title: How do individuals value health states? A qualitative investigation.
abstract: Despite the importance of health state values in informing resource allocation in health care, there is arguably little known about how individuals value health. Previous studies have shown that a variety of non-health factors and beliefs are important in valuing health, but there is less evidence in the literature about how individuals' beliefs affect their preferences or what role non-health factors play in the process of forming preferences. This study investigated the thought processes of 21 U.K. based participants in March 2013 who valued health states using semi-structured interviews and a think-aloud protocol, with the aim to better understand the relationship between health states, the individual's underlying beliefs, and the individual's preferences. Participants followed several stages in valuing health. First, participants interpreted the health states more concretely, relying on their imagination and their experience of ill health. Participants judged how the concrete health problems combined with their personal interests, circumstances, and environment would affect them personally. Ultimately, participants valued health by estimating and weighing the non-health consequences of the health states. Six consequences were most frequently mentioned: activities, enjoyment, independence, relationships, dignity, and avoiding being a burden. At each stage participants encountered difficulties and expressed concerns. The findings have implications for methods of describing health, for example, whether the focus should be on health or a broader notion of well-being and capability. This is because the consequences are similar to the domains of broader measures such as the ICECAP measures for adults and older people, and the Warwick-Edinburgh Mental Wellbeing Scale. The findings suggest the need for testing whether individuals are informed about the health states they are valuing. Participants valued health by estimating the non-health consequences of health states and these estimates relied on individuals' beliefs about the interaction of the health state and their personal and social circumstances.
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, United Kingdom; Health Economics & Evidence Synthesis Research Unit, Luxembourg Institute of Health, Luxembourg. Electronic address: milad.karimi@lih.lu.
authors.forename: M
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Brazier
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Paisley
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D012945:Social Values; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Discrete choice experiment; EQ-5D; Health state valuation; Preferences; Qualitative methods; Think-aloud; Time trade off; United Kingdom