title: Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
abstract: 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.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.forename: Trisha M
authors.initials: TM
authors.lastname: Crutchfield
authors.forename: Paul M
authors.initials: PM
authors.lastname: Brown
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Jane L
authors.initials: JL
authors.lastname: Laping
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Lewis
authors.forename: Kristen Hassmiller
authors.initials: KH
authors.lastname: Lich
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Florence Kl
authors.initials: FK
authors.lastname: Tangka
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
mesh_terms: D001741:Black or African American / Q000523:psychology; D001499:Bayes Theorem; D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D005006:Ethnicity; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D016730:Program Development; D012424:Rural Population; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations; D044465:White People / Q000523:psychology