Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 23, 2022
Date Accepted: Apr 25, 2023
Public Preference Heterogeneity and Predicted Uptake of Upper Gastrointestinal Cancer Screening Programs in rural China: Discrete Choice Experiments and Latent Class Analysis
ABSTRACT
Background:
The low uptake rate of upper gastrointestinal cancer (UGC) screening remains a major public health challenge worldwide.
Objective:
The objective of this study was to determine what characteristics influence the residents’ preference heterogeneity for a UGC screening program and to assess to what extent these characteristics predict residents’ participation rates.
Methods:
A discrete choice experiment (DCE) was conducted in 1000 subjects aged 40-69 years who were randomly selected from three countries of Shandong province in China. Each respondent was repeatedly asked to make a choice from 9 screening scenarios comprised with screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model (LCL) was used to estimate residents’ preference heterogeneity when selecting the UGC screening programs.
Results:
The best model contained four latent classes of respondents, defined by different preferences for the five attributes. In the four-class model, 88 (9.50%) residents were assigned to class 1, 216 (23.33%) residents to class 2, 434 (46.89%) residents to class 3, 188 (20.30%n) residents to class 4. All residents in different classes have different preferences for the five selected attributes, except for painless endoscopy. Their participation rate could increase 89% and above (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow up, 45% mortality reduction, every year, and painless endoscopy was implemented.
Conclusions:
Public preference heterogeneity for UGC screening does exists, and this heterogeneity was explored and analyzed in this study. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes including screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. Policy makers should take these heterogeneities into account to formulate UGC screening programs with high uptake.
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