SUPPLEMENT File 1: Attribute selection
Here we describe the process of selecting attributes for this study. The steps are shown in Fig 1.
Figure 1
Literature Review
We started off by conducting a literature review, where we searched for previous research of what recipients think is important when receiving test result from a health check. Listing of possible factors important to receiver when receiving test result from a health-check.
Listing possible attributes
Based on the literature review we listed possible attributes on the basis that they were plausible, realistic and tradeable. Many factors mentioned in the previous research were in fact levels of the same attribute. Many factors were also related to the context of the health-check and not to how the test results were communicated, e.g. many recipients valued a good relationship with the health care provider and some wanted a good
description of the aim of the health-check to better understand the results. Since the context were important, we made sure to describe the context of the DCE instead of including it as an attribute.
Input from experts
We talked to three experts working in the field of cardiovascular risk and health-checks. They were all researchers with background in medicine and risk communication. They gave us their thoughts on how test result should be communicated and gave feedback on the list of attributes. For instance, they emphasized the cost associated when offering consultation time and more individualized test results. They also gave input on possible factors that could predict differences in how people prefer to receive their test results.
At this moment, the list consisted of 12 attributes.
Nominal group technique – group discussions
We conducted three focus groups (n=9) age 40-65. The participants were asked to rank their top-five most important attributes from the list of twelve. They were also able to add attributes that they thought were missing from the list. After that followed a group discussion, where they shared and motivated their choices. After the discussion, they had the possibility to change their ranking. No additional attributes were added but the
discussions gave rise to possible reasons to why people want different things. E.g. a few of the older participants said that the interest of health-checks increase with age making them willing to pay more and wanting more comprehensive information while the younger participants settled for a basic response. It was also clear that people without medical training found it difficult to interpret basic lab numbers. We also asked the participants how much they would be willing to pay a health check to guide when deciding the attribute levels. After the discussions, all ranking were summed up.
The top-ranked attributes in three group:
Group 1: (two older men, one younger, none was medical trained): receiving an overall assessment, lifestyle recommendations, consultation time, lab report, waiting time.
Group 2: (an older man and an older woman both with chronic diseases): waiting time, consultation time, notification method, overall assessment, test results written in everyday words.
Group 3: (four woman age 40-65): test result written in every day words, lab report, consultation time, waiting time, overall assessment.
Literature review
Listing possible attributes Expert input
Nominal Group Technique Ranking survey
Many factors related to how the results are formulated resulted in levels of the same attribute.
Ranking survey
To increase the number of rankings, we sent out an electronic ranking survey to a convenience sample through social media. The survey included the same list of twelve attributes that were used in the NGT-discussions. We received 52 responses. In the end of the survey, the respondents were able to add attributes that, they though was missing which some did. One wanted a calculated risk score in percentages. Since that is already recommended by current guidelines, it is not a tradable attribute and were not included. Two asked for a follow-up, which is too similar to consultation time to be included as an additional attribute. One asked for knowing the reliability of the test results. Since it only appeared once and was not mentioned in the literature search, it was excluded.
Three comments included the competence of the provider, good conversation with the provider and a safe atmosphere at the provider.
Attributes with best mean scores: Overall assessment, consultation time, lifestyle recommendations, waiting time, the aim of the test, receiving a lab report.
Attributes that were number one ranked most times: waiting time, consultation time, overall assessment, lifestyle recommendations
We could also see that respondents, who answered that they were not medically trained, valued receiving their result in every day words.
Final selection of attributes
When deciding on the final selection of attributes we looked at the ranking scores and therefore picked waiting time, consultation time, and lifestyle recommendations. Several of the attributes (overall assessment, lab-report, every day words, and aim of the test) are all related to how the written test results are formulated. Therefore, we decided to use them as different levels of the same attribute (written results). Cost was not ranked high by the respondent but judged to be too policy relevant to be left out. Notification method was also scored low, however, we used social media to recruit people to our ranking survey, possibly creating a bias by excluding people who do not use internet in the same extent as others. In our previous qualitative work, it also got clear to us that not all people use their electronic health record and rather prefer an actual letter. Therefore, we added notification method as a final attribute.
