The Effect of Reflection and Deliberation on Health State Values: A Mixed-Methods Study

• Published in: Value in health Vol. 22; no. 11; pp. 1311 - 1317
• Main Authors: Karimi, Milad, Brazier, John, Paisley, Suzy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019; Elsevier Science Ltd
• Subjects: deliberation; Economists; Health economics; health state valuation; Internal Medicine; MCDA; mixed methods; Mixed methods research; Preferences; Quantitative analysis; Questionnaires; reflection; Valuation; United Kingdom > UK; mixed methods; reflection; health state valuation; deliberation; MCDA
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2019.07.013

AbstractBackgroundHealth economists ask members of the general public to value health states, but it is recognized that individuals construct their preferences during the valuation tasks. Conventional methods rely on one-off interviews that do not give participants time to reflect and deliberate on their preferences. ObjectiveThis study investigates the effect of reflection and deliberation on health state preferences using the EQ-5D questionnaire and time trade-off valuation method. MethodsA novel concurrent explanatory mixed-methods design is used to investigate the explanation for the quantitative findings. ResultsA total of 57 participants in the United Kingdom valued health states before and after a group-based deliberation exercise. There were large changes in health state values at the individual level, but the changes canceled out at the aggregate level. The mixed-methods findings suggest deliberation did not reveal new information or reduce inconsistencies in reasoning but rather focused on an exchange of personal subjective beliefs. In cases of disagreement, the participants accepted but did not adopt other participants' opinions. Participants remained uncertain about the relevance of their experiences and about their values. ConclusionsThe evidence suggests that reflection and deliberation, as designed in this study, are unlikely to result in large systematic changes of health state values. The uncertainties expressed by participants means future research should investigate whether preferences are informed or whether providing participants with more information helps them construct their preferences with more certainty. The mixed-methods design used is a promising design to help elucidate the reasons for quantitative findings.