Poverty is endemic in the highly populated Eastern Gangetic Plains where agriculture is critical to more than half the population. However, the mechanisms to support agriculture for development are contested. For example, some have advocated a strong role for government support and assistance due to market weaknesses, while others have promoted the need for more market-oriented approaches. We use an elicitation process focussed on expert policymaking communities, employing stated preference techniques to explore these options. Differences in perceptions about the effectiveness of policies and their delivery are reported between countries, while also empirically examining the influence of the respondents' organisational background. The results show support for policies that improve farmers' access to inputs, especially when delivered by private sector actors. The research provides an important contribution to the literature on policies for agricultural development.

This project concerns the impacts of food hypersensitivity on people’s quality of life and the monetary value people assign to the removal of those impacts. Food hypersensitivities (FHS) are, in this report, defined as comprising food allergy, coeliac disease and food intolerance. Estimates of the economic value of removal of food hypersensitivity were generated from a stated preference (SP) survey in which people completed a discrete choice experiment (DCE). The DCE comprised of choices between (i) no change in respondents’ food hypersensitivity and (ii) the condition being removed for a specified period, at a cost. The surveys were conducted between July and December 2021 by adults regarding their own food hypersensitivity or by parents/carers regarding their child’s food hypersensitivity. The samples comprised 1426 adults and 716 parents. The average WTP for the removal of an adult’s FHS for a year, pooled across all conditions was £718. For models estimated separately by condition, the WTP values for food allergy, coeliac disease and food intolerance were £1064, £1342 and £540 respectively. In models estimated on DCE data from parents regarding their children’s food hypersensitivity the average WTP, pooled across all conditions, was £2501. The annual WTP values by condition were: £2766 for food allergy; £1628 for coeliac disease; £1689 for food intolerance. Respondents rated their (child’s) health and the impacts of their (child’s) FHS using several established instruments including the Food Allergy Quality of Life Questionnaire (FAQLQ); Food Intolerance Quality of Life Questionnaire (FIQLQ); Coeliac Disease Quality of Life Questionnaire, (CDQ). In the adult allergy and intolerance models we find robust evidence of effects of the perceived severity of FHS on WTP – the higher people’s FAQLQ and FIQLQ scores, the more they are willing to pay to remove their condition. There was no effect of variation in the CDQ score on WTP to remove coeliac disease. In the child WTP results we find condition-severity effects in the coeliac sample: the worse the child’s CDQ score the higher the parents’ WTP to remove the condition. The WTP values are estimates of the combined annual costs associated with (i) the intangible costs including the pain, anxiety, inconvenience and anxiety caused by FHS and (ii) additional incurred costs (time and money) and lost earnings. The values can be incorporated into the FSA Cost of Illness (COI) model, the Burden of Foodborne disease in the UK (Opens in a new window) which is currently used to measure the annual, social, cost of foodborne disease. A Best Worst Scaling (BWS) exercise was conducted to identify the relative importance of the many and diverse impacts which comprise the FAQLQ, FIQLQ and CDQ instruments. The BWS results indicate that people assign very different levels of importance to the impacts comprising the three instruments. This unequal prioritisation contrasts with the equal weighting used in the construction of the FAQLQ, FIQLQ and CDQ measures. Embarrassment and fear related to eating out or social situations feature in the top three impacts for all the conditions. Identifying the effects which most affect quality of life (from the perspective of people living with those conditions) has the potential to inform policy and practice by both regulators and private organisations such as food business operators.

Food hypersensitivities (FH) include food allergy, food intolerance and coeliac disease. Food allergy and coeliac disease involve an immune mediated reaction to certain foods; food intolerance is caused by a non-immune mediated reaction (such as an enzymatic or pharmacological effect). Each of these FHs result in unpleasant symptoms if the food is eaten in sufficient quantity, with food allergic reactions sometimes resulting in life-threatening symptoms. Management of FH by an individual or members of their family therefore involves constant vigilance and risk assessment to determine if a food is safe to eat. Research over the last twenty years has demonstrated that this burden, along with the unpredictable nature of FH reactions, has an impact on quality of life (QoL). QoL encompasses our emotions, physical health, the environment we live in, our social networks and day-to-day activities. FH has been shown to have an impact on many of these areas, however there are still research gaps. In particular, many studies focus on children, adolescents or parents rather than the adult population and little is known about those with food intolerances. In order to make a comprehensive characterisation and evaluation of the burden caused by living with FH, the day-to-day management of FH and associated inconveniences, the FSA has commissioned this project, led by Aston University. The project is called the FoodSensitive study and this report relates to findings for workstream one, a survey to assess the impact of FH on QoL. This survey was carried out in two waves, one year apart. This report covers the second wave and a comparison of wave one and two for those participants who completed both waves.

We commissioned this survey to better understand how food allergies, intolerances and coeliac disease affect people across the UK, and the factors associated with higher or lower quality of life. It will also inform our ongoing work to monitor and evaluate the success of the FSA’s food hypersensitivity programme. The FSA will be running a second wave of the survey in autumn this year, and we will use this to observe any differences in the eating out and quality of life data collected across the two timepoints.

Pollutants found in the water and air environment represent an ever-growing threat to human health. Contact with some air-, water- and foodborne pathogens (e.g. norovirus) results in gastrointestinal diseases and outbreaks. For future risk mitigation, we aimed to measure people's awareness of waterborne and foodborne norovirus relative to other environment-associated pollutants (e.g. pesticides, bioaerosols, antibiotic resistant bacteria) and well-known risks (e.g. diabetes, dementia, terrorist attack). We used an online survey, which included a best-worst scaling component to elicit personal levels of control and fear prompted by norovirus relative to 15 other risks. There was a negative correlation between levels of fear vs. control for all 16 measured risks. Perceived infection control levels were higher amongst women compared to men and correlated with age and the level of qualification in both groups. Participants who had sought advice regarding the symptoms caused by norovirus appeared to have more control over the risks. Norovirus is associated with high levels of fear, however, the levels of control over it is low compared to other foodborne illnesses, e.g. Salmonella. Addressing this deficit in the public's understanding of how to control exposure to the pathogen in an important health need.

The psychometric paradigm has dominated the field of empirical work analysing risk perceptions. In this paper, we use an alternative method, Best-Worst Scaling (BWS), to elicit relative risk perceptions concerning potentially unsafe domestic food behaviours. We analyse heterogeneity in those risk perceptions via estimation of latent class models. We identify 6 latent segments of differing risk perception profiles with the probability of membership of those segments differing between experts and the lay public. The BWS method provides a practical approach to assessing relative risks as the choices made by the participants and subsequent analysis have a strong theoretical basis. It does so without the influence of scale bias, the cognitive burden of ranking a large number of items or issues of aggregation of data, often associated with the more commonly used psychometric paradigm. We contend that BWS, in conjunction with latent class modelling, provides a powerful method for eliciting risk rankings and identifying differences in these rankings in the population.

The desire to understand the preferences of patients, healthcare professionals and the public continues to grow. Health valuation studies, often in the form of discrete choice experiments, a choice based survey approach, proliferate as a result. A variety of methods of pre-choice process analysis have been developed to investigate how and why people make their decisions in such experiments and surveys. These techniques have been developed to investigate how people acquire and process information and make choices. These techniques offer the potential to test and improve theories of choice and/or associated empirical models. This paper provides an overview of such methods, with the focus on their use in stated choice-based healthcare studies. The methods reviewed are eye tracking, mouse tracing, brain imaging, deliberation time analysis and think aloud. For each method, we summarise the rationale, implementation, type of results generated and associated challenges, along with a discussion of possible future developments.

A common goal in psychological research is the measurement of subjective impressions, such as first impressions of faces. These impressions are commonly measured using Likert ratings. Although these ratings are simple to administer, they are associated with response issues that can limit reliability. Here we examine best-worst scaling (BWS), a forced-choice method, as a potential alternative to Likert ratings for measuring participants’ facial first impressions. We find that at the group level, BWS scores correlated almost perfectly with Likert scores, indicating that the two methods measure the same impressions. However, at the individual participant level BWS outperforms Likert ratings, both in terms of ability to predict preferences in a third task, and in terms of test-retest reliability. These benefits highlight the power of BWS, particularly for use in individual differences research.

Background. Discrete choice experiments (DCEs) are increasingly used to elicit preferences for benefit-risk tradeoffs. The primary aim of this study was to explore how eye-tracking methods can be used to understand DCE respondents’ decision-making strategies. A secondary aim was to explore if the presentation and communication of risk affected respondents’ choices. Method. Two versions of a DCE were designed to understand the preferences of female members of the public for breast screening that varied in how risk attributes were presented. Risk was communicated as either 1) percentages or 2) icon arrays and percentages. Eye-tracking equipment recorded eye movements 1000 times a second. A debriefing survey collected sociodemographics and self-reported attribute nonattendance (ANA) data. A heteroskedastic conditional logit model analyzed DCE data. Eye-tracking data on pupil size, direction of motion, and total visual attention (dwell time) to predefined areas of interest were analyzed using ordinary least squares regressions. Results. Forty women completed the DCE with eye-tracking. There was no statistically significant difference in attention (fixations) to attributes between the risk communication formats. Respondents completing either version of the DCE with the alternatives presented in columns made more horizontal (left-right) saccades than vertical (up-down). Eye-tracking data confirmed self-reported ANA to the risk attributes with a 40% reduction in mean dwell time to the “probability of detecting a cancer” (P = 0.001) and a 25% reduction to the “risk of unnecessary follow-up” (P = 0.008). Conclusion. This study is one of the first to show how eye-tracking can be used to understand responses to a health care DCE and highlighted the potential impact of risk communication on respondents’ decision-making strategies. The results suggested self-reported ANA to cost attributes may not be reliable.

An induced value laboratory experiment is conducted to explore the vulnerability of discrete choice experiments to strategic misrepresentation of preferences. We consider strategic behaviour to arise when an agent: (i) believes the choice experiment will be used to determine a provision decision over a discrete set of alternatives; and (ii) has expectations about the relative likelihood of those alternatives being selected and delivered. In the experiment, agents receive induced values for the discrete set of provisioning alternatives. In treatments where agents receive information that their first best outcome is unlikely to win, we investigate the extent to which their choices change, in a manner consistent with them seeking to deliver their second best outcome in the provisioning decision. We find that 27% of respondents misrepresent their preferences and reveal evidence of strategic bias. We find that this behaviour is sufficient to change inferences about preferred provision at the aggregate level.

Risk is increasingly used as an attribute in discrete choice experiments (DCEs). However, risk and probabilities are complex concepts that can be open to misinterpretation, potentially undermining the robustness of DCEs as a valuation method. This study aimed to understand how respondents made benefit–risk trade-offs in a DCE and if these were affected by the communication of the risk attributes.

Background: The relative benefits and risks of screening programs for breast cancer have been extensively debated. Objectives: To quantify and investigate heterogeneity in women's preferences for the benefits and risks of a national breast screening program (NBSP) and to understand the effect of risk communication format on these preferences. Methods: An online discrete choice experiment survey was designed to elicit preferences from female members of the public for an NBSP described by three attributes (probability of detecting a cancer, risk of unnecessary follow-up, and out-of-pocket screening costs). Survey respondents were randomized to one of two surveys, presenting risk either as percentages only or as icon arrays and percentages. Respondents were required to choose between two hypothetical NBSPs or no screening in 11 choice sets generated using a Bayesian D-efficient design. The trade-offs women made were analyzed using heteroskedastic conditional logit and scale-adjusted latent class models. Results: A total of 1018 women completed the discrete choice experiment (percentages-only version = 507; icon arrays and percentages version = 511). The results of the heteroskedastic conditional logit model suggested that, on average, women were willing-to-accept 1.72 (confidence interval 1.47-1.97) pound additional unnecessary follow-ups and willing to-pay 79.17 pound (confidence interval 66.98- 91.35) for an additional cancer detected per 100 women screened. Latent class analysis indicated substantial heterogeneity in preferences with six latent classes and three scale classes providing the best fit. The risk communication format received was not a predictor of scale class or preference class membership. Conclusions: Most women were willing to trade-off the benefits and risks of screening, but decision makers seeking to improve uptake should consider the disparate needs of women when configuring services.

Objectives: To examine the extent, and nature, of impact on junior doctors' career decisions, of a proposed new contract and the uncertainty surrounding it.Design: Mixed methods. Online survey exploring: doctors' future training intentions; their preferred specialty training (ST) programmes; whether they intended to proceed immediately to ST; and other plans. Linked qualitative interviews to explore more fully how and why decisions were affected.Setting: Doctors (F2s) in second year of Foundation School (FS) Programmes in England.Participants Invitations sent by FSs. Open to all F2s November 2015-February 2016. All FSs represented. Survey completed by 816 F2s. Sample characteristics broadly similar to national F2 cohort.Main outcome measures: Proportions of doctors intending to proceed to ST posts in the UK, to defer or to exit UK medicine. Proportion of doctors indicating changes in training and career plans as a result of the contract and/or resulting uncertainty. Distribution of changes across training programmes. Explanations of these intentions from interviews and free text comments.Results: Among the responding junior doctors, 20% indicated that issues related to the contract had prompted them to switch specialty and a further 20% had become uncertain about switching specialty. Switching specialty choice was more prevalent among those now choosing a community-based, rather than hospital-based specialty. 30% selecting general practice had switched choice because of the new contract. Interview data suggests that doctors felt they had become less valued or appreciated in the National Health Service and in society more broadly.Conclusions: Doctors reported that contract-related issues have affected their career plans. The most notable effect is a move away from acute to community-based specialities, with the former perceived as more negatively affected by the proposed changes. It is concerning that young doctors feel undervalued, and this requires further investigation.

Campylobacter contamination of chicken on sale in the UK remains at high levels and has a substantial public health impact. This has prompted the application of many interventions in the supply chain, including enhanced biosecurity measures on-farm. Catching and thinning are acknowledged as threats to the maintenance of good biosecurity, yet the people employed to undertake this critical work (i.e. 'catchers') are a rarely studied group. This study uses a mixed methods approach to investigate catchers' (n=53) understanding of the biosecurity threats posed by the catching and thinning, and the barriers to good biosecurity practice. It interrogated the role of training in both the awareness and practice of good biosecurity. Awareness of lapses in biosecurity was assessed using a Watch-&-Click hazard awareness survey (n=53). Qualitative interviews (n=49 catchers, 5 farm managers) explored the understanding, experience and practice of catching and biosecurity. All of the catchers who took part in the Watch-&-Click study identified at least one of the biosecurity threats with 40% detecting all of the hazards. Those who had undergone training were significantly more likely to identify specific biosecurity threats and have a higher awareness score overall (48% compared to 9%, p=0.03). Crucially, the individual and group interviews revealed the tensions between the high levels of biosecurity awareness evident from the survey and the reality of the routine practice of catching and thinning. Time pressures and a lack of equipment rather than a lack of knowledge appear a more fundamental cause of catcher-related biosecurity lapses. Our results reveal that catchers find themselves in a 'catch-22' situation in which mutually conflicting circumstances prevent simultaneous completion of their job and compliance with biosecurity standards.3 Hence, although education about, and enforcement of, biosecurity protocols has been recommended, our findings suggest that further reforms, including changing the context in which catching occurs by improving the equipment and other resources available to catchers and providing more time for biosecurity, will be essential for successful implementation of existing biosecurity protocols.

Background. The use of qualitative research (QR) methods is recommended as good practice in discrete choice experiments (DCEs). This study investigated the use and reporting of QR to inform the design and/or interpretation of healthcare-related DCEs and explored the perceived usefulness of such methods. Methods. DCEs were identified from a systematic search of the MEDLINE database. Studies were classified by the quantity of QR reported (none, basic, or extensive). Authors ( n = 91) of papers reporting the use of QR were invited to complete an online survey eliciting their views about using the methods. Results. A total of 254 healthcare DCEs were included in the review; of these, 111 (44%) did not report using any qualitative methods; 114 (45%) reported “basic” information; and 29 (11%) reported or cited “extensive” use of qualitative methods. Studies reporting the use of qualitative methods used them to select attributes and/or levels ( n = 95; 66%) and/or pilot the DCE survey ( n = 26; 18%). Popular qualitative methods included focus groups ( n = 63; 44%) and interviews ( n = 109; 76%). Forty-four studies (31%) reported the analytical approach, with content ( n = 10; 7%) and framework analysis ( n = 5; 4%) most commonly reported. The survey identified that all responding authors ( n = 50; 100%) found that qualitative methods added value to their DCE study, but many ( n = 22; 44%) reported that journals were uninterested in the reporting of QR results. Conclusions. Despite recommendations that QR methods be used alongside DCEs, the use of QR methods is not consistently reported. The lack of reporting risks the inference that QR methods are of little use in DCE research, contradicting practitioners’ assessments. Explicit guidelines would enable more clarity and consistency in reporting, and journals should facilitate such reporting via online supplementary materials.

An important motivation for the implementation of the Water Framework Directive is the creation of non-market environmental benefits, such as improved ecological quality, or greater opportunities for open-access river recreation via microbial pollution remediation. Pollution sources impacting on ecological or recreational water quality may be uncorrelated, but non-market benefits arising from riverine improvements are typically conflated within benefit valuation studies. Using stated preference choice experiments embedded within a survey that also collected respondents’ socio-economic characteristics, we aimed to disaggregate these sources of value for different river users, thereby allowing decision makers to understand the consequences of adopting alternative investment strategies. Our results suggested that anglers derived greater value from improvements to the ecological quality of river water, in contrast to swimmers and rowers, for whom greater value is gained from improvements to recreational quality. More generally, we found three distinct groups of respondents: a majority preferring ecological over recreational improvements, a substantial minority holding opposing preference orderings, and a yet smaller proportion expressing relatively low values for either form of river quality enhancement. As such, this research demonstrates that the non-market benefits that may accrue from different types of water quality improvements are nuanced in terms of their potential beneficiaries and, by inference, their overall value and policy implications.

Foodborne disease poses a serious threat to public health. In the UK, half a million cases are linked to known pathogens and more than half of all outbreaks are associated with catering establishments. The UK Food Standards Agency (FSA) has initiated the UK Food Hygiene Rating Scheme in which commercial food establishments are inspected and scored with the results made public. In this study we investigate the prevalence of food risk increasing behaviours among chefs, catering students and the public. Given the incentive for respondents to misreport when asked about illegal or illicit behaviours we employed a Randomised Response Technique designed to elicit more accurate prevalence rates of such behaviours. We found 14% of the public not always hand-washing immediately after handling raw meat, poultry or fish; 32% of chefs and catering students had worked within 48 hours of suffering from diarrhoea or vomiting. 22% of the public admitted having served meat "on the turn" and 33% of chefs and catering students admitted working in kitchens where such meat was served; 12% of the public and 16% of chefs and catering students admitted having served chicken at a barbeque when not totally sure it was fully cooked. Chefs in fine-dining establishment were less likely to wash their hands after handling meat and fish and those who worked in award winning restaurants were more likely to have returned to work within 48 hours of suffering from diarrhoea and vomiting. We found no correlation between the price of a meal in an establishment, nor its Food Hygiene Rating Score, and the likelihood of any of the food malpractices occurring.