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Using Best–Worst Scaling to Measure Caregiver Preferences for Managing their Child’s ADHD: A Pilot Study

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Abstract

Background

Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers’ concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers.

Objective

The aim was to develop and to pilot an instrument to elicit caregivers’ preferences for evidence-based management of their child’s ADHD.

Methods

Mixed methods were used to develop a Best–Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals.

Results

Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child’s ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication.

Conclusions

The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child’s ADHD.

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Acknowledgments

The authors are indebted to Ms. Bev Butler, Ms. Jane Walker, and Ms. Angela Vaughn-Lee for their support, advice, and assistance with this project; without their support this work would not be possible. The authors are grateful to Sarah Brant for assisting with the family support meetings and with the instrument development and to Osler Andres for his help with the survey pilot. Dr. Susan dosReis conceptualized the study, collected research data, interpreted the research results, wrote the manuscript, and has no conflicts to disclose. Ms. Xinyi Ng assisted with the study conceptualization and the data collection, analyzed and interpreted the data, contributed to the writing and editing of the manuscript, and has no conflicts to disclose. Dr. Emily Frosch contributed to the conceptualization of the study, the interpretation of the findings, the review and edits to the manuscript, and has no conflicts to disclose. Dr. Gloria Reeves contributed to the conceptualization of the study, the interpretation of the findings, the review and edits to the manuscript, and has no conflicts of interest. Dr. Charles Cunningham assisted with the identification of the attributes, conceptualized the study design, and reviewed and edited the manuscript. Dr. Cunningham has conducted workshops on COPE, a parenting program for families of children with externalizing problems. Dr. John Bridges assisted with the conceptualization of the study, the development of the attributes, created the BWS instrument design, led the data analysis and interpretation, reviewed and edited the manuscript, and has no conflicts to disclose. Dr. Susan dosReis, the principal author, serves as the overall guarantor for this work.

Funding source

This research was funded by the National Institute of Mental Health (R43-MH093502; PI: dosReis). Dr. Cunningham’s participation was supported by the Jack Laidlaw Chair in Patient-Centered Health Care.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA

    Susan dosReis & Xinyi Ng

  2. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Emily Frosch

  3. University of Maryland School of Medicine, Baltimore, MD, USA

    Gloria Reeves

  4. McMaster University, Hamilton, ON, Canada

    Charles Cunningham

  5. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

Authors
  1. Susan dosReis
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  2. Xinyi Ng
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  4. Gloria Reeves
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  5. Charles Cunningham
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  6. John F. P. Bridges
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Corresponding author

Correspondence to Susan dosReis.

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dosReis, S., Ng, X., Frosch, E. et al. Using Best–Worst Scaling to Measure Caregiver Preferences for Managing their Child’s ADHD: A Pilot Study. Patient 8, 423–431 (2015). https://doi.org/10.1007/s40271-014-0098-4

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