title: Prioritising wheelchair services for children: a pilot discrete choice experiment to understand how child wheelchair users and their parents prioritise different attributes of wheelchair services.
abstract: BACKGROUND
  Approximately 95 million children worldwide are disabled; 10 % use a wheelchair. In the UK, an estimated 770,000 children are disabled. National Health Service Wheelchair Services are the largest provider of wheelchairs in the UK; however, recent reports have highlighted issues with these services. This study explores the use of discrete choice experiment methods to inform wheelchair service provision for disabled children based on service user preferences. The aim was to explore how disabled children and their parents prioritise different attributes of wheelchair services. The secondary aims were to compare priorities between parents and disabled children and to explore marginal rate of substitution for incremental changes in attributes.
  
  
  METHODS
  Discrete choice experiments are a method of attribute-based stated preference valuation used by health economists to understand how individuals prioritise different attributes of healthcare services and treatments. We conducted the first pilot discrete choice experiment to explore how disabled children (aged 11 to 18) and their parents prioritise different attributes of hypothetical wheelchair services. Eleven disabled children (aged 11 to 18) and 30 parents of disabled children completed eight pairwise choice tasks based on five service attributes: wheelchair assessment, cost contribution, training, delivery time and frequency of review. Data were analysed using conditional logistic regression. For each pairwise choice, the participants were asked to choose which service scenario (A or B) they preferred.
  
  
  RESULTS
  Comprehensiveness of wheelchair assessment and wheelchair delivery time significantly (P< 0.05) affected service preferences of children (β-coefficients = 1.43 [95 % bootstrapped CI = 1.42 to 2.08] and -0.92 [95 % bootstrapped CI = -1.41 to -0.84], respectively) and parents (β-coefficients = 1.53 [95 % bootstrapped CI = 1.45 to 2.16] and -1.37 [95 % bootstrapped CI = -1.99 to -1.31], respectively). Parents were willing to contribute more financially to receive preferred services, although this was non-significant.
  
  
  CONCLUSIONS
  Both samples placed the greatest importance on holistic wheelchair assessments encompassing more than health. The National Health Service should consider using discrete choice experiment methods to examine wheelchair service preferences of disabled children (aged 11 and over) and their parents on a wider scale; however, care must be taken to ensure that this method is used appropriately.
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bray
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK.
authors.forename: Seow Tien
authors.initials: ST
authors.lastname: Yeo
authors.affiliation: School of Social Sciences, Bangor University, Neuadd Ogwen, Bangor, Gwynedd LL57 2DG UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.affiliation: DesignAbility, Bath Institute of Medical Engineering, The Wolfson Centre, Royal United Hospital, Bath, BA1 3NG UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Harris
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK.
authors.forename: Rhiannon Tudor
authors.initials: RT
authors.lastname: Edwards
keywords: Assistive technology; Childhood disability; Conjoint analysis; Discrete choice experiment; Health economics; Wheelchair