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PubMed1997

Choice and participation in the health services: a survey of preferences among Swedish residents.

Extending the possibilities for health-service consumers to choose among providers has been an important objective on the political agenda in Sweden and elsewhere. Little is known, however, about individual and group preferences concerning the demand for choices. It is often implicitly assumed that individuals can be treated as a group with similar values and demands, but is this true? To what extent do individuals want more options in health care? Do preferences vary depending on age, education and place of living? This article explores these questions, starting from a survey of 2,000 residents in four Swedish counties. The results of the survey point to many similarities, but also indicate important differences among residents. In particular, preferences seem to vary significantly depending on age and level of education. On the other hand, older people are more favourably inclined towards the free choice of physician. On the other hand, members of the younger generation, as well as well-educated residents, demand a more active part in the process of medical decision making. These differences, as well as expectations from younger generations, pose a great challenge to the future management of health services.

Choice Behavior↗
PubMed2002

Effects of appropriate and inappropriate odors on product evaluations.

In accounting for an odorant's effect on the evaluation of a product, both the odor's intrinsic pleasantness and its appropriateness for that particular product are relevant. When comparing the effects of pleasant smells, consumers are likely to prefer products with appropriate smells to those with an inappropriate smell. We investigated the effect of adding congruent and incongruent odorants on product evaluations for each of three product categories: food (tea, instant whip, cake mix), personal care (shampoo, deodorant, lip balm), and household products (cream cleaner, air freshener, furniture wax). In a between-subjects design, 96 respondents judged scented and unscented products presented in commercial packages of major national brands. The respondents assessed the overall evaluation, 14 to 19 beliefs about the product, buying intention, and the frequency of use for each product. Respondents were instructed to evaluate each product as they would in a store. Although congruency ratings between odor and product show that the manipulation of congruency was successful, no main effect was found for the congruency on overall evaluations of the products. To account for this unexpected finding, we speculate that congruency between odor and product may be more important during product consumption or product use than during its selection. In addition, the odor's effects may have been attenuated in our experiment because we asked our respondents to rate each product on the attribute 'has a nice smell'.

Adolescent↗
PubMed1998

The influence of the mass media on the selection of physicians.

The purpose of this study was to examine now media sources influence an individual's reported choice of a physician as compared to personal referral sources and how consumers use the Yellow Pages to search for health care information. A random sample of 762 residents was systematically selected from the Charlotte, North Carolina White Pages and was asked to participate in a 20-item descriptive phone survey designed and tested by the investigator. Five hundred and seventy-eight individuals completed the survey, with a response rate of 75.9%. This study supports previous research suggesting that personal referrals are the most influential sources in selecting health care services. Therefore, satisfying and delighting the physician's/practice's existing client base may be one of the most potent advertising resources at hand. Mass media sources played a relatively minor role in influencing provider selection in this study. Nevertheless, it should not be dismissed in as much as the media may be an important way for physicians to promote "brand recognition," a problem not considered in this study. Finally, approximately 28% of the participants were "Yellow Pages users"; that is, individuals who tended to be heavy users of the Yellow Pages and used it for multiple information-seeking tasks. The findings related to the Yellow Pages suggest that while it may be useful to advertise in the Yellow Pages, a more modest financial allocation to this source may be considered.

Adult↗
PubMed2006

Consumer determinants of the use of health plan information in plan selection.

One of the major issues in achieving optimum levels of performance in health-care markets is to enhance consumer understanding of their health plan choices in order to facilitate the expansion of 'high-value' health plans at the expense of 'low-value' health plans. The Federal government offers employees many choices of health plans and provides large amounts of information on all of these options through (1) comparative written health plan information, (2) information from the health plans themselves, and (3) comparative health plan information on the Internet. The present study examines the degree to which 1722 Federal employees in the Department of Health and Human Services utilized health plan information from the above three sources in making their annual health plan selection. Results indicate that most employees (64%) used at least one information source, with written information from health plans the most common (53%), followed by comparative written information in The Guide (32%) and the Internet (16%). Those employees who regularly search for information prior to making an important purchase, those with a short time in their current plan, those with family coverage, Whites, African-Americans, and men were all more likely to use health plan information to make their annual choice. The Internet was accessed more often by younger and higher paid employees. Implications for policy and future research are discussed.

Adult↗
PubMedDate not supplied

Identifying program preferences through conjoint analysis: illustrative results from a parent sample.

PURPOSE: The purpose of this article is to illustrate the application of conjoint analysis, a consumer research technique, using data from a survey of parents' preferences for prevention programs. DESIGN: This study utilized a one-time, cross-sectional telephone survey. SETTING: Data were collected from subjects living in economically disadvantaged rural midwestern counties. SUBJECTS: Subjects were 202 randomly selected parents with preadolescents who indicated interest in family-focused prevention programs. MEASURES: Conjoint analysis software was employed in computer-assisted telephone interviews to evaluate relative preferences for 39 individual features of family-focused prevention programs falling under 11 categories (e.g., program meeting time, facilitator background). The software also guided computer simulations of parent choices among four types of programs. RESULTS: Findings indicated that meeting time was the most important category of program features. Strongly preferred individual features included meetings scheduled on weekday evenings, instruction by child development specialists, and programs based on extensive research. Two multiple-session programs evaluated via computer simulations incorporated several preferred features and received higher ratings than did single-session programs. Estimated variance z-tests indicated limited differences in perceived importance of program feature categories across sociodemographic subgroups. CONCLUSIONS: Findings highlight a) differences in the relative value parents place on various features of prevention programs in the surveyed population and b) the importance of practical aspects of program delivery.

Adolescent↗
PubMed2002

Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination.

Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.

Adult↗
PubMed2004

Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting.

OBJECTIVE: To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool. STUDY DESIGN: We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans--a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system. PRINCIPAL FINDINGS: Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive. CONCLUSIONS: This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.

Choice Behavior↗
PubMed2004

Consumers' use of the Internet for health insurance.

OBJECTIVES: We examined consumers' search for information about health insurance choices and their use of the Internet for that search and to manage health benefits. STUDY DESIGN: We surveyed a random sample of more than 4500 individuals aged 21 years and older who were members of a survey research panel during December 2001 and January 2002. METHODS: The survey included questions about searching for health insurance information in 3 health insurance markets: Medicare, individual or nongroup, and employer-sponsored group. We also asked questions about use of the Internet to manage health benefits. We tabulated means of responses to each question by market and tested for independence across demographic groups using the Pearson chi-square test. RESULTS: We identified important differences across and within markets in the extent to which people look for information about health insurance alternatives and the role of the Internet in their search. Although many individuals were unaware of whether their employer or health plan provided a website to manage health benefits, those who used the sites generally evaluated them favorably. CONCLUSIONS: Our results suggest that the Internet is an important source of health insurance information, particularly for individuals purchasing coverage individually in the nongroup and Medicare markets relative to those obtaining coverage from an employer. In the case of Medicare coverage, studies focusing on beneficiaries' use of Internet resources may underestimate the Internet's importance by neglecting caregivers who use the Internet. Many individuals may be unaware of the valuable resources available through employers or health plans.

Adult↗
PubMedDate not supplied

[The elderly as consumers].

The spending behavior of elderly people is discussed by time-series and cross-section-data. It is continued by an analysis of the information processing of elderly people in connection with spending decisions that leads to marketing perspectives and consumer policy aspects.

Aged↗
PubMed2003

Revisiting the axiom of completeness in health care.

Experiments concerned with modelling individual preferences are based on the assumption of completeness i.e. it is assumed that individuals have well-defined preferences for any choice they are presented with. However, this may not be the case for goods such as health care, where individuals are not used to making choices. If this assumption is violated, the large body of experimental economic literature eliciting patient preferences in health care may be challenged. This paper reports the results of a discrete choice experiment carried out to examine the assumption of complete preferences within health care. The tests carried out are based on the comparison of preferences for three different goods for which different levels of formed preferences are expected: a supermarket; dentist consultation and bowel cancer screening. The results do not provide sufficient evidence to support this hypothesis. However, further research is required before these results are generalised.

Attitude to Health↗
PubMed2002

Children's satisfaction with out-of-home care in South Australia.

Two studies were undertaken to assess children's satisfaction with their current placement experiences in South Australian alternative care. A total of 99 children with a mean age of 11 years were interviewed while still in care. Over 80 per cent of children reported being satisfied with both their case-worker and their placement, although children in residential (group) care reported being less satisfied than their counterparts in foster care. Foster homes were generally considered secure, happy and supportive, and case-workers were considered helpful, caring and willing to listen. Comparisons of background characteristics, measures of adjustment and demographic characteristics suggested that the samples interviewed were highly representative of the population of children referred for placements during the study period.

Adaptation, Psychological↗
PubMed1979

Responsive parenting: an approach to training parents of problem children.

Two behavior modification groups for parents of problem children between the ages of two and ten were conducted along the lines of the Responsive Teaching Model. The two groups met for 10 and 8 weeks, respectively, with six families represented in each group. In Responsive Parenting (RP), parents are taught to observe and measure their children's problematic behavior. Subsequently, each parent develops a home project designed to modify this behavior; 11 of the 12 parents developed a successful home project. In addition, the attendance was approximately 90% and the completion of weekly assignments was close to 100%. Paper-and-pencil measures revealed that the parents were very satisfied with the parent-training group and rated their children as improved on a bipolar adjective checklist. These results are discussed with regard to implications for the delivery of mental health services for children. Future research directions are delineated.

Adult↗
PubMed1990

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children.

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.

Adult↗
PubMedDate not supplied

Modification of residents' behavior by preceptor feedback of patient satisfaction.

The authors tested the effect of preceptor feedback to residents of patients' ratings of perceived art and technical quality of care on residents' subsequent performances. New ambulatory patients were asked to complete questionnaires measuring satisfaction with physician behavior during initial encounters. Sixty-eight residents were evaluated by 424 patients over a six-month period. Continuing residents with the lowest scores were assigned to a feedback or a non-feedback group. Residents in the feedback group were individually shown their mean scores on each item, as well as scores for all residents, and were then advised of physicians' behaviors that could increase patient satisfaction. During a subsequent six-month survey of new patients, scores in the feedback group improved more than those in the non-feedback group in art of care, technical quality, and total patient satisfaction (p less than 0.001).

Behavior Therapy↗
PubMed1985

A randomized controlled trial of a new approach to preoperative teaching and patient compliance.

A randomized controlled experiment evaluating the effects of a new approach to preoperative teaching on patient compliance is described. In this study, compliance was measured by the accuracy, regularity and willingness that patients showed in execution of the prescribed activities after surgery. A significant difference was found between the experimental and control patients in the regularity, willingness and accuracy with which they performed the prescribed postoperative exercises. The experimental patients were significantly more satisfied with this approach to preoperative teaching than the control patients. This study is seen to have implications for both nursing education and nursing service.

Aged↗
PubMed2006

Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities.

This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities. Families were randomly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills (SSTP-E), standard parent training intervention alone (SSTP-S) or waitlist control (WL) condition. At post-intervention, both programs were associated with lower levels of observed negative child behavior, reductions in the number of care-giving settings where children displayed problem behavior, and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. Gains attained at post-intervention were maintained at 1-year follow-up. Both interventions produced significant reductions in child problem behavior, with 67% of children in the SSTP-E and 77% of children in the SSTP-S showing clinically reliable change from pre-intervention to follow-up. Parents reported a high level of satisfaction with both interventions.

Adaptation, Psychological↗