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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi
BMC Health Services Research, Volume 14, No. 1, Article 235, Year 2014
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Description
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. © 2014 Abiiro et al.; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4032866/bin/1472-6963-14-235-S1.doc
Authors & Co-Authors
Abiiro, Gilbert Abotisem
Germany, Heidelberg
Medizinischen Fakultät Heidelberg
Ghana, Tamale
University for Development Studies Ghana
Leppert, Gerald
Germany, Koln
Universität zu Köln
Mbera, Grace Bongololo
Malawi, Lilongwe
Research for Equity and Community Health Trust
Robyn, Paul Jacob
United States, Washington, D.c.
The World Bank, Usa
De Allegri, Manuela
Germany, Heidelberg
Medizinischen Fakultät Heidelberg
Statistics
Citations: 114
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1186/1472-6963-14-235
e-ISSN:
14726963
Research Areas
Health System And Policy
Study Design
Grounded Theory
Study Approach
Qualitative
Quantitative
Systematic review
Study Locations
Malawi