Regular self-monitoring of glucose levels is integral to diabetes management to achieve glycaemic control and reduce the risk of acute and long-term complications. Wearable glucose monitoring devices provide more comprehensive information on glucose fluctuations than traditional finger-prick testing. However, access restrictions contribute to inequalities in adoption. This study elicited the preferences of patients with type 1 diabetes in the UK and Canada for attributes of glucose monitoring devices. An online discrete choice experiment was conducted among adults (aged ≥ 18 years) with type 1 diabetes. Respondents chose between standard finger-prick testing (usual care) and two hypothetical glucose monitoring devices described using six attributes: convenience of monitoring, time lag, level of information, alarm to signal low and high glucose levels, glycated haemoglobin level and time in range, and an out-of-pocket monthly cost. Responses were analysed using a mixed logit model, and marginal willingness to pay was calculated. A pooled model using country interaction terms was used to formally compare preferences across countries. The discrete choice experiment was completed by 112 UK and 102 Canadian respondents. Across countries, respondents preferred devices offering convenience, alarm capabilities, real-time glucose readings and more comprehensive glucose information. Preferences were broadly consistent across countries, with only preferences for alarm functionality differing significantly. However, substantial preference heterogeneity was observed within both countries, indicating variation in the device characteristics valued by individuals. Overall, the discrete choice experiment results indicate that adults with type 1 diabetes preferred characteristics relating to the newer glucose monitoring devices. Substantial variation in individual preferences suggests that access to a range of glucose monitoring devices may be important to accommodate differences in the characteristics patients value.
This study aimed to elicit the preferences of Quebec adults regarding consultation modalities with a general practitioner (GP) and to examine how clinical and socioeconomic factors shape stated preferences for telephone and video modalities. Participants were recruited via quota-based sampling to reflect Quebec’s demographic profile (age, gender, and education) through a structured online survey conducted in 2025. The study employed a discrete choice experiment (DCE) featuring seven key attributes to elicit preferences for three synchronous consultation modalities: in-person, telephone, and video. Preferences and trade-offs were analyzed using mixed logit models. Willingness to pay (WTP) was calculated, and the influence of socioeconomic and clinical factors on the utility of digital care was examined. Finally, policy-relevant scenarios were simulated to estimate predicted choice probabilities and welfare implications. A total of 1303 responses were analyzed. The most important attributes were total cost, patient–GP relationship and continuity of care, appointment availability, and consultation modality. In-person consultations remained the preferred option, with participants requiring compensation of 27.05 Canadian dollars (CAD) to accept a telephone consultation and CAD 29.37 for a video consultation in place of an in-person visit. The highest valuation was placed on continuity of care, with a WTP of CAD 45.43 to avoid consulting an unfamiliar GP without regular access to the patient’s health record. Higher educational attainment was associated with significantly less negative preferences for video consultation. Scenario simulations showed that conditional choice probabilities exceeded 0.8 under ideal conditions, while in the best-case scenario, WTP was higher for in-person consultation (CAD 85.69) than for telephone (CAD 58.81) or video (CAD 56.62). In-person visits remain the preferred option in Quebec. Telephone carried the smaller penalty and was valued consistently in the WTP-space model, whereas preferences for video varied more and were more favorable among respondents with higher education. Future service design should integrate virtual options without losing the continuity of care and affordability that patients value.
To make informed choices in health-related discrete choice experiments (DCEs), respondents need to understand the choice scenarios, alternatives, attributes and attribute levels presented to them. Respondent populations are often highly diverse in knowledge and experience, leading to varying informational needs that make it challenging to design educational materials that sufficiently inform all respondents without disengaging others. At present, however, structured guidance on developing DCE educational materials is lacking. Drawing on the instructional design literature, this paper investigates whether theory-driven adaptations to educational materials improve respondent comprehension and engagement in health-related DCEs. Informed by three focus groups on DCE informational needs, we identified four design principles from the instructional design literature relevant to DCE educational materials: whole-task instruction, making inferences explicit, adapting information to respondents’ prior knowledge and embedding self-check questions with corrective feedback. Educational materials for three existing DCEs (influenza vaccination, colorectal cancer screening and rheumatoid arthritis prevention) were redesigned to incorporate these principles. Panel respondents (N = 1754) were randomized to receive either the original or the adapted educational materials, and effects on comprehension, engagement, internal validity and choice consistency were assessed. Adapted materials increased time spent on educational content and were associated with small improvements in selected comprehension outcomes, though effects were often not statistically significant against the co-created comparator. Self-check questions revealed considerable comprehension gaps regardless of condition, underscoring that co-creation and pre-testing alone do not guarantee sufficient respondent comprehension. Educational materials also emerged as a meaningful source of selective dropout in all surveys, predominantly among respondents with lower education levels, posing a risk to sample representativeness that warrants attention in future research. Adapting DCE educational materials based on educational theory and instructional design principles offers a promising approach to improving respondent engagement and understanding. To enable cumulative learning, we further encourage researchers to report comprehension outcomes and publish educational materials as supplementary materials.
There is an unmet need for effective and well-tolerated oral formulations of glucagon-like peptide 1 receptor agonists for the management of type 2 diabetes. Orforglipron and oral semaglutide are two oral glucagon-like peptide 1 receptor agonists evaluated in the ACHIEVE-3 clinical trial (NCT06045221). These novel treatments have the means to achieve clinically meaningful glycemic control and weight reduction, which may result in substantial positive changes in patients’ daily lives. The objective of this study was to conduct exit interviews following the ACHIEVE-3 trial to characterize positive treatment experiences and outcomes, beyond glycated hemoglobin and weight reduction, reported by patients living with type 2 diabetes who received oral glucagon-like peptide 1 receptor agonist-based treatments. Qualitative interviews were conducted across ten clinical sites within the USA with patients who had enrolled in ACHIEVE-3 and completed at least 3 months of treatment. Interviews were conducted in English or Spanish, audio-recorded, and transcribed. Transcripts were analyzed to identify and categorize positive treatment benefits reported during the interviews. Descriptive statistics were used to characterize the sample. Sixty patients completed the qualitative exit interviews. Patients had a mean age of 59.1 years (standard deviation [SD] = 10.3), and almost half were female (n = 28, 46.7
Acute leukaemia is an aggressive rapidly-progressing form of blood cancer that often requires intensive treatment, placing substantial demands on informal carers. In this study, we aimed to explore the lived experience of informal carers of adults with acute leukaemia, including the impact of caregiving on their quality of life and their role in treatment decisions, across six countries. We conducted a multinational mixed-methods study using semi-structured interviews with 60 informal carers of adults with acute leukaemia in the UK (n = 20), USA (n = 20), France (n = 5), Germany (n = 5), Italy (n = 5) and Spain (n = 5). Demographic data and data from the administration of Family Reported Outcome Measure (FROM-16) were collected prior to the interviews. Interview transcripts were analysed using reflexive thematic analysis. Informal carers reported a substantial burden: 59
