Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care

Abstract

We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite.

A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care

“…As can be seen the packages of care are different; thus, the conjoint methods were useful in those terms (first part of Question 2). The attributes are shown in descending order of their importance scores-i.e., each attribute's influence on patient choice (see Herman et al [47]). As can be seen, where patients receive these services and the language spoken as well as cultural awareness of the provider who screens them for these services exerted the largest influence on mental health service choices in this population.…”

“…From the importance scores we learned that where services were located and the language/cultural awareness of the prescribing provider are not just ranked as important (see Herman et al [47]), they are roughly equal in importance and have almost twice the influence on choices as the next most influential attribute.…”

“…According to the estimated utilities (see Herman et al [47]) the second most preferred level for the language/culture attribute was talking "to someone who speaks English but understands my culture." This level was strongly preferred over talking "to someone who speaks Spanish, but does not understand my culture" indicating that cultural understanding was more important to patient choice than having a Spanish-speaking provider.…”

“…These simulations predicted the percentage of patients who would choose various hypothetical mental health service package options by assuming that in general each patient would choose the option that has the highest total utility but allowing for the fact that patients (like all of us) don't always make perfect choices. [27,45,46] More detail on the conjoint methods can be found in Herman et al (2015). [47] Evaluation of the research questions Whether the application of conjoint analytic methods was feasible in this FQHC (Question 1) was determined by whether the FQHC and academic partner staff could work together to successfully design the survey, field it, collect adequate data and analyze the results.…”

“…[27,45,46] More detail on the conjoint methods can be found in Herman et al (2015). [47] Evaluation of the research questions Whether the application of conjoint analytic methods was feasible in this FQHC (Question 1) was determined by whether the FQHC and academic partner staff could work together to successfully design the survey, field it, collect adequate data and analyze the results.…”