Using Best-Worst Scaling to Measure Caregiver Preferences for Managing their Child's ADHD: A Pilot Study.
BACKGROUND
Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers' concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers.


OBJECTIVE
The aim was to develop and to pilot an instrument to elicit caregivers' preferences for evidence-based management of their child's ADHD.


METHODS
Mixed methods were used to develop a Best-Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals.


RESULTS
Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child's ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication.


CONCLUSIONS
The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child's ADHD.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA. sdosreis@rx.umaryland.edu.
Susan
S
dosReis
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
Xinyi
X
Ng
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Emily
E
Frosch
University of Maryland School of Medicine, Baltimore, MD, USA.
Gloria
G
Reeves
McMaster University, Hamilton, ON, Canada.
Charles
C
Cunningham
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
John F P
JF
Bridges
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics; D015142:Baltimore; D017028:Caregivers / Q000191:economics / Q000193:education / Q000523:psychology*; D002648:Child; D002755:Choice Behavior; D003258:Consumer Behavior; D055317:Evidence-Based Practice; D005190:Family / Q000523:psychology*; D006801:Humans; D010865:Pilot Projects; D018570:Risk Assessment; D012944:Social Support