Targeting uptake of exercise-promoting structured patient education intervention: foundational research and process description of a discrete choice experiment to understand perceived intervention utility and design preferences for men with prostate cancer

Ezenwankwo, Elochukwu Fortune

Targeting uptake of exercise-promoting structured patient education intervention: foundational research and process description of a discrete choice experiment to understand perceived intervention utility and design preferences for men with prostate cancer

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Human Biology

Faculty

Faculty of Health Sciences

Abstract

Beyond effectiveness, critical aspects of the design process for complex healthcare interventions, including the organisation of the various independent components and features of the interventions or how they are presented to the users, can influence their overall uptake and long-term sustainability. The discrete choice experiment offers a pragmatic consumer-oriented approach to exploring and understanding individual preferences and perceived utility when planning complex interventions, ensuring that even without real-life observational data, only intervention attributes most valued by the intended users are prioritised in the design phase. This thesis presents foundational research and process description of a discrete choice experiment designed to understand perceived intervention utility and design preferences among men with prostate cancer for an exercise-promoting structured patient education intervention. The overarching goal is to clarify critical issues about effective components and delivery procedures for developing/implementing patient education intervention to increase daily/weekly exercise among prostate cancer survivors. This project began with foundational research to examine and identify key attributes (or variables) and attribute levels (i.e., different functionalities of the attributes) for the discrete choice experiment using two key research approaches, (a) systematic literature reviews and (b) qualitative research. At the end of the foundational research, issues and challenges raised by men along with the opportunities and mechanisms identified in the literature and the qualitative interviews was resolved into four conditions central to the success (or failure) of promoting and increasing exercise engagement among survivors of prostate cancer in Cape Town, South Africa, using structured patient education interventions. These conditions, 1) program/service [Levels: Counselling/Education; b) Unsupervised exercise PLUS counselling; c) Supervised exercise program PLUS education/counselling], 2) delivery structure [Levels: a) Alone; b) Group-based; c) Individual and group-based], 3) setting [Levels: a) Community centre (or Local Gym); b) Home; c) Hospital (in-/outpatient rehab setting)], and 4) service personnel [levels: a) Physiotherapists (other cancer exercise specialists); b) Technology-assisted (mHealth); c) Former PCa patient now cancer exercise couch], comprised attributes of the discrete choice experiment. This research aimed for five attributes and three attribute levels for the experiment. A fifth attribute, service operation [levels: a) 12 weeks; 1x/wk; 2hr/session; operates Weekends only; b) 8 weeks; 2x/wk; 2hr/session; operates Mon-Thurs; c) 12 weeks; 2x/wk; 1hr/session; operates Mon-Thurs], was further introduced, bringing the total number of attributes to five. Qualitative research played a crucial role in establishing the attribute levels. An unlabelled fractional-factorial design with 27 choice tasks was developed using Ngene software (v.1.3). The 27 choice tasks were further blocked into 3 separate surveys of 9 choice sets each. An ‘opt-out' was included in the experiment to allow respondents to reject the two alternatives in a given choice scenario where such alternatives have not reflected their preferred choice. The Multinomial Logit Regression was chosen to determine the main effect of the five attributes (the independent variables) on the choice alternatives (the dependent variables) upon when the discrete choice experiment is implemented. Overall, nine choice tasks were deemed sufficient per survey to fit a regression model while minimising time and cognitive burden on the participants. Targeting the uptake of exercise-promoting structured patient education intervention can be particularly challenging among men with prostate cancer, especially in care contexts like Cape Town, South Africa, such intervention does not yet form part of patients' core management suite. This thesis recognises the place of discrete choice experiments in designing and implementing effective complex interventions like structured patient education interventions. It is thus hoped that this thesis and, ultimately, the implementation of the discrete choice experiment amount to well-invested efforts in the quest for effective strategies to increase daily/weekly exercise among prostate cancer survivors and mainstream exercise oncology in standard cancer care practice in Cape Town, South Africa.

Keywords

Medicine

Reference:

Collections

Masters

Full item page