Article Text

Original research
Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment
  1. Sarah EG Moor1,
  2. Andrew K Tusubira2,
  3. Dallas Wood3,
  4. Ann R Akiteng2,
  5. Deron Galusha4,
  6. Baylah Tessier-Sherman4,
  7. Evelyn Hsieh Donroe5,6,
  8. Christine Ngaruiya6,7,
  9. Tracy L Rabin2,5,6,
  10. Nicola L Hawley6,8,
  11. Mari Armstrong-Hough9,
  12. Brenda D Nakirya10,
  13. Rachel Nugent11,
  14. Robert Kalyesubula12,13,
  15. Christine Nalwadda14,
  16. Isaac Ssinabulya2,13,
  17. Jeremy I Schwartz2,4,5,6
  1. 1Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
  3. 3Center for Applied Economics and Strategy, RTI International, Research Triangle Park, North Carolina, USA
  4. 4Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
  5. 5Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  6. 6Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
  7. 7Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  8. 8Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
  9. 9Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
  10. 10Community Concerns Uganda Initiative, Jinja, Uganda
  11. 11Global Non-Communicable Diseases, RTI International, Seattle, Washington, USA
  12. 12African Community for Social Sustainability, Nakaseke, Uganda
  13. 13Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
  14. 14Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
  1. Correspondence to Sarah EG Moor; sarah.moor{at}yale.edu

Abstract

Objective To explore how respondents with common chronic conditions—hypertension (HTN) and diabetes mellitus (DM)—make healthcare-seeking decisions.

Setting Three health facilities in Nakaseke District, Uganda.

Design Discrete choice experiment (DCE).

Participants 496 adults with HTN and/or DM.

Main outcome measures Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility.

Results Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal.

Conclusions Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.

  • Hypertension
  • DIABETES & ENDOCRINOLOGY
  • International health services

Data availability statement

Data are available upon reasonable request. All data requests should be submitted to the corresponding author for consideration. Access to anonymised data may be granted following review. Data will be shared, with investigator support, after approval of a proposal, with a signed data access agreement.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available upon reasonable request. All data requests should be submitted to the corresponding author for consideration. Access to anonymised data may be granted following review. Data will be shared, with investigator support, after approval of a proposal, with a signed data access agreement.

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Footnotes

  • Twitter @c_ngaruiya, @rachelnugent, @jeremy_schwartz

  • Contributors SEGM, JIS, MA-H contributed to concept development. SEGM, AKT, ARK performed data collection. SEGM, AKT, and BDN performed the qualitative analysis. SEGM, AKT, ARK, EHD, CN, TR, NLH, MA-H, RN, RK, CNK, IS, and JIS contributed to development of DCE tool. DG and BT-S performed statistical analysis and interpretation of results. DW performed additional and confirmatory statistical analysis, guided interpretation, and addressed reviewer comments. SEGM prepared the draft manuscript. All authors commented on the draft manuscript and approved the final manuscript for submission. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. JIS is the guarantor for this work.

  • Funding Funding for this project was provided by the Wilbur G. Downs International Health Student Travel Fellowship and Yale Institute for Global Health Hecht Global Health Faculty Network Award. EHD is supported by NIH/Fogarty International Center K01TW009995.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.