Respondent Understanding in Discrete Choice Experiments: A Scoping Review

Area of Science:

• Health Economics
• Health Services Research
• Behavioral Science

Background:

• Participant understanding is vital for the validity and reliability of discrete choice experiment (DCE) results.
• Limited research exists on how participants understand DCEs, particularly within health contexts.
• The conceptualization of 'understanding' in health-related DCEs requires further investigation.

Purpose of the Study:

• To systematically review and identify how participant understanding is conceptualized in the health DCE literature.
• To address research questions on the definition, measurement, and application of participant understanding in DCEs.

Main Methods:

• Conducted comprehensive searches in MEDLINE, EMBASE, PsychINFO, and Econlit databases, supplemented by hand searching (June 2019).
• Included peer-reviewed health-related DCE or best-worst scaling (BWS3) studies assessing participant understanding.
• Employed a descriptive analytical approach to extract and categorize data on study characteristics, understanding definitions, measurement methods, and usage.

Main Results:

• Analyzed 75 included studies, categorizing them into applied DCEs (n=52), pretesting studies (n=7), and studies of understanding (n=16).
• Understanding was typically defined by the choice context (e.g., attribute terminology) or the act of choosing; respondent engagement was rarely considered.
• Measurement primarily involved qualitative pretesting, rationality/validity tests, and self-report, with inconsistent reporting and utilization of results.

Conclusions:

• Researchers and practitioners must carefully select, justify, and report the measurement and impact of participant understanding in health DCEs.
• Further research is needed on the components of understanding (especially engagement), its impact on DCE validity/reliability, optimal measurement tools, and methods to enhance understanding.