A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care
- 203 Downloads
Consideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services.
This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework.
Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis.
Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE.
The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data.
The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients.
Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.
KeywordsFocus Group Mental Health Service Choice Task Conjoint Analytic Importance Score
The authors would like to acknowledge the partnership of the Sunset Community Health Center in carrying out this research, and the Sunset Community Health Workers who participated in research activities.
Compliance with Ethical Standards
This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Pilot Project Program award (1IP2PI000275-01). The participation of Dr. Cunningham and Ms. Rimas was supported by the Jack Laidlaw Chair in Patient-Centered Health Care. Lucy Murrieta is an employee of the FQHC that was the subject of this research. With the exception of Ms. Murrieta’s employment status, all authors declare that they have no conflicts of interest, financial or otherwise, with respect to this research. Our study received exempt approval from the University of Arizona Institutional Review Board. Informed consent was obtained from all individual participants included in this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
- 1.Croghan TW, Brown JD. Integrating mental health treatment into the patient-centered medical home. Rockville (MD): Mathematical Policy Research; 2009.Google Scholar
- 3.Caldwell A, Couture A, Nowotny H. Closing the mental health gap: eliminating disparities in treatment for Latinos. Kansas City: Mattie Rhodes Center; 2008.Google Scholar
- 5.Surgeon General. Mental health: culture, race, ethnicity. A supplement to mental health: a report of the Surgeon General. Washington, DC: US Department of Health and Human Services; 2001.Google Scholar
- 10.Institute of Medicine. Crossing the quality chasm: a new health system for the twenty-first century. Washington, DC: National Academies Press; 2001.Google Scholar
- 11.Agency for Healthcare Research and Quality. Chapter 5. Patient centeredness: national healthcare disparities report, 2010. Rockville : Agency for Healthcare Research and Quality; 2014.Google Scholar
- 27.Orme BK. Getting started with conjoint analysis: strategies for product design and pricing research. 2nd ed. Madison: Research Publishers; 2010.Google Scholar
- 32.Bridges J, Onukwugha E, Johnson F, Hauber A. Patient preference methods: a patient centered evaluation paradigm. ISPOR Connect. 2007;13(6):4–7.Google Scholar
- 36.Ingram M, Schachter KA, Guernsey de Zapien J, Herman PM, Carvajal SC. Using participatory methods to enhance patient-centred mental health care in a federally qualified community health center serving a Mexican American farmworker community. Health Expect. doi: 10.1111/hex.12284 (Epub 10 Oct 2014).
- 37.Bergold J, Thomas S. Participatory research methods: a methodological approach in motion. FORUM: Qual Soc Res. 2012;13(1):30.Google Scholar
- 42.Sawtooth Software I. The CBC/HB system for hierarchical Bayes estimation version 5.0 technical paper. Sequim: Sawtooth Software, Inc.; 2009.Google Scholar
- 44.Orme BK. SSI Web V6.6 software for web interviewing and conjoint analysis. Sequim: Sawtooth Software, Inc.; 2009.Google Scholar
- 45.Orme B, Huber J. Improving the value of conjoint simulations. Mark Res. 2000;12(4):12–20.Google Scholar
- 47.Herman PM, Ingram M, Rimas H, Carvajal S, Cunningham CE. Patient preferences of a low-income Hispanic population for mental health services in primary care. Adm Policy Ment Health (Epub 26 Sep 2015).Google Scholar
- 48.Carvajal SC, Rosales C, Rubio-Goldsmith R, Sabo S, Ingram M, McClelland DJ, et al. The border community and immigration stress scale: a preliminary examination of a community responsive measure in two southwest samples. J Immigr Minor Health. 2013;15(2):427–36.CrossRefPubMedPubMedCentralGoogle Scholar