Preferences for investment in and allocation of additional healthcare capacity.

Policy makers need to make decisions regarding the allocation of scarce healthcare resources. We study preferences for investment in additional healthcare capacity and allocation between two regions, focusing on reducing waiting time for elective surgery for a physical health problem. We elicit preferences from a societal and an individual perspective, with unequal initial waiting times between the two regions. In an online survey, 1039 respondents were randomly assigned to one of three versions of the experiment: (1) a social planner perspective, placing respondents in the role of a policy maker; (2) an individual perspective where the respondent's own region was better off regarding initial waiting times; (3) an individual perspective where the individual's own region was worse off regarding initial waiting times. Respondents were asked to rank the status quo and five scenarios where the investment in additional capacity led to different distributions of shorter waiting times between regions. For all allocations we presented both the reduction in waiting time and the resulting final waiting time for both regions. We find that in version 1 of the experiment, preferences were in line with inequality aversion and Rawlsian preferences regarding final waiting time. In version 3, similar preferences were found, although here they also align with individualistic preferences. In version 2, preferences were more heterogeneous, with both individualistic and egalitarian preferences present. Concluding, individualistic and egalitarian preferences mostly concerned final waiting time. We therefore recommend policy makers to focus on the effect on final waiting time instead of the reduction of waiting time.

Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion.

BACKGROUND: Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. METHODS: Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women's needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. RESULTS: Women's primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. CONCLUSION: Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.

Motivation and preferences of cancer patients to perform physical training.

OBJECTIVE: The aims of this cross-sectional study were to investigate the knowledge about and experience with exercise as well as the motivation and preferences (e.g. availability) of cancer patients to participate in training groups. METHODS: From 11/2017-06/2018, 181 cancer patients undergoing or completing treatment responded to a compiled questionnaire. The stage of motivation (transtheoretical model of behavioural change), exercise-related knowledge, experience and preferences were evaluated. RESULTS: Knowledge about the positive effects of exercise was not associated with higher motivation stages. Higher motivation stages showed significant correlations with age (p = 0.044), exercise experience before cancer disease onset (p = 0.022) and exercise experience during cancer therapy (p = 0.013). For 59% of patients, group offers were an attractive option. Physically inactive patients preferred specialised cancer exercise groups (p = 0.002), whereas physically active patients preferred cross-disease rehabilitation exercise groups (p = 0.034) and exercise groups with healthy people (p = 0.018). CONCLUSIONS: Results indicate that motivation of cancer patients for exercise depends on their experiences with physical training before and during disease treatment. Motivation could be increased by integrating exercise programmes during cancer therapy. These programmes should focus on patients inexperienced in physical training.