title: Understanding the stakeholders' intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool.
abstract: BACKGROUND
  Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understanding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e., the Return on Investment tool.
  
  
  METHODS
  Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA's were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool.
  
  
  RESULTS
  Ninety-three stakeholders participated. Significant differences in beliefs were found between non-intenders and intenders: risk perception, attitude, social support, and self-efficacy towards using the tool. Regression showed that demographics, pre-motivational, and motivational factors explained 69% of the variation in intention.
  
  
  CONCLUSIONS
  This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies.
authors.affiliation: Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, GT Maastricht, 6229, The Netherlands. Electronic address: kl.cheung@maastrichtuniversity.nl.
authors.forename: Kei Long
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Duboisdomein 30, GT Maastricht, 6229, The Netherlands.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, GT Maastricht, 6229, The Netherlands.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/a, Budapest, 1117, Hungary; Syreon Research Institute, Thököly út 119, Budapest, 1146, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Vokó
authors.affiliation: Health Economics Research Group, Brunel University London, UB8 3PH, Uxbridge, United Kingdom.
authors.forename: Subhash
authors.initials: S
authors.lastname: Pokhrel
authors.affiliation: Health Economics Research Group, Brunel University London, UB8 3PH, Uxbridge, United Kingdom.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jones
authors.affiliation: Centre for Research in Health and Economics (CRES), University Pompeu Fabra, Ramon Trias Fargas 25-27, Barcelona, 08005, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Institute of Health Economics and Health Care Management Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Member of the German Center for Lung Research (DZL), Ingolstädter Landstr. 1, Neuherberg, 85764, Germany.
authors.forename: Silke B
authors.initials: SB
authors.lastname: Wolfenstetter
authors.affiliation: Syreon Research Institute, Thököly út 119, Budapest, 1146, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Józwiak-Hagymásy
authors.affiliation: Caphri school of Public Health and Primary Care Health Promotion, Maastricht University, POB 616 6200, MD Maastricht, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
mesh_terms: D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D007449:Investments / Q000191:economics*; D008297:Male; D036301:Qualitative Research; D061845:Smoke-Free Policy; D011795:Surveys and Questionnaires; D062789:Tobacco Products
keywords: Decision-support tool; Economic evaluations; Health policy; Tobacco control; Uptake