[show abstract][hide abstract] ABSTRACT: Schools are sometimes slow to adopt evidence-based strategies for improving the mental health outcomes of students. This study used a discrete-choice conjoint experiment to model factors influencing the decision of educators to adopt strategies for improving children’s mental health outcomes. A sample of 1,010 educators made choices between hypothetical mental health practice change strategies composed by systematically varying the four levels of 16 practice change attributes. Latent class analysis yielded two segments with different practice change preferences. Both segments preferred small-group workshops, conducted by engaging experts, teaching skills applicable to all students. Participants expressed little interest in Internet options. The support of colleagues, administrators, and unions exerted a strong influence on the practice change choices of both segments. The Change Ready segment, 77.1 % of the sample, was more intent on adopting new strategies to improve the mental health of students. They preferred that schools, rather than the provincial ministry of education, make practice change decisions, coaching was provided to all participants, and participants received post-training follow-up sessions. The Demand Sensitive segment (22.9 %) was less intent on practice change. They preferred that individual teachers make practice change decisions, recommended discretionary coaching, and chose no post-training follow-up support. This study emphasizes the complex social, organizational, and policy context within which educators make practice change decisions. Efforts to disseminate strategies to improve the mental health outcomes of students need to be informed by the preferences of segments of educators who are sensitive to different dimensions of the practice change process. In the absence of a broad consensus of educators, administrators, and unions, potentially successful practice changes are unlikely to be adopted.
[show abstract][hide abstract] ABSTRACT: Although most young adults with mood and anxiety disorders do not seek treatment, those who are better informed about mental health problems are more likely to use services. The authors used conjoint analysis to model strategies for providing information about anxiety and depression to young adults. Participants (N = 1,035) completed 17 choice tasks presenting combinations of 15 four-level attributes of a mental health information strategy. Latent class analysis yielded 3 segments. The virtual segment (28.7%) preferred working independently on the Internet to obtain information recommended by young adults who had experienced anxiety or depression. Self-assessment options and links to service providers were more important to this segment. Conventional participants (30.1%) preferred books or pamphlets recommended by a doctor, endorsed by mental health professionals, and used with a doctor's support. They would devote more time to information acquisition but were less likely to use Internet social networking options. Brief sources of information were more important to the low interest segment (41.2%). All segments preferred information about alternative ways to reduce anxiety or depression rather than psychological approaches or medication. Maximizing the use of information requires active and passive approaches delivered through old-media (e.g., books) and new-media (e.g., Internet) channels.
Journal of Health Communication 11/2013; · 1.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Parents seeking help for children with mental health problems are often assigned to a waiting list. We used a discrete choice conjoint experiment to model preferences for interim services that might be used while waiting for the formal assessment and treatment process to begin. A sample of 1,059 parents (92 % mothers) seeking mental health services for 4 to 16 year olds chose between hypothetical interim services composed by experimentally varying combinations of the levels of 13 interim service attributes. Latent Class analysis yielded a four-segment solution. All segments preferred interim options helping them understand how agencies work, enhancing their parenting knowledge and skill, and providing an opportunity to understand or begin dealing with their own difficulties. The Group Contact segment (35.1 %) preferred interim services in meetings with other parents, supported by phone contacts, frequent checkup calls, and wait-time updates. Virtual Contact parents (29.2 %) preferred to meet other parents in small internet chat groups supported by e-mail contact. Membership in this segment was linked to higher education and computer skills. Frequent Contact parents (24.4 %) preferred face-to-face interim services supported by weekly progress checks and wait time updates. Limited Contact parents (11.3 %) were less intent on using interim services. They preferred to pursue interim services alone, with contacts by phone, supported by fewer check-up calls and less frequent wait time updates. All segments were more likely to enroll in interim services involving their child.
Journal of Abnormal Child Psychology 02/2013; · 3.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Patients value health service teams that function effectively. Organizational justice is linked to the performance, health, and emotional adjustment of the members of these teams. OBJECTIVES: We used a discrete-choice conjoint experiment to study the organizational justice improvement preferences of pediatric health service providers. METHODS: Using themes from a focus group with 22 staff, we composed 14 four-level organizational justice improvement attributes. A sample of 652 staff (76 % return) completed 30 choice tasks, each presenting three hospitals defined by experimentally varying the attribute levels. RESULTS: Latent class analysis yielded three segments. Procedural justice attributes were more important to the Decision Sensitive segment, 50.6 % of the sample. They preferred to contribute to and understand how all decisions were made and expected management to act promptly on more staff suggestions. Interactional justice attributes were more important to the Conduct Sensitive segment (38.5 %). A universal code of respectful conduct, consequences encouraging respectful interaction, and management's response when staff disagreed with them were more important to this segment. Distributive justice attributes were more important to the Benefit Sensitive segment, 10.9 % of the sample. Simulations predicted that, while Decision Sensitive (74.9 %) participants preferred procedural justice improvements, Conduct (74.6 %) and Benefit Sensitive (50.3 %) participants preferred interactional justice improvements. Overall, 97.4 % of participants would prefer an approach combining procedural and interactional justice improvements. CONCLUSIONS: Efforts to create the health service environments that patients value need to be comprehensive enough to address the preferences of segments of staff who are sensitive to different dimensions of organizational justice.
[show abstract][hide abstract] ABSTRACT: Indirect bullying occurs frequently yet receives little attention by teachers. Using conjoint analysis, we examined the influence of situational attributes on teachers' decisions to intervene in indirect bullying. Results revealed that teachers (N = 235) were most influenced by victimized children's distress. Additional analyses identified two subgroups that differed in terms of degree of influence: protective teachers (61%) who were highly influenced by victimized children's distress and by physical aspects of bullying, and contextually sensitive teachers (39%) who considered relatively more situational attributes and showed more sensitivity to indirect bullying. These findings indicate that teachers could benefit from professional development that sensitizes them to the psychosocial and health risks to children who bully and to children who are victims of indirect bullying.
Journal of School Violence 01/2012; 11(3):226-245.
[show abstract][hide abstract] ABSTRACT: The current study examined treatment preferences of 183 parents of young (average age = 5.8 years, SD = 0.6), medication naive children with ADHD. Preferences were evaluated using a discrete choice experiment in which parents made choices between different combinations of treatment characteristics, outcomes, and costs. Latent class analysis yielded two segments of parents: (a) medication avoidant parents constituted 70.5% of the sample whose treatment decisions were strongly influenced by a desire to avoid medication, and (b) outcome oriented parents constituted 29.5% of the sample whose treatment decisions were most influenced by a desire for positive treatment outcomes. Parents in the outcome oriented segment were more stressed and depressed, had lower socioeconomic status and education, were more likely to be single parents, and had more disruptive and impaired children. Simulations predicted that parents would prefer treatments with behavior therapy over treatments with stimulant medication only.
[show abstract][hide abstract] ABSTRACT: We used discrete choice conjoint analysis to model the ways 645 children's mental health (CMH) professionals preferred to provide information to parents seeking CMH services. Participants completed 20 choice tasks presenting experimentally varied combinations of the study's 14 4-level CMH information transfer attributes. Latent class analysis revealed three segments. Open Access professionals (32.2%) preferred that intake workers automatically provide all parents with CMH information. They preferred information prepared by professional organizations and located at accessible settings such as public schools. They responded favorably to the internet as a source of information for parents. Controlled Access professionals (22.2%) preferred information that was approved and recommended by a child's therapist, prepared by an experienced clinician, and located at hospitals and CMH clinics. Process Sensitive professionals (45.6%) showed a stronger preference for active learning materials with parenting groups and therapist "coaching" calls supporting the knowledge transfer process. Simulations suggested that realizing the benefits of CMH information requires the development of knowledge transfer strategies that align the preferences of professionals with those of the families they serve.
[show abstract][hide abstract] ABSTRACT: We used discrete choice conjoint analysis to model the bullying prevention program preferences of educators. Using themes from computerized decision support lab focus groups (n = 45 educators), we composed 20 three-level bullying prevention program design attributes. Each of 1,176 educators completed 25 choice tasks presenting experimentally varied combinations of the study's attribute levels. Latent class analysis yielded three segments with different preferences. Decision Sensitive educators (31%) preferred that individual schools select bullying prevention programs. In contrast, Support Sensitive educators (51%) preferred that local school boards chose bullying prevention programs. This segment preferred more logistical and social support at every stage of the adoption, training, implementation, and long term maintenance processes. Cost Sensitive educators (16%) showed a stronger preference for programs minimizing costs, training, and implementation time demands. They felt prevention programs were less effective and that the time and space in the curriculum for bullying prevention was less adequate. They were less likely to believe that bullying prevention was their responsibility and more likely to agree that prevention was the responsibility of parents. All segments preferred programs supported by the anecdotal reports of colleagues from other schools rather than those based on scientific evidence. To ensure that the bullying prevention options available reflect the complex combination of attributes influencing real world adoption decisions, program developers need to accommodate the differing views of the Decision, Support, and Cost Sensitive segments while maximizing the support of parents and students.
[show abstract][hide abstract] ABSTRACT: A consensus regarding the components of a patient-centered approach to healthcare does not exist. Although patient-centered care should be predicated on patient preferences, existing models provide little evidence regarding the relative importance of different care processes to patients themselves.
To involve patients in the design of a model of patient-centered care for a corporation of Canadian teaching hospitals.
Using themes from focus groups and interviews, a conjoint survey was developed comprising 14 four-level patient-centered care attributes. Sawtooth Software's Choice Based Conjoint module (version 2.6.7) was used to design the survey. Each participant completed 15 choice tasks, each task presenting a choice between three hospitals described by a different combination of patient-centered care attribute levels. Latent class analysis was used to identify segments of participants with similar patient-centered care choice patterns. Randomized First Choice simulations were used to predict the percentage of participants in each segment who would choose different approaches to improving patient-centered care.Representative hospital service users were recruited from a corporation of five Canadian teaching hospitals serving a regional population of 2.2 million.
A total of 508 patients and family members of children completed a choice-based conjoint survey. Latent class analysis revealed two segments: an informed care segment and a convenient care segment. Participants in the informed care segment (71.3% of the sample) were more likely to have higher education, be non-immigrants, speak English as a first language, and be outpatients or family members.The information needed to understand health concerns, an opportunity to learn health improvement skills, teams that communicated effectively, short waiting times, and collaborative treatment planning were more important to the informed care segment than to the convenient care segment. Convenient settings, a welcoming environment, and ease of internal access exerted a greater influence on the choices made by the convenient care segment. Both segments preferred hospitals that provided health information and gave prompt feedback on patient progress.
This study suggests that many patients would exchange an increase in waiting times for prompt feedback, information, and the skills to improve their health.
The patient 12/2008; 1(4):317-30. · 1.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although materials informing parents about children's mental health (CMH) problems can improve outcomes, we know relatively little about the design factors that might influence their utilization of available resources. We used a discrete choice conjoint experiment to model the information preferences of parents seeking mental health services for 6 to 18 year olds. Parents completed 30 choice tasks presenting experimentally varied combinations of 20 four-level CMH information content, transfer process, and outcome attributes. Latent class analysis revealed three segments with different preferences. Parents in the Action segment (43%) chose materials providing step-by-step solutions to behavioral or emotional problems. They preferred weekly meetings with other parents and coaching calls from a therapist. The Information segment (41%) chose materials helping them understand rather than solve their child's problems. These parents were more sensitive to logistical factors such as receiving information in groups, the location where information was available, the modality in which the information was presented, and the time required to obtain and use the information. The Overwhelmed segment (16%) reported more oppositional and conduct problems, felt their children's difficulties exerted a greater adverse impact on family functioning, and reported higher personal depression scores than those in the Action or Information segments. Nonetheless, they did not choose information about, or solutions to, the problems their children presented. Simulations predicted that maximizing utilization and realizing the potential benefits of CMH information would require knowledge transfer strategies consistent with each segment's preferences.
[show abstract][hide abstract] ABSTRACT: To use methods from the field of marketing research to involve students in the redesign of McMaster University's small group, problem-based undergraduate medical education program.
We used themes from a focus group conducted in an electronic decision support lab to compose 14 four-level educational attributes. Undergraduate medical students completed a discrete choice experiment composed of 15 web-administered, partial-profile, conjoint-choice tasks.
Latent class analysis revealed two segments with different preferences. Segment 1, (86% of students), preferred a problem-based approach with more small group tutorial sessions led by expert tutors who facilitated the tutorial process without teaching didactically. Segment 2, (14% of students), preferred more large group lectures, explicit learning objectives, expert tutors who taught didactically, and streaming options based on learning preferences. Although Segment 1 preferred smaller tutorial groups, simulations predicted these students would trade increases in tutorial group size for a conceptually integrated program that included tutorial problems based on core curriculum concepts, greater integration of the content of clinical skills training sessions and the tutorial curriculum, and a link between clerkship patient selection and the program's curriculum. A majority of both segments would accept a more conceptually integrated program if the savings associated with increases in tutorial group size was reinvested in web-enhanced tutorial processes and computer-simulated health care problems.
Most students preferred a small group, web-supported, problem-based learning approach led by content experts who facilitated group process. Students favored a program in which tutorial group problems, clinical skills training sessions and the patients selected for clerkship activities were more closely linked to core curriculum concepts.
Advances in Health Sciences Education 09/2006; 11(3):245-66. · 2.06 Impact Factor