supplementary material
  
  The online version of this article (doi:10.1186/s12913-014-0611-4) contains supplementary material, which is available to authorized users.
  
  
• Subjects:
  Bayes Theorem Black Or African American/psychology Choice Behavior Colorectal Neoplasms/diagnosis Early Detection Of Cancer/methods Ethnicity Female Health Promotion Humans Male Middle Aged North Carolina Patient Acceptance Of Health Care Program Development Rural Population Surveys And Questionnaires Vulnerable Populations White People/psychology

  More +
• Source:
  BMC Health Serv Res. 14(1).
• Document Type:
  Journal Article
• Place as Subject:
  North Carolina
• Volume:
  14
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:39a8d8b6c0483f043cb5e2ed5324d8f09aa2cda7060ae1c8b8f3561ced62b934
• Download URL:
  https://stacks.cdc.gov/view/cdc/26395/cdc_26395_DS1.pdf
• File Type:
  [PDF - 301.30 KB ]