Exploring how individuals complete the choice tasks in a discrete choice experiment: an interview study.
BACKGROUND
To be able to make valid inferences on stated preference data from a Discrete Choice Experiment (DCE) it is essential that researchers know if participants were actively involved, understood and interpreted the provided information correctly and whether they used complex decision strategies to make their choices and thereby acted in accordance with the continuity axiom.


METHODS
During structured interviews, we explored how 70 participants evaluated and completed four discrete choice tasks aloud. Hereafter, additional questions were asked to further explore if participants understood the information that was provided to them and whether they used complex decision strategies (continuity axiom) when making their choices. Two existing DCE questionnaires on rotavirus vaccination and prostate cancer-screening served as case studies.


RESULTS
A large proportion of the participants was not able to repeat the exact definition of the risk attributes as explained to them in the introduction of the questionnaire. The majority of the participants preferred more optimal over less optimal risk attribute levels. Most participants (66%) mentioned three or more attributes when motivating their decisions, thereby acting in accordance with the continuity axiom. However, 16 out of 70 participants continuously mentioned less than three attributes when motivating their decision. Lower educated and less literate participants tended to mention less than three attributes when motivating their decision and used trading off between attributes less often as a decision-making strategy.


CONCLUSIONS
The majority of the participants seemed to have understood the provided information about the choice tasks, the attributes, and the levels. They used complex decision strategies (continuity axiom) and are therefore capable to adequately complete a DCE. However, based on the participants' age, educational level and health literacy additional, actions should be undertaken to ensure that participants understand the choice tasks and complete the DCE as presumed.
National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands. jorien.veldwijk@rivm.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. jorien.veldwijk@rivm.nl.|Centre for Research Ethics and Bioethics, Uppsala University, PO box 564, SE-751 22, Uppsala, Sweden. jorien.veldwijk@rivm.nl.
Jorien
J
Veldwijk
National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands.|Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Domino
D
Determann
National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands.
Mattijs S
MS
Lambooij
Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
Janine A
JA
van Til
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Ida J
IJ
Korfage
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Esther W
EW
de Bekker-Grob
National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services Research, PO Box 1 (internal postal code 101), 3720, BA, Bilthoven, The Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
G Ardine
GA
de Wit
D000368:Aged; D001294:Attitude to Health; D002675:Child, Preschool; D002755:Choice Behavior; D015331:Cohort Studies; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D057220:Health Literacy; D006801:Humans; D007223:Infant; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
Decision-making; Discrete choice experiment; Interview; Methodology; Preference measurement; Testing assumptions; Think aloud