Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment

Abstract

Background and Objective The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia. Methods The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods. Results This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios. Conclusions This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-023-00628-9.

Pretesting Discrete-Choice Experiments: A Guide for Researchers

“…The value that decision-makers place in DCE findings is in large part dependent on the quality of the instrument design process itself. Numerous quality indicators of DCEs have been discussed in the literature, including validity and reliability [ 5 ], match to research question [ 17 ], patient-centricity [ 18 ], heterogeneity assessment [ 19 ], comprehensibility [ 20 ], and burden [ 21 ]. Developing a DCE that reflects these qualities requires a rigorous design process, which is often achieved through activities such as evidence synthesis, expert consultation, stakeholder engagement, pretesting, and pilot testing [ 15 , 17 ].…”