applying expectancy-value model to understand health preference an exploratory study xu-hao zhang...
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Applying Expectancy-value ModelApplying Expectancy-value Modelto understand Health Preferenceto understand Health Preference
An Exploratory StudyAn Exploratory Study
Xu-Hao ZhangXu-Hao Zhang
Department of PharmacyDepartment of Pharmacy
National University of SingaporeNational University of Singapore
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Outline of Presentation Outline of Presentation
IntroductionIntroduction
Health Preference & the Expectancy-value modelHealth Preference & the Expectancy-value model
Methods Methods
Study Design & Statistical Analysis Study Design & Statistical Analysis
Results Results
Discussion Discussion
Conclusions Conclusions
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Health PreferenceHealth Preference
Indicating people’s preference of a particular health Indicating people’s preference of a particular health statestate
Measured by Measured by RSRS (Rating Scale)(Rating Scale) / TTO / SG / TTO / SG Quantified as Quantified as utility scoresutility scores
Confined to bed Some problems washing or dressing self Unable to perform usual activities No pain or discomfort Extremely anxious or discomfort
100
0
8
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WhyWhy do we needdo we need to understand health preference?to understand health preference?
Health PreferenceHealth Preference
Utility Utility ScoresScores
Preference-based HRQoL instruments
CUA for treatment comparisons
Reported: Health preference to be associated with
different demographic backgrounds
Diseasemanagement
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HowHow can wecan we understand health preference ?understand health preference ?
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Health PreferenceHealth Preference
Health preferenceHealth preference Attitude Attitude
Expectancy Expectancy - - valuevalue model model
Subjective probability that Subjective probability that the attitude has the attributethe attitude has the attribute
Attitudinal Attributes Attitudinal Attributes
Evaluative value of Evaluative value of the attribute the attribute
External
External Variables
Variables
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Objectives of the studyObjectives of the study
To generate factors of the health preference To generate factors of the health preference
for the “for the “Expectancy-value modelExpectancy-value model” (“” (“EVMEVM”)”)
To investigate the usefulness of To investigate the usefulness of EVM EVM in in
explaining health preference explaining health preference
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Study Design Study Design
Focus group approach Focus group approach Attitudinal Attributes (AA) Attitudinal Attributes (AA)
QuestionnaireQuestionnaireDevelopment Development
Pilot studyPilot study One-to-one interview Eligible Chinese and Indian Singaporeans (aged above 20 and with over 6 yrs of education) across 5 age groups (20-29;30-39;40-49;50-59; 60+)
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Questionnaire DevelopmentQuestionnaire Development1.1. Design:Design:
Measure of health preference of the health state by a 0-100 Visual Measure of health preference of the health state by a 0-100 Visual Analogue Scale Analogue Scale (VAS)(VAS)
Expectancy and value of each attribute, measured on a Expectancy and value of each attribute, measured on a 7-point Likert Scale 7-point Likert Scale
External variables: age, gender, ethnicity, education, housing, mariExternal variables: age, gender, ethnicity, education, housing, marital status, and concurrent chronic diseasestal status, and concurrent chronic diseases
2.2. Face validity: Face validity:
Reviewed by 10 postgraduate students Reviewed by 10 postgraduate students
3.3. Finalization: Finalization:
Amended accordingly, if necessary Amended accordingly, if necessary
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Statistical AnalysisStatistical Analysis
Univariate analysis: Univariate analysis:
To identify external variable(s) to be included in EVM
Multiple linear regression models (MLR):
To investigate the explanative power of EVM by examining attitudinal attributesattitudinal attributes and significant external variables (if any) separately or in combination
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Results Results
Demographic information: Demographic information: 25 Chinese and 21 Indian Singaporeans 25 Chinese and 21 Indian Singaporeans Age: 45.0 (SD: 15.55) yearsAge: 45.0 (SD: 15.55) years 55.6% female55.6% female
Four attitudinal attributes generated:Four attitudinal attributes generated: reduction in Health-related quality of life (RQoL) reduction in Health-related quality of life (RQoL) adding a burden to family (BTF) adding a burden to family (BTF) dependence on others ( DOO) dependence on others ( DOO) inability to work or study (ITW)inability to work or study (ITW)
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Ethnicity Ethnicity to be the only external variable identified to to be the only external variable identified to cause significant difference in VAS scorecause significant difference in VAS score (p<0.05)(p<0.05)
ResultsResults
Chinese Indian Ethnicity
0
10
20
30
40
50
60
70
vas
34
36
4
20
13
16.9(11.8)6.9 (16.7)
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ResultsResults
Power of EVM in explaining health preference:Power of EVM in explaining health preference:
The combined sample
(n=46)
Chinese
(n=25)
Indians
(n=21)
EVM
(sum of 4AA, ethnicity)
0.27 * 0.13 0.24*
Sum of 4 AA 0.16 * / /
Ethnicity 0.11 * / /
Table 1. Regression analysis on EVM, AAs and ethnicity
Figures shown as adjusted R square: *p<0.05
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ResultsResults Power of each AA in explaining health preferencePower of each AA in explaining health preference
The combined sample
(n=46)
Chinese
(n=25)
Indians
(n=21)
RQol RQol 0.14 *0.14 * 0.16 *0.16 * 0.12 *0.12 *
BTFBTF 0.16 *0.16 * 0.14 *0.14 * 0.09 *0.09 *
DOODOO 0.10 *0.10 * 0.040.04 0.23 *0.23 *
ITW ITW 0.07 *0.07 * 0.09*0.09* 0.0030.003
Table 2. Regression analysis on each AA
Figures shown as adjusted R square; The scores of 4 AAs are not statistically different for two ethnic groups; *: p<0.05
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DiscussionDiscussion
Significance of the study Significance of the study the 1st ever to investigate factors influencing health preferencethe 1st ever to investigate factors influencing health preference
from the psychological angle from the psychological angle demonstrating usefulness of EVM in explaining health preferencedemonstrating usefulness of EVM in explaining health preference providing justification of its application to other populations to providing justification of its application to other populations to
enable comparisonsenable comparisons
Limitations Limitations Small sample sizeSmall sample size generalization of the result generalization of the result х
Studies with larger sample size are suggested to verify the results Studies with larger sample size are suggested to verify the results
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The Expectancy-value model is helpful The Expectancy-value model is helpful in explaining the variances in health in explaining the variances in health preference. preference.
Future studies with larger sample sizes Future studies with larger sample sizes and among other populations are and among other populations are suggested for its further verifications.suggested for its further verifications.
ConclusionsConclusions
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Thank You !Thank You !