gamble (SG); time off (TTO); the visual analogue scale (VAS). These 3 approaches to the elicitation of utilities will now be outlined and a brief overview of their advantages and disadvantages is provided. Standard Gamble The SG methodology varies slightly depending on whether the health states being valued are chronic or temporary, and whether they are states worse or better than death (Drummond, 2005). The methodology for valuing chronic health states is described below. The SG methodology for the valuation of health states better than death is shown in Figure 2. Individuals are presented with two alternatives: (where time = 10 years) Alternative 1: A certain immediate outcome (health statej) for 10 years. Alternative 2: The uncertainty of a gamble with 2 possible outcomes: Either the patient is returned to perfect health and lives for an additional 10 years (probability P), or they die immediately (probability
services can be described by their attributes, and that an individual’s valuation of the intervention or service is based on the level of the attributes (Ryan, 2004). Discussion Despite the development of alternative techniques, SG, TTO and the VAS remain the 3 most commonly used methods for eliciting preferences for health states. Out of these 3, health economists recommend the use of the SG and TTO approaches (Brazier et al. 1999). Although the most complex to complete, SG is seen by some as the method of utility elicitation (Drummond, 2005). This is due to its foundation in expected utility theory (EUT) which provides a framework for how individuals make decisions under uncertainty (Von Neumann & Morgenstern, 1944). EUT states that individuals aim to maximise utility, and choose between uncertain outcomes by comparing the expected utility values of these outcomes, multiplied by the probability of receiving the outcome. The existence of both risk and uncertainty in decision making when using SG is said to reflect the risk and uncertainty experienced when receiving health care (Brazier et al. 2007). Others however dispute this, and suggest that SG results violate the axioms of expected utility as individuals responses are also influenced by factors such as risk attitude, gambling effects and loss aversion (Green et al. 2000). For
On completion of the questionnaire the patient receives a results summary. This contains results for each of the 4 dimensions and provides scores for the symptoms within each domain and scores reflecting the impact these symptoms have on the patient’s life. The impact scores are presented as a clock face where an empty circle represents “not a problem”, 1/3 circle represents “a bit of a problem”, 2/3 circle represents “quite a problem” and a complete circle represents “a serious problem”. Patients can click on this impact score and obtain more information relevant to that domain. A more detailed report on each specific domain can also be printed from the responses reporting specific results for each question answered (). ePAQ was developed with the aim of creating an assessment tool for symptoms and quality of life related to bowel, bladder, vaginal and sexual function in women. The aim of the tool is to provide a comprehensive summary of a patient’s present condition which can be used to aid in the clinical process (Jones et al. 2008). Example of an ePAQ bothersome question. The Rationale for the ePAQ EEACT. The ePAQ-pelvic floor questionnaire is currently administered to all patients attending the urogynaecology department in advance of their clinic
appointment 23.3 minutes Gynaecology OP Outpatient visit 141.00 NHS Reference costs NHS trusts and PCTs combined consultation led: follow up attendance non-admitted face to face. Service code 502. Cost per day off work Day 88 ONS 2011 Based on 2011 Annual Survey of hours and earnings. Computer cost in group 2 (control) per patient 0.25 Personal from STH (SR) Assuming 2 touchscreen computers costing 1,000 per computer; average number of completions 1,000; computers replaced every 8 years. Annuity factor of 6.874. Cost of software per patient 2.40 Personal from STH (SR) Based on annual software cost of £2,400; average number of completions 1,000 per year. 11
Consultant cost in group 1 (intervention) – including OH per patient 29.35 study - Consultant cost group 2 (control) – including OH per patient 69.52 study - Genital prolapse or incontinence Per elective inpatient episode 1,741 HRG MB02Z - Hysterectomy Per elective inpatient episode 3,346 HRG MA02Z - Bladder repair/bladder surgery Per elective inpatient episode 1,958 HRG MA04B - costing
Baseline characteristics of women in each trial arm. Characteristic Intervention (n = 98) Control (n = 97) n Mean SD n Mean SD Mean age in years 95 51.51 11.20 97 50.96 10.63 Mean number of 95 2.17 1.16 97 2.29 1.15 Mean weight (Kg) 91 71.44 12.80 93 70.39 13.44 n % n % Ethnic Origin White British n (%) White Irish White Other Mixed Race Not reported 90 1 3 1 3 91.8 % 1.0 % 3.1 % 1.0 % 3.1 % - 95 1 0 1 0 97.9 % 1.0 % 0.0 % 1.0 % 0.0 % - Education level n (%) None Junior school Senior School University Not reported 15 30 23 26 1 4 15.3 % 30.6 % 23.5 % 26.5 % 1.0 % 4.1% 17 26 27 27 0 17.5 % 26.8 % 27.8 % 27.8 % 0.0% 0.0%
Personal expenditure in 6 month follow-up period (£) 74 27.944 (53.207) 73 15.503 (27.666) 12.441 -1.395 26.294 .078 Time off work (days) 70 3.09 0 (12.473) 78 5.210 (20.763) -2.119 -7.763 3.525 .459 Time away from normal activities 74 2.410 (8.039) 79 1.290 (6.752) 1.114 -1.252 3.480 .354
2014; Gomes et al. 2012); which led to 70 imputations being used. Costs and change in QALYs from baseline were jointly imputed using patient age, and parity and treatment group as explanatory imputation variables. The imputation was performed by treatment group for all imputed variables except baseline utility. Imputation of baseline utility was performed across all observations rather than specified by treatment group. The MI process generates the imputed data by using the Multiple Imputation Chained Equation (MICE) with Predictive Mean Matching (PMM) method (Faria et al. 2014). This model generated imputed values by prediction of missing data from the posterior distribution of missing observations given the values of observed data from the imputation variables. The SUR was then undertaken across the 70 resultant datasets in order to take account of the uncertainty in the imputed values, but in a way that recognises that the datasets do not represent independent observations. Likewise, the cost-effectiveness confidence ellipses and cost-effectiveness acceptability curves (CEAC) were generated (parametrically) using means, correlations and standard errors generated from the output of the SUR estimated across the 70 datasets (Hoch et al. 2002). Five parameters were used in this analysis: the difference in mean total cost, standard error of the difference in mean total cost, difference in mean QALYs, standard error of the difference in mean QALYs and the covariance between cost and QALYs. These parameters were used for producing the CEAC and confidence ellipses.
treatment added to oral treatment glucose levels not in control, body weight 10% higher than current weight and suffering from multiple complications Cairns (1996) Scotland Antenatal screening for cystic fibrosis Stepwise vs. couple carrier screening Level of information 6 scenarios: 1 with 100% chance the foetus had cystic fibrosis; 5 including different levels of information being available to the couple General population SG Upper anchor: full information Lower anchor: foetal loss
Sweden with insulin treatment. injections and self-measured blood glucose (SMBG) flexible injection, once daily fixed injection and 2 fixed injections. At 2 treatment intensities: Basal only Basal and bolus and sub analyses on patients with T1DM T2DM Both approaches were modified to consist of 1 multiple choice question. Howard (2008) Australia Cervical screening Medical management of mildly abnormal Pap smears Repeat Pap smear vs. immediate HPV test 4 clinical management scenarios: 1 anchor state for cervical cancer needing hysterectomy; 2 describing General population (women) Two stage SG Upper anchor: full health Lower anchor: cancer state needing treatment with hysterectomy
Johnson (1996) USA AIDS-related retinitis treatment Intravenous ganciclovir compared with oral ganciclovir Route of administration (intravenous vs. oral) 3 health states: patients current state of health; IV therapy: oral therapy Patients TTO Kauf (2008) (Europe and the USA) HIV treatment Treatment regimen attributes Dose frequency, symmetrical regimen, treatment taken with food/drink/empty stomach No, SF-36 in HIV patients Patients SF-6D Matza (2013) UK Bone metastasis Intravenous (infusion) (with renal monitoring) Hypothetical health states: bone metastases; plus 9 additional General population VAS and TTO s
and exenatide vs. BID) free of diabetes Sadigh (2013) USA Diagnosis of coronary artery disease Coronary computed tomography angiography and conventional catheter angiography Administration type Telephone interviews with patients, plus descriptions of hypothetical tests. Patients WTO and rating scale Salkeld (2004) Australia Preventative health care Hip protectors vs. no hip protectors Comfort, reassurance 6 scenarios: full health; 2 process states; 3 psychological states General population (women) TTO
Osborne, RH. De Abreu Lourenço, R. Dalton, A. Houltram, J. Dowton, D. Joshua, DE. Lindeman, R. Ho, PJ. (2007) Quality of Life Related to Oral versus Subcutaneous Iron Chelation: A Time Trade-off Study. Value Health, 10(6), 451-6. Osbourne, RH. Dalton, A. Hertel, J. Schrover, R. Smith, DK. (2012) Health-related quality of life advantage of long-acting injectable antipsychotic treatment for schizophrenia: a time-trade-off study. Health and Quality of Life Outcomes, 10, 35. Polster, M. Zanutto, E. McDonald, S. Conner, C. Hammer, M. (2010) A comparison of preferences for two GLP-1 products-liraglutide and exenatide-for the treatment of type 2 diabetes. J Med Econ, 13(4), 655-61. Ryan, M. Kinghorn, P. Entwistle, VA. Francis, JJ. (2014) Valuing patients’ experiences of healthcare processes: Towards broader applications of existing methods. Social Science and Medicine 106,194-203. Sadigh, G. Carlos, RC. Kazerooni, EA. Kelly, AM. (2013) Patient preferences for coronary computed tomography angiography versus conventional catheter angiography for the diagnosis of coronary artery disease. Academic Radiology, 20(9)1091-1098.
descriptions on the scale between the two anchors so that the intervals between the scores corresponded to the differences they perceive. The distribution of EQ-5D questionnaires and EQ-5D+C questionnaires was performed randomly. Analysis of the data included: Calculations of means and standard deviations for all valued health-state descriptions; Statistical testing within pairs (EQ-5D versus EQ-5D+C); Paired t-tests were performed for some health states i.e. health states; health states with level variations. Results of t tests for differences between the EQ-5D and EQ-5D+C showed significant differences in 2 cases: health state 11211(2) where a “moderate” cognition level was added to a “good“ state, and health state 12311(3) where a “bad“ cognition level was added to a “moderate“ state. Adding a “good” cognition level to a “bad” health state did not result in any meaningful improvements. Adding a “bad” cognition level to a “bad” health state resulted in a poor valuation. Therefore indicating that “good” health states were affected more by the addition of impaired cognition, but the reverse was not true for adding a “bad” health state. The authors reported that “generally, the
Summary of bolt-on studies. Author (date) Existing tool Added Domain Methodology Method Tariff Results Advantages Disadvantages Brazier (2011) AQL-5D – asthma specific measure Pain Valuation study and regression analysis AQL-5D and AQL-6D were applied to clinical trial data TTO No Addition of pain significantly on co-efficients of dimensions, but by dimension and severity level. When relating back to the trial, the mean HS value produced from the AQL-5D was consistently lower than for the AQL-6D across the 5 asthma symptom groups. Use of patient data with both measures (EQ-5D and Potential focusing effect Explored only an additive model Results not Krabbe (1999) EQ-5D Cognition EQ-5D+C Comparison of paired health states, valued using VAS. VAS No 87 questionnaires returned. Cognitive generated systematically values Maintains 3 level of the Valuation university faculty members (they may place more emphasis on
compared with the standard EQ-5D. Good states more, bad states less model due to dependencies between specific levels of attributes. et al., (2013) EQ-5D 2 domains: Skin irritation and EQ-PSO Literature review. Clinician and patient interviews. Psychometric testing. Valuation study. TTO No The revised EQ-PSO questionnaire more variance than the EQ-5D. It was also better at predicting psoriasis outcomes than some existing disease measures. Maintains 5 level system of the EQ-5D. Has undergone psychometric Paper included a valuation study TTO. The literature used to the domains was not Domains were by only 8 interviews and one clinical Unable to translate to utilities due to differences in studies for ed.
EQ-5D-5L and study Wolfs (2007) EQ-5D Cognition EQ-5D+C Application of Krabbe (1999) in practice VAS No 234 patients Construct validity – similar correlations found between and MMSE, and EQ-5D+C and MMSE. EQ-5D adequate to detect differences, little gained by using EQ-5D+C EQ-5D was slightly more responsive than the EQ-5D+C Application of Krabbe (1999) study in clinical practice Exploration of new tool within existing trial (not designed specifically for this purpose) Completion by proxies. Focusing effect Yang EQ-5D Sleep Valuation study TTO No Co-efficient for sleep dimension non Maintains 3 level system Small sample size
(2008) and regression analysis Inclusion of sleep had no impact on valuation of other dimensions. No need to add sleep dimension of the EQ-5D. Yang (2015) EQ-5D 3 domains: Vision Hearing tiredness Valuation study TTO No The additional did impact on the health state Differences were associated with the levels of the domain added and the of the underlying health state. Maintains 3 level system of the EQ-5D Reviews more than one dimension, and allows to be made between each as based on same methodology. Interviews in 1 area of UK, therefore may not be to UK Dimensions added to EQ-5D-3L, not 5L version – which may be more to changes. taken
Item-total statistics for outcome. Scale Mean if Item Scale Variance if Item Deleted Corrected Item-Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item PEQ: Know what to do to floor problems 8.79 11.131 .783 .623 .797 PEQ: Know what to expect from now on 8.12 12.950 .594 .362 .873 PEQ: Able to handle pelvic floor problems differently 9.02 11.423 .760 .606 .807 PEQ: Lead to fewer or prevent pelvic floor problems 8.86 11.760 .719 .538 .824 Communication (PEQ). Item-total correlation values again all exceeded .3 and were therefore deemed to be reliable. The item showing the greatest correlation was “PEQ: Clinician understood what was on my mind” This had an item-total correlation of .822.
regression (SUR) to account for correlation between costs and QALYs (Faria et al. 2014; Gomes et al. 2012). Outputs from the SUR can be seen in Table 30, where QALYs and costs are slightly higher in the intervention (.0026 and £4.31 respectively). NHS Costs and SF-7D Group Co-efficient Std.err t P> 95% CI NHS Costs Intervention1 4.31 148.60 0.03 0.98 -287.27 295.89 Control2 704.71 100.61 7.00 0.00 507.40 902.03 SF-7D Intervention1 .0026 .0064 0.40 0.687 -.0101 .0153 Control2 .0028 .0043 5.32 0.000 .01435 .0312 Cost and SF-6D Group Std.err t P> 95% CI NHS Costs Intervention 15.10 146.30 0.10 0.92 -271.87 302.08 Control 701.40 101.42 6.92 0.00 502.50 900.30 SF-6D Intervention1 -.00273 .00496 -0.55 0.58 -.01251 .00705 Control2 .00259 .00354 0.73 0.47 -.00440 .00957 Figure 20 shows the SF-7D cost-effectiveness plane and cost-effectiveness acceptability curve alongside the SF-6D results which were estimated in Chapter 3. The SF-7D point estimate lays in the North East quadrant of the cost-effectiveness plane and the cost-effectiveness acceptability curve (CEAC)
Summary of Think Aloud Studies in Health Economics. Author (year of Aim method Sample size Qualitative: interview Al-Janabi et al. (2013) To investigate the feasibility of individuals reporting their own capabilities using the ICECAP-A and EQ-5D. - EQ-5D ICECAP-A 34 general population No Yes Baker and Robinson (2004) Qualitative study alongside a SG preference elicitation study to explore how respondents answer SG questions. SG N/A 31 of patients with HT Yes utility estimates reported for 8 health states Yes et al. (2007) Think aloud study into a DCE evaluating patient priorities in primary care DCE N/A 20 University staff. No No )
et al. (2005) To explore whether people mention considerations related to distributive principles rather than more often in PTO or TTO elicitations. PTO TTO N/A 64 General population yes yes Horwood at al. (2014) Evaluating the face validity of the ICECAP-O Capabilities measure: A “think aloud” study with hip and knee arthroplasty patients. N/A ICECAP-O 20 Patients with OA knee/hip No No Mulhern et al. (2012) Exploration of how respondents perceive health state valuation exercises using TTO and DCE. TTO, DCE N/A 30 sample Yes Yes Osch and Stigglebout (2008) To explore SG biases using qualitative data. SG N/A 45 General population Yes No et al. (2014) To explore the feasibility of TTO to elicit valuations for depression experienced alongside a somatic illness. TTO N/A 10 sample Yes No
Summary of Think Aloud Interview Methodologies Author (year of publication) Warm up questions Prompting and probing Analysis method reported Additional information Al-Janabi et al. (2013) Concurrent Two warm up questions: Count the number of windows in their home Complete a 5 point question on their general health Researcher silent throughout TA task. Only interrupted if silent for 10 seconds or more. Asked to keep thinking aloud. No specific approach reported, although used coding of “errors and struggles” Semi-structured interview used to follow up on any questions respondents had expressed during think aloud. Baker and Robinson (2004) Not reported Not reported Not reported No specific method reported, although included familiarisation, sorting, ordering and indexing, building themes, mapping and linking themes and interpretation. Semi-structured interview followed think aloud. Cheraghi-Sohi et al. (2007) Concurrent Basic arithmetic Choosing a destination. Prompted if silent for “any length of time” (p278). Researcher only provided prompts and responded to occasional requests for clarification. No specific approach reported, although included use of an existing coding framework and the incorporation of new themes. They report that the analysis was “in line with conventional procedures”. (p279). Nil
Damschroder et al. (2005) Concurrent and retrospective Not reported Verbal probing whereby researcher prompted respondent to expand on their TA statements and/or to provide retrospective reported of their thoughts to elicit more complete verbalisation Termed their analysis as a descriptive analysis, where they identified themes, and coded transcripts according to the themes. Nil Horwood at al. (2014) Not reported (although appears to be concurrent with retrospective follow-up questions to clarify). Asked 3 warm up questions. Questions not reported. Researcher did not interrupt respondent unless they were silent for a few seconds, when the researcher reminded them to think aloud. Segmenting, application of the framework used by Al-Janabi et al. (2013) to identify errors and struggles. They then reported using thematic analysis to explore participants’ problems with completing the measure. Researcher sat out of line of sight of respondent when completing think aloud. After completion of the questionnaire, the researcher asked any questions which had arisen. Mulhern et al. (2012) Concurrent and retrospective Two warm up questions: Asked how many windows are there in your house? Presented with a DCE question about a choice of holidays. (same one as used by Cheraghi-Sohi et If the respondent was unable to verbalise their thoughts they were asked the reasoning behind their decision after providing an answer. Framework analysis Nil
al. 2007) Van Osch and Stigglebout (2008) Not reported Given 2 examples to practice thinking aloud before each task. If the subject became quiet during a task additional instructions were given to think aloud No specific approach reported, although included familiarisation with the data and sorting and indexing of themes. Nil Papageorgiou et al. (2014) Concurrent Not reported Occasionally used motivational probes to encourage thinking aloud. A 3 step approach: Interviews and Quotes were for similarities or differences. scheme was Quotes recoded into final coding scheme. Nil Robinson et al. (1997) Not reported Not reported Not reported No specific approach reported - report that a “verbal protocol analysis” Nil ing
was performed on all taped material, and responses were classified into broad categories. No further detail was provided. Ryan et al. (2009) Combination of concurrent and retrospective (approach selected from pilot study). Practice game of noughts and crosses. If the respondent was silent for a period of time they were reminded to keep thinking aloud. If respondents asked for clarification further explanation was given to maintain trust. A charting approach whereby a chart was produced to record participants’ performance and summarise the comments made. Respondents were asked a de-briefing question. Spencer (2000) Not reported Not reported Not reported Based on “grounded theory”. Included categorisation, coding, grouping of codes to form categories. The interviewer verbalised respondents’ hand non-verbal cues e.g. eye movements. Spencer (2001) Not reported Not reported Not reported Minimal information reported. Report interviews were transcribed and analyses using HyperResearch ® software. The interviewer verbalised respondents’ hand non-verbal cues e.g. eye movements. Whitty (2014) Concurrently Noughts and crosses If after the first and 2 subsequent questions, the participant had not verbalised their thought Analyses “thematically” by developing initial framework and updating as new themes emerged. At the end respondents were asked which 2 approaches (DCE or BWS) they preferred and
supervision. A mutually convenient date, time and telephone number will also be agreed with you for a telephone consultation with your specialist. This consultation will take approximately 15 minutes and will involve discussion of your condition and aims to provide you with information as well as discussing or starting treatment. Appropriate follow-up appointments or investigations will also be arranged for you. If you are allocated to group (2) in this study, you will be given a routine appointment to attend the Urogynaecology Clinic as normal. You will be given the opportunity to use the ePAQ system at the time of your appointment (as is currently our standard practice in the outpatient department). We will ask all women who agree to enter this study to complete paper questionnaires about the care that they have received, their quality of life, and their feelings about the service and the ePAQ system that they have used. These paper questionnaires will be posted to you before and immediately following your appointment and at 6 months after your first consultation. They will take about 5 - 10 minutes to complete and you will be provided with a stamped addressed envelope to send them back to us. We will also closely monitor what medical and surgical treatments are used for all women in this study, as well as what investigations are used, what follow-up appointments are arranged and how long patients have to wait. Why have I been chosen? Women referred to the Urogynaecology Unit at the Jessop Wing of the Royal Hallamshire Hospital in Sheffield will be given the option of entering this study. We aim to recruit around 304 women to ensure that we can make statistical comparisons between women who use ePAQ in advance of their clinic appointments & then have a telephone consultation, compared with women who use the ePAQ at the time of their appointment. With your permission, we will inform your GP that you are taking part in this study. Confidentiality All reasonable steps will be taken to ensure confidentiality. Any information collected using the Internet ePAQ system is anonymous and can only be used with your permission by the clinicians involved in your care. All the information that is collected about you during the course of the research will be kept strictly confidential. When the results are published, no names will be used, and it will not be possible to identify anyone who has taken part. Will my taking part involve any extra visits?
re-visit Non-normally distributed Skewness= 3.44 Kurtosis = 13.62 6 month personal expenditure Non-normally distributed Skewness= 5.44 Kurtosis = 41.49 Total 6 month resource use Intervention Non-normally distributed Skewness= 1.321
Know what to expect from now on 86 4 3.41 1.25 85 4 3.48 1.23 .08 -.30 .45 .692 Control Intervention 95% CI N Mean SD N Mean SD Mean Diff Lower Upper Able to handle pelvic floor problems 84 3 2.74 1.25 77 2 2.36 1.32 -.37 -.78 .03 .067 Lead to fewer or pelvic floor 71 3 2.73 1.24 70 3 2.71 1.42 -.02 -.46 .43 .936 Had a good talk 87 4 3.85 .84 85 4 4.28 .68 .43 .20 .66 .000 Felt reassured 87 4 3.71 .82 86 4 4.08 .79 .37 .13 .61 .003 Clinician understood what was on my mind 88 4 3.80 .89 86 4 4.27 .69 .47 .24 .71 .000 Felt was taken care of 87 4 4.02 .73 87 4 4.26 .69 .24 .03 .46 .026
Bit difficult to connect with clinician 88 4 3.98 .96 85 4 4.25 .79 .27 .01 .53 .045 Control Intervention 95% CI N Mean SD N Mean SD Mean Diff Lower Upper Too much time spent on small talk 87 4 4.26 .66 87 4 4.37 .65 .16 -.019 .34 .079 Bit difficult to ask questions 88 4 3.91 .98 87 4 4.28 .76 .38 .12 .64 .005 Important decisions made over head 86 4 4.30 .75 87 4 4.37 .65 .07 -.14 .28 .494 Relieved - Worried 86 5 4.80 1.49 86 6 5.50 1.24 .70 .29 1.11 .001 Cheerful - Sad 85 4 4.55 1.52 81 6 5.37 1.47 .82 .36 1.3 .001 Strengthened - Worn out 85 4 4.71 1.20 83 5 5.12 1.40 .42 .02 .81 .041
back to services PEQ: Know what to do to reduce pelvic floor problems -.095 .037 .070 -.034 .030 -.064 -.006 -.029 PEQ: Know what to expect from now on .091 -.118 -.022 .187 -.105 -.042 -.044 .033 PEQ: Able to handle pelvic floor problems differently -.036 .043 .008 -.212 -.087 -.152 .061 .207 PEQ: Lead to fewer or prevent pelvic floor problems .132 -.006 -.084 .037 .094 -.096 .118 -.122 PEQ: Had a good talk -.081 -.084 .097 -.250 -.185 .104 .025 .325 PEQ: Felt reassured -.053 .014 -.036 .144 -.008 -.046 -.034 -.051 PEQ: Clinician understood what was on my mind -.174 .139 .063 .295 .104 -.074 -.181 -.199
PEQ: Know what to do to reduce pelvic floor problems PEQ: Know what to expect from now on PEQ: Able to handle pelvic floor problems differently PEQ: Lead to fewer or prevent pelvic floor problems PEQ: Had a good talk PEQ: Felt reassured PEQ: Clinician understood what was on my mind PEQ: Felt was taken care of CSQ: Rate service received -.095 .091 -.036 .132 -.081 -.053 -.174 .007 CSQ: Kind of service wanted .037 -.118 .043 -.006 -.084 .014 .139 -.091 CSQ: Extent service met needs .070 -.022 .008 -.084 .097 -.036 .063 -.008 CSQ: Would recommend service -.034 .187 -.212 .037 -.250 .144 .295 .081 CSQ: Satisfied with amount of help .030 -.105 -.087 .094 -.185 -.008 .104 -.013 CSQ: Services helped to deal more effectively with problems -.064 -.042 -.152 -.096 .104 -.046 -.074 .065 CSQ: Overall, satisfied with service -.006 -.044 .061 .118 .025 -.034 -.181 .078 CSQ: If were to seek help again, -.029 .033 .207 -.122 .325 -.051 -.199 -.154
would come back to services PEQ:Know what to do to reduce pelvic floor problems .872a -.190 -.382 -.340 -.051 -.121 -.054 .115 PEQ: Know what to expect from now on -.190 .911a -.094 -.144 .034 -.172 -.102 -.039 PEQ: Able to handle pelvic floor problems differently -.382 -.094 .830a -.334 .095 .054 .019 -.184 PEQ: Lead to fewer or prevent pelvic floor problems -.340 -.144 -.334 .842a -.016 .041 -.009 .006 PEQ: Had a good talk -.051 .034 .095 -.016 .876a -.418 -.157 -.369 PEQ: Felt reassured -.121 -.172 .054 .041 -.418 .925a -.060 -.113 PEQ: Clinician understood what was on my mind -.054 -.102 .019 -.009 -.157 -.060 .934a -.335 PEQ: Felt was taken care of .115 -.039 -.184 .006 -.369 -.113 -.335 .936a
therefore is an unplanned expenditure. The finding is required to develop and host an online questionnaire which incorporates the online use of the VAS. Without the assistance of the funding it is highly unlikely that I will be able to recruit a sample size of greater than 50-60 as for the pilot study I was unable to reach a sample size of A key paper by Krabbe et al., 1999 which used a similar approach reports using a convenience sample of 87 and discusses this as a key limitation to their study. This, and discussions with my supervisor Simon Dixon indicate that a sample size of nearer 200 is required, and therefore an online questionnaire is needed to facilitate this. Describe the logistics involved i.e. sample size, location, transcription, travel, etc. These should match with the itemised costs and timescales on the page overleaf The funding will allow me to develop the health state valuation questionnaire online. This will be performed through a company called epiGenesys who have been working with staff at ScHARR (Donna Rowan) to develop online questionnaires for health state preference studies. Once developed, the funding will allow me to work through a panel company to obtain a sample size of 200 people who are representative of the general population and therefore enhance the scientific rigour of the study. Do you have any other sources of funding e.g. RTSG? If how much will you be using for this I have sought the funding through my current employer, who have said no as they are funding my attendance at a conference to present a poster related to my PhD work. I have also sought funding from Sheffield Teaching Hospital Trust, however, they only provide funding for trust employees which I am not. I therefore
[PEQ_comm_4=4] 1.238 .237 27.400 1 .000 3.450 2.170 5.485 [PEQ_comm_4=5] 0b . . 0 . . . . The reference category is: Very good. This parameter is set to zero because it is redundant. Observed and predicted frequencies. Response to PEQ 4 Response to PEQ 3 Response to PEQ 2 Response to PEQ 1 Rating for health Frequency Percentage
Very good 4 .767 3.698 1.5% 0.3% Disagree completely Agree completely Disagree Agree Very poor 72 66.172 .825 26.8% 24.6% Poor 13 18.057 -1.232 4.8% 6.7% Average 4 6.279 -.920 1.5% 2.3% Good 35 27.554 1.497 12.9% 10.2% Very good 124 116.455 .926 45.8% 43.0% Disagree Disagree completely Agree completely Agree Very poor 35 27.554 1.497 12.9% 10.2% Poor 124 116.455 .926 45.8% 43.0% Average 88 92.055 -.520 32.5% 34.0% Good 16 19.259 -.770 5.9% 7.1% Very good 8 15.677 -1.998 3.0% 5.8% Disagree Disagree Agree Disagree completely Very poor 51 55.444 -.669 18.7% 20.3% Poor 178 166.962 1.371 65.2% 61.2% Average 30 39.101 -1.572 11.0% 14.3% Good 7 7.086 -.033 2.6% 2.6% Very good 7 4.406 1.246 2.6% 1.6% Disagree So-so So-so So-so Very poor 33 26.935 1.231 12.0% 9.8%
Poor 95 108.937 -1.718 34.5% 39.6% Average 126 129.715 -.449 45.8% 47.2% Good 11 7.905 1.117 4.0% 2.9% Very good 10 1.510 6.929 3.6% 0.5% Disagree Agree Disagree Agree completely Very poor 5 7.840 -1.029 1.8% 2.8% Poor 107 122.373 -1.860 38.6% 44.2% Average 142 116.614 3.089 51.3% 42.1% Good 13 13.710 -.197 4.7% 4.9% Very good 10 16.462 -1.642 3.6% 5.9% Disagree Agree completely Disagree completely Disagree Very poor 53 59.227 -.915 19.6% 21.9% Poor 164 153.273 1.315 60.5% 56.6% Average 37 45.515 -1.384 13.7% 16.8% Good 12 11.040 .295 4.4% 4.1% Very good 5 1.945 2.199 1.8% 0.7% So-so Disagree completely Agree Disagree Very poor 35 36.813 -.322 13.1% 13.7% Poor 141 148.915 -.973 52.6% 55.6% Average 75 56.772 2.725 28.0% 21.2%
So-so Agree completely Agree completely Agree completely Very poor 2 .083 6.675 0.7% 0.0% Poor 2 6.703 -1.839 0.7% 2.4% Average 28 46.644 -2.997 10.2% 17.0% Good 148 139.934 .975 54.0% 51.1% Very good 94 80.637 1.771 34.3% 29.4% Agree Disagree completely So-so Agree completely Very poor 7 13.396 -1.792 2.6% 4.9% Poor 63 46.879 2.586 23.0% 17.1% Average 162 173.005 -1.378 59.1% 63.1% Good 36 36.915 -.162 13.1% 13.5% Very good 6 3.805 1.133 2.2% 1.4% Agree Disagree Disagree Disagree Very poor 87 76.398 1.430 32.0% 28.1% Poor 129 138.684 -1.175 47.4% 51.0% Average 41 45.546 -.738 15.1% 16.7% Good 12 10.825 .365 4.4% 4.0% Very good 3 .547 3.319 1.1% 0.2% Agree So-so Disagree completely Agree Very poor 3 8.961 -2.025 1.1% 3.3% Poor 37 35.681 .237 13.7% 13.2%
Very good 8 4.547 1.633 3.0% 1.7% Agree completely Disagree Disagree completely Agree completely Very poor 9 6.090 1.193 3.3% 2.2% Poor 73 69.708 .458 26.9% 25.7% Average 150 153.224 -.395 55.4% 56.5% Good 30 31.339 -.254 11.1% 11.6% Very good 9 10.639 -.513 3.3% 3.9% Agree completely So-so Agree completely Disagree Very poor 1 2.323 -.872 0.4% 0.9% Poor 15 20.654 -1.295 5.6% 7.7% Average 127 114.014 1.602 47.2% 42.4% Good 120 121.232 -.151 44.6% 45.1% Very good 6 10.777 -1.485 2.2% 4.0% Agree completely Agree Agree Agree Very poor 0 .034 -.185 0.0% 0.0% Poor 4 3.619 .201 1.5% 1.3% Average 14 34.548 -3.741 5.1% 12.7% Good 94 86.763 .941 34.4% 31.8% Very good 161 148.035 1.575 59.0% 54.2% Agree Agree So-so Disagree Very poor 6 3.277 1.513 2.2% 1.2%
A5. Briefly summarise: The project’s aims and objectives: (this must be in language comprehensible to a lay person) To improve decision-making about funding different health care programmes health economists aim to measure and compare the benefits of different health care treatments. These benefits are often measured by asking the general public their views about the desirability of different health state descriptions. Health economists often use ‘choice tasks’ to measure peoples’ desire for different health state descriptions. These choice tasks are methods such as the ‘Visual Analogue Scale’, the ‘Time Trade Off’ and the ‘Standard Gamble’. During choice tasks people are presented with a health outcome and asked a series of questions. For example, in the time trade off participants decide between living a certain number of years in ‘less than Full Health’ or a lesser number of years in ‘Full Health’. By discovering how many years people are willing to ‘sacrifice’, health economists can infer the desirability of different health outcomes. Some research does exist which explores the thought processes people have in completing these choice tasks. For example, Baker and Robinson (2004) presented respondents with health state descriptions related to hypertension and asked them to value these using a technique called standard gamble; and Spencer (2001) explored issues relating to the use of both standard gamble and time-trade off techniques in health state
Appendix 32: Think Aloud Framework Matrices Framework matrix theme 1 (Sections 1.1 and 1.2). 1.1 Don't understand what it means. 1.2 Interpretation of bad process domain 1.2.1 Lack of support /help from doctor 1.2.2 Reflection of communication 1.2.3 Reflection of health 1.2.4 Other Transcript 1.2.2.1 Doctor and patients communication 1.2.2.2 Doctors communication 1.2.2.3 Patients communication 1.2.4.1 Not being listened to 1.2.4.2 Reflection of outcome F1 And you’ve got a crappy doctor. F2 if your doctor is not on your side but you’ve evaluated that you’re feeling like this, There is nothing worse than going to the doctors and just (sighs), and just being not listened to Hmmmm, not he’s not listening to either of the times. F3 so you might have a, a bad experience going to the doctors and feel
M1 Whereas this person looks like they are not getting the help they need. M2 Can I just ask when it says communication experience, what does that really, what does that mean? Not having had a good communication good with your doctor whether it’s how you have portrayed it or he has received it. M3 Can I just ask about the um, consultation thing, um, when, when its evaluated as communicated as communication experience as good, does that mean good news was given, or just kind of like you enjoyed having a chat. M4 M5 M6 M7 I’m not sure what conclusions to draw I’m assuming from the question that it’s I’m assuming from the question
Framework matrix theme 1 (Sections 1.3). 1.3 Interpretation of a good process domain 1.3.1 Being listened to 1.3.2 Doctor helps 1.3.3 Reflection of communication 1.3.4 Reflection of health 1.3.5 Reflection of hope 1.3.6 Reflection of outcome/ progress 1.3.7 Other 1.3.3.1 Doctor and patients 1.3.3.2 Doctors communication 1.3.3.3 Patients communication F1 if I’ve had a good experience, I feel like it’s on the way to being sorted. If I go to the doctors for a health issue even just seeing the doctor if I’ve had a good experience, I feel like it’s on the way to being sorted. F2 yep, the same scenario again, um, but if you, if you have been to the doctors, and they’ve said, oh yes, it’s your thyroid and we can do something about that, and this is why you’re tired all of the time, oh hang on, sorry. Bloody doctors, so. Um, (sniffs) the first one, Q10 is where you would get help from your GP I would definitely take the 4 weeks, (giggles) with hope, um, uhh, and you know the doctor saying we can sort this out, I can send you for some tests. You take these antibiotics. Whenever, you know, this is
M5 M6 M7 It could potentially be a doctor, very, you know well communicated things properly, possibly the health state has prevented me from communicating with the doctor very well. M8 M9 M10 communication experience good, um I mean yes, so I suppose thinking about how I’ve felt when I’ve come out of the doctors, and the experience has been, you feel like the doctor you feel like the doctor has listened to you, and understands what you are going through, um. Again, um, I feel that quality of life would be better um, for 2 years, then health state A for 5 years, especially, there’s um, you’d feel more rubbish, um, if you didn’t feel the doctor was
Framework matrix theme 2 (Section 2.2). 2.2 Impact of having a negative consultation. 2.2.1 Negative impact 2.2.2 Second opinion 2.2.3 Other 2.2.4 No impact Transcript 2.2.1.1 On the way you feel 2.2.1.2 Give hope or encouragement 2.2.1.3 On health 2.2.1.4 On coping with your illness 2.2.1.5 Other F1 I think you’d be down regularly, I think that would make me sad. Um, and the doctor, I think adds a huge influence on all of those, on, especially on the kind of mentality of a person when they go into a doctor if you’re feeling low and your doctor picks you up that has an impact on how you approach your disease you’d probably change doctor if you felt that strongly about it, F2 you’ve evaluated that you’re feeling like this, and you’ve gone to your GP and if they’ve just fobbed you off, that makes you feel worse quite a lot of the time it’s just going to be a bloody long old battle. if you go and there is a negative experience then you think, well I’ve got nowhere to go now. I think, me personally, if you’ve got pain or if you’re feeling low, and um, you know your life’s limited by things., or if you, you’ve always got that hope that if you go to your GP They’ll always be able to magically sort it for you, or give you something. And I think that’s just how most people view my previous one where I could handle it for a week, um, and just change doctor or something. I probably wouldn’t change doctor, but I'd um, I’d think. Think twice twice about going to him with
You assume that you’re going to get sorted. You just do, and then when you realise you don’t, then you go into the pits of despair. Or someone says you’re just making it up in your mind, there’s nowhere to go from there, um and if you haven’t got the, the strength of mind because you’re feeling downhearted and low, and you haven’t got the friends to talk to, then you have a bad experience with your GP. Where are you going to go from there? Mentally? GPs, but I think if you go to your GP and you get fobbed off, or um, they say, you know, just do this or do this, or exercise more, it’s not that helpful to you, um. And I think a lot of the time you just want, I don’t know, just to be, sort of listened to and have something that you can um, deal with. And work on, so um, ye, I think to be ye, that’s not the best state, because of the, hmmm, ok, I would say about just because you feel you’ve got nowhere to go after that and you’d have to look into alternative therapies which is just time consuming (giggles) I would say about, fifty, no about six, no, 58 just because of the lack of hope. I think if you go and something, something um, similar again, um, but I think again I mean you could change doctors obviously but if he’s just going “pick yourself up” and you’re going “I can’t” and he’s not offering you any alternatives, then it’s just going to be a bloody long old battle. You could go to another doctor, there are quite a lot of people who you know what ever medical people say goes. For example, my dad, like he says well that’s what the doctor says, so that must be true, and I say, well there are second opinions
there is a negative experience then you think, well I’ve got nowhere to go now. So it’s that hope, a little bit, For example, my dad, like he says well that’s what the doctor says, so that must be true, and I say, well there are second opinions dad. But, so quite a lot of people are in the mind-set that the medical profession are always right. So wouldn’t seek out a second opinions, and also, if they are of a low mood anyway. They wouldn’t seek out that second opinions. So I think that’s a massive, massive thing. Because then that hopes then for someone. it, alters you, it alters your view on hope. dad. But, so quite a lot of people are in the that the medical profession are always right. So wouldn’t seek out a second opinions, and also, if they are of a low mood anyway. They wouldn’t seek out that second opinions. So I think that’s a massive, massive thing. F3 where it says I had a
feeling rubbish, um, emotionally it’s when you’ve had other problems, then I know I’ve come out and it had impacted on the way I’d felt and perhaps hindered my um, kind of improvement in health, F6 F7 F8 um they’ve had a poor communication experience with the doctor. Um. So I’d value this a little bit lower, because that would make you feel a bit downhearted about this, and less positive about things. The consultation with the doctor, it didn’t affect the quality of life, although it probably would have made you feel a bit low. I know it’s disappointing to have a poor consultation with your doctor. But I think in the wider scheme of things I’m only interested in the actual If you have a good consultation with the doctor it’s not going to do anything to change your health.
and how that’s made me feel, or you feel, gloomier about your, the outcome or, gloomier about how you might deal with the problems you’re facing so, um. Ye, that might not be a long term kind of impact on the health state, but it can have an um, impact, on initial moods,..... you’d feel more rubbish, um, if you didn’t feel the doctor was supportive, and it depends on your kind of emotional mood as well, so it could have, if you are feeling rubbish, um, emotionally it’s when you’ve had other problems, then I know I’ve come out and it had impacted on the way I’d felt it might make you feel worse if your doctors kind of still, if you’re still having poor experiences with them, wasn't much hope, um which I think with that consultation with the doctor, you might not feel that there’s much room for improvement. just had a rubbish experience with your doctor, and how that’s made me feel, or you feel, gloomier about your, the outcome or, gloomier about how you might deal with the problems you’re facing so, um. Ye, that might not be a long term kind of impact on the health state, but it can have an um, impact, on initial moods, you’d feel more rubbish, um, if you didn’t feel the doctor was supportive, and it depends on your kind of emotional mood as well, so it could have, if you are feeling rubbish, um, doctors understood what’s going on. Um, but then, I don’t think overall, it would have that much impact.
and it um, you know as a result of his depression and such, so it’s um. And I know it can really limit his life a lot. So I’d say that was a little bit worse. And communicating, ye, he’s become quite agoraphobic and he sort of pulls back from society, so I would say that’s a bit worse. I’d say its 40. F5 Right, I don’t think this one is so difficult, um, I know it it’s got a lot of the same things, but um, we haven’t got the doctor bit, and um, tense and downhearted, but still, still only low a little bit of the time, so I think, I’ll have it a little bit higher than the previous one maybe, go up to 40. Um, you’ve just had a con… ye, I think that’s quite, quite significant, that you’ve tried to explain to your doctor how you’re feeling and um, what, I’m assuming, or maybe I’m assuming that, um, you haven’t communicated very well, but it could be that the doctor possibly hasn’t
received what you are saying very well. So, I would find that quite difficult to feel that, so I think, I would put that at about 20. VB Yep V3 A1 OK (Reads through health state silently) Right, I don’t think this one is so difficult, um, I know it it’s got a lot of the same things, but um, we haven’t got the doctor bit, and um, tense and downhearted, but still, still only low a little bit of the time, so I think, I’ll have it a little bit higher than the previous one maybe, go up to 40. What did I put there, it was 20, so 40. Because I would think not being able to explain to the
doctor how you feeling is quite significant really. F6 I think the same, ye, 35, I don’t think this will influence me. F7 So its quite similar to the other ones, but here, the fact that you’ve actually communicated that, that makes you feel quite poor, um in terms of your health status, I’m going to say, um, 40. Because you’ve communicated that all of those things are going on. F8 This question appears to be the same as the other question apart from that the consultation Then this next question has got um a separate question at the bottom um although the health is limited only a little, um, um they’ve had a poor communication
with the doctor was good. So I’ll put this back up to 80 because it would make you feel more positive about your outcomes and how things would progress. experience with the doctor. Um. So I’d value this a little bit lower, because that would make you feel a bit downhearted about this, and less positive about things. So I would rate this as 70. F9 Do you think it altered your value? The way you valued that health state? A7 Ye, definitely, um, because, I'm I think as I was going along I was sort of jumping to the top and then jumping to the bottom to see what the outcome was, a little bit more for the doctor. And thinking oh alright, this isn’t going to be as well, or this is going to be better this one. So it sort of surmised it slightly. So I think I’m going to give this one, um a slightly higher score, of nearly 60. Also the consultation with the doctor. It’s been a good one as well. Do you think it altered Do you think it altered your value? The way you valued that health state? A7 Ye, definitley, um, because, I'm I think as I was going along I was sort of jumping to the top and then jumpting to the bottom to see what the oucome was, a little bit more for the doctor. And thinking oh alright, this isnt going to be as well,
slightly. M1 Reads question…… you have just had a consultation with your doctor, and you valued your communication experience as poor. Ye, so I still think that’s, ye, ahhh, you are downhearted and low a little of the time. I'd still say that’s pretty good. I’d still say its ok. I’d say 75. M2 Right, ok, sure, um well, I’d I’d even place that shortly before on the scale, a little worse than the previous one, because the conditions are similar, but I think in terms of um, (lip slapping) your state of mind. Um. Not having had a good communication good with your doctor Right, ok, sure, um well, I’d I’d even place that shortly before on the scale, a little worse than the previous one, because the conditions are similar, but I think in terms of um, (lip slapping) your state
whether it’s how you have portrayed it or he has received it sort of doesn’t um, give you any hope or anything like that, so yes. OK, um, so it’s the thing with the doctor. So that makes it worse. So that’s quite easy. I’m just going to put crosses all of the way down. Do you think adding on the communication to that question made it easier or harder? P Um, well it made it easier for me. ye, it made it easier. of mind. Um. Not having had a good communication good with your doctor whether it’s how you have portrayed it or he has received it sort of doesn’t um, give you any hope or anything like that, so yes. M3 So I think the only difference is the um, consultation with the doctor. So, for me it’s very similar, So I think the only difference is the um, consultation with the doctor. So, for me it’s very similar, Do you think adding the communication component into
toward doctors like um, if I’m not satisfied with one, I would again try another one, so I’m not, I wouldn’t be like, and I think I’m making decisions mostly by myself, so if the experience with the doctor was poor, the doctor maybe really negative, but then I’m also thinking like well, this is something about 5 years, or um, there will be many people around and, um, so, I wouldn’t change much like, maybe (fills in the table), ye, the doctor wouldn’t change it. M5 M6 That’s on the second question. Yes. Because. Ye, is the first one where you are going to recover regardless. So I think. I know 4 weeks might sound not very much for someone who hasn’t personally experienced such bad health That’s on the second question. Yes. Because. Ye, is the first one where you are going to recover regardless. So I think. I know 4 weeks might sound not very much for someone who
and having no, no being tense and downhearted. The consultation with the doctor, it didn’t affect the quality of life, although it probably would have made you feel a bit low. I don’t think it would have affected it much. It was more the pain that I was interested in, and the activities on some of them it said you couldn’t go out at all, you couldn’t do anything. Whereas the communication with the doctor was poor I don’t think, it would have mattered so much, because that’s just a small part of your life, the consultation with your doctor. This bit of information about the consultation, do you think it’s a good idea, or not a good idea? A6 Um, I don’t think it’s, when you’re looking at the wider context of your health. I know it’s disappointing to have a poor consultation with your doctor. But I think in the wider scheme of things I’m only interested in the actual health. Um. I mean it’s a plus if you have a good consultation but I don’t think that it can’t all be good and if you’ve got a poor health outcome anyway. If you have a good consultation with the doctor it’s not going to do anything to change your health. You can’t do anything about your health anyway. So, I don’t think it’s, it’s that important. I think it’s all of the other factors that were important. F9 I’m not really taking that into consideration really. I’m not really looking at that one. No, no, I’m just sort of taking the, the other questions into account, not the one with the doctor. M1 Definitely the tension, and feeling downhearted all of the time. That sort of thing. So to me, the emotional state is more important than, it kind of outweighs any physical pain that you might be feeling moderately or quite a bit. So those were more important. And if it interferes with your social activities as well, the pain
F6 VB OK, and you obviously didn’t think this was important at all. The communication. Why? A4 Because, I don’t know. I maybe its just the kind of person I am, or just, um. I much more rely on what I feel like and on my personal evaluation of myself. Even though that might sound a bit, I don’t know. Um. Too confident or assertive. But still I, I don't think that the type of communication with my doctor would be something which would determine anything in my health state. I don’t, I just don’t find it important. F7 some of them it didn’t make a difference, but a few of them, where they were quite similar, but it was, additionally they said they had communicated very poor, it stood out that, ok you need to take that into consideration. I think the last thing that’s key here is the last bullet point, about communicating with your doctor F8 This bit of information about the consultation, do you think it’s a good idea, or not a good idea? A6 Um, I don’t think it’s, when you’re looking at the wider
context of your health. I know it’s disappointing to have a poor consultation with your doctor. But I think in the wider scheme of things I’m only interested in the actual health. Um. I mean it’s a plus if you have a good consultation but I don’t think that it can’t all be good and if you’ve got a poor health outcome anyway. If you have a good consultation with the doctor it’s not going to do anything to change your health. You can’t do anything about your health anyway. So, I don’t think it’s, it’s that important. I think it’s all of the other factors that were important. F9 M1 For me, it wasn’t particularly significant because, ye, you can go to another doctor. So it’s not so bad. And especially since there is a lot of other help available, like you can use the internet, you can talk to people, you can find out different ways, for you dealing with it. So it’s not. For it its wasn’t particularly significant. But I guess, it is more significant if you are feeling tense already and then you go to the doctor and don’t get anything from that, and it is a very poor consultation. Then it adds there. But if you are I think it was definitely more important if it’s followed by death. I think that’s really important that you are having a good communication with your doctor. Whereas the other one where you are talking about much greater expanse of time, and is followed by a definite death, I think it’s really important that you have some encouragement, or that you feel like you are going somewhere with your doctor. Coz if not, that just, ye, can tip you over the edge a lot, so ye.
Framework matrix theme 7. 7.1 Positive view 7.2 Negative view 7.3 Relevant for some 7.4 Distinction between process and health made Transcript 7.1.1 Important information to include 7.1.2 Makes sense 7.1.3 Other F1 OK so I guess it’s useful in that way to kind of set on a scale how that would affect the persons perceived health state, then I think that’s a good idea. It’s just, how it’s used I guess is the, the thing. But ye, doctors like individuals doctors are individuals and they might have had a bad day, and just made that experience poor for that patient. So, I guess that’s maybe something to, account for, if you’re asking what I feel about that statement, I think its subject to individuals and that’s the problem with that method of maybe measuring, um although I can say if I had a good example of a doctor and a bad example of a doctor I would feel differently about the health state I was in at the time. But ye, doctors like individuals doctors are individuals and they might have had a bad day, and just made that experience poor for that patient. So, I guess that’s maybe something to, account for F2 I think it gives people a different view, definitely. Because I think, if that’s not there. Most people would just assume you
Framework matrix theme 9. (Section 9.1) 9.1.1 Positive views on technique 9.1.2 Negative views on technique 9.1.3 Interviewer prompts Transcript 9.1.2.1 Own concerns when completing 9.1.2.1 General views on technique 9.1.2.2 Other F1 OK, I think I just read aloud, which is quite annoying, um, but I found it ok to kind of go through what I was thinking about things, OK, I think I just read aloud, which is quite annoying, um, but I found it ok to kind of go through what I was thinking about things, F2 So, how generally did you find the think aloud exercise? S Ummm, uh, ye, it is hard because you sometimes think, you know what’s going to come out of my mouth, but um, ye, I think when you get used to it (giggles) So, how generally did you find the think aloud exercise? S Ummm, uh, ye, it is hard because you sometimes think, you know what’s going to come out of my mouth, but um, ye, I think when you get used to it (giggles) Ye, because, because, I was reading, I was conscious that I didn’t want to say out loud what I was reading, because you already know it, do you know what I’m mean, I didn’t want to verbatim, but then I was rushing through because I didn’t want to waste your time. No, but do you know what I mean? So I was just a bit, so ye, the questions weren’t hard it was just because I couldn’t switch between (giggles) reading and saying. F3 Um. I quite enjoyed it kind of explaining what I was Sometimes its difficult to explain
Yep. T Um, I don’t think it helped me that much in the decision making. Yep. T Um, I don’t think it helped me that much in the decision making. M6 You have to think really hard, and when I have to talk when I don’t really want to it messes with me a little bit. I find it easier to work thinking silently really. You have to think really hard, and when I have to talk when I don’t really want to it messes with me a little bit. I find it easier to work thinking silently really. Really weird. It doesn’t feel right. I don’t know. I mean. It feels like I still have thoughts inside my head that I’m not saying out loud. It feels as though my voice is clashing with the thoughts inside my head. And I mean t hats the best way to describe it. Even though I’m saying things out loud, I’m only doing it for the purpose of this experiment. So sometimes I feel like I’m having to speak for the sake of speaking. So ye, it is a strange experience. M7 I think possibly it may have, it may have helped me um, think about things, a bit more laterally and a bit more holistically really. If I maybe I didn’t think aloud I may have just answered it a bit more quickly. It was, strange initially M8 I think its ok. I really enjoy it M9 Um, it was alright, I've not really done it before I guess, but it was normal.
Framework matrix theme 9 (Sections 9.2 and 9.3). 9.2 Impact of TA on responses 9.3 Impact of interviewer listening 9.2.1 Uncertain 9.2.2 No impact 9.2.3 Changed responses 9.3.1 Uncertain 9.3.2 No impact 9.3.3 Changed responses Transcript 9.2.4 More thoughtful if TA 9.2.5 Interviewer could correct me 9.2.6 Better constructed if not TA F1 Ye, without any doubt, I think the only thing I kind of avoided doing was swearing, but everything else was just what was in my mind you know. I would probably have sea sawed between the questions a bit more if you hadn’t helped me with the clarification of some bits. But that wouldn’t have affected the output of what id said particularly. Like on the scale. I didn’t get the concept this was a whole health state. But obviously, once I knew that, then that made it much clearer. F2 Um. I think they might have been better constructed answers (giggles), um, because I do think if you’re asked to think out loud, then um, people know your thought processes and how Um, yes, I think so, but also having you there, um even thought I wasn’t bouncing my heads off you, because you weren’t obviously speaking back in that way. But
um I could, um, I felt like I needed to, really express myself, where as if you weren’t here the less I had to talk out loud. I think I would have been quieter. F4 So do you think if you hadn’t been asked to think aloud, do you think your answers would have been the same or different? Y Um, maybe would have spent some more time thinking. Hm, maybe having to verbalise everything made me rush through it. VB And do you think, so there is one thing thinking outloud, but there is also me sitting her listening. Do you think if I hadn’t been here your answered would have been any different? Y Um, I think, well I think always having somebody in the room, you are all. I am very much aware of my surroundings all of the time. So even though I feel comfortable and relaxed. It couldn’t
you think your answers would have been the same? A1 Um, I, cant, another one that’s quite hard for me to answer, because I think, um part of the thinking, part of the thinking process, is there’s a sort of little bit of panic. And you can’t your can’t quite, so you don’t express that, except for once or twice, when I’ve said am I don’t this is right. Um, I don’t think um, oh. personal answers would have been any different, or would they have been the same. A1 I think they would have been the same. what about if I hadn’t been here listening to you thinking outloud. Do you think things would have been any different or the same? A1 No, I don’t think so, it’s actually quite nice to have somebody sitting next to you, and no, (giggles) F6 Oh, I think it was good. But I didn’t really see it. I mean the same would have happened if I’d been thinking in my head. Yes, except I wouldn’t have seen the differences, before. But the answers would have been the same. VB Yep, ok. And what about if I hadn’t been sat here listening do you think your answers would have been the same? A4
Yes, except I wouldn’t have seen the differences, before. But the answers would have been the same. Yes. F7 I think my answers are more thoughtful and more, ye accurate. Um, I don’t think they would have been as thoughtful, um. Because I might have felt like you’re rushing or waiting for me to like give and answer It might have felt a time pressure if you weren’t here, like she might be back here, and it was good to have assurance. Like that I was going at it the right way. So I felt like my answers were true because of that. F8 I think you may answer differently because you’re not fully concentrating. I think they would have been the same, because I, I was aware if was being taped, and if it hadn’t been taped I might have perhaps had longer gaps and I might have tried to digest the question more. But I was
think aloud technique itself. Do you think that you would have given different answers if you hadn’t been asked to think outloud? X I don’t think so, I think I would have given the same answer. sat her listening, do you think your answers would be any different? X No, they would be the same. M9 OK, um. So, just thinking about the think aloud technique itself. Do you think if you hadn’t been asked to think aloud. Do you think your answers would have been the same? Z Um, ye. Ye. VB And do you think if I hadn’t been sat here listening do you think your answers would OK, um. So, just thinking about the think aloud technique itself. Do you think if you hadn’t been asked to think aloud. Do you think your answers would have been the same? Z Um, ye. Ye.