A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care

Published in: The Patient - Patient-Centered Outcomes Research, v. 9, no. 4, Aug. 2016, p. 293-301

Posted on RAND.org on July 14, 2016

by Patricia M. Herman, Maia Ingram, Charles E. Cunningham, Heather Rimas, Lucy Murrieta, Ken A. Schachter, Jill de Zapien, Scott Carvajal

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Research Question

  1. Can a consumer-products design method help to reveal patient preferences for delivery of mental health services to low-income Hispanics?

Background

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.

Objectives

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.

Research Design

Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis.

Subjects

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.

Measures

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.

Results

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.

Conclusions

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.

Key Finding

  • A consumer-products design method can be used by an academic/federally-qualified health center within a community-based participatory research framework to improve the package of mental health services provided to low-income Hispanics.

Recommendation

The additional resources required to implement this method may only be justified in a larger health care system.

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