Email updates

Keep up to date with the latest news and content from BMC Pregnancy and Childbirth and BioMed Central.

Open Access Research article

Obstetrical outcome valuations by patients, professionals, and laypersons: differences within and between groups using three valuation methods

Denise Bijlenga1*, Erwin Birnie2, Ben WJ Mol3 and Gouke J Bonsel4

Author Affiliations

1 Dept. of Social Medicine, Academic Medical Centre - University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands

2 Institute of Health Policy and Management, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands

3 Dept. of Obstetrics and Gynecology, Academic Medical Centre - University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands

4 Institute of Health Policy and Management, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands

For all author emails, please log on.

BMC Pregnancy and Childbirth 2011, 11:93  doi:10.1186/1471-2393-11-93

Published: 12 November 2011

Abstract

Background

Decision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people's preferences. We compared valuations assigned by three groups: patients, obstetrical care professionals, and laypersons, for health states involving both mother and (unborn) child. Our aim was to compare the valuations of different groups using different valuation methods and complex obstetric health outcome vignettes that involve both maternal and neonatal outcomes.

Methods

Patients (n = 24), professionals (n = 30), and laypersons (n = 27) valued the vignettes using three valuation methods: visual analogue scale (VAS), time trade-off (TTO), and discrete choice experimentation (DCE). Each vignette covered five health attributes: maternal health ante partum, time between diagnosis and delivery, process of delivery, maternal outcome, and neonatal outcome. We used feasibility questionnaires, Generalization theory, test-retest reliability and within-group reliability to compare the valuation patterns between groups and methods. We assessed relative weights from each valuation method to test for consistency across groups.

Results

Test-retest reliability was equal across groups, but different across methods: highest for VAS (ICC = 0.61-0.73), intermediate for TTO (ICC = 0.24-0.74) and lowest for DCE (kappa = 0.15-0.37). Within-group reliability was highest in all groups with VAS (ICC = 0.70-0.73), intermediate with DCE (kappa = 0.56-0.76) and lowest with TTO (ICC = 0.20-0.66). Effects of groups were smaller than effects of methods. Differences between groups were largest for severe health states.

Conclusion

Based on our results, decision making among laypersons should use TTO or DCE; patients should use VAS or TTO.

Keywords:
health outcome valuation; preference; vignettes; psychometrics; pregnancy; obstetrics