1.4 Thesis aims and objectives
Aim #1: Conduct qualitative research to investigate women’s preferences for
consultant- and midwifery-led care and subsequent motivations when choosing place
of delivery.
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a) A key objective of this research is to identify women’s motivations when
choosing a model of maternity care. Initially, this objective is addressed by
collecting primary data via a number of focus groups with expectant mothers
and performing a thematic analysis of the data.
b) Provide important information to policy makers on women’s preferences for
alternative models of maternity care and identify potential barriers to the
successful implementation of midwifery-led care in Ireland.
Aim #2: Assess the performance of SP methodology to inform benefit valuations and
examine women’s strengths of preferences for consultant- and midwifery-led care in Ireland using a DCE and CVM.
The specific research objectives of Aim #2 are:
a) An important objective of this research is to investigate women’s strengths of
preferences for different features of consultant- and midwifery-led care in
Ireland using a DCE. A number of discrete choice models are explored to
examine whether preferences change given changes in underlying assumptions
about respondent’s choices. For instance, this analysis investigates whether preferences are fixed or vary across respondents.
b) A relatively recent innovation in DCE methodology is incorporated into the
study design. A dual response choice (DRC) format is proposed as a solution
to minimise information loss arising from the inclusion of an opt-out
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respondents one choice from a set of competing alternatives that include an
opt-out alternative, the DRC format is set up to capture the preferences of any
respondent that initially opts-out of a choice question by asking them to answer
a follow-up question where the opt-out alternative is no longer available. The
objective of this study is to assess the impact of this approach on choices by
comparing choice consistency across the initial and subsequent choice
scenarios.
c) The literature suggests that initial endowments of experience and knowledge
of a service’s availability influence preferences (Cartwright 1979; Hundley and Ryan 2004; Ryan and Ubach 2003; Salkeld et al 2000). Another objective of
the DCE is to explore whether these factors influence preferences in an Irish
context.
d) An important objective of the DCE is to model the potential demand for
consultant- and midwifery-led care in Ireland. Potential uptake for DOMINO
care is also explored given the flexibility of the DCE to explore different
combinations of attributes. These data are then used to calculate women’s WTP for maternity care, which is an important objective of this research as the DCE
is employed to assess the performance of the approach to benefit valuation.
e) A key objective of this research is to calculate women’s WTP for maternity care using the CVM for use in a CBA. Given certain methodological issues
associated with the different elicitation formats (Frew 2010a), two approaches
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the WTP question affects responses: an open-ended WTP question and a
payment scale WTP question. The literature suggests that the open-ended
question generates ill-considered valuations due to the absence of a cue
(Donaldson et al 1995; Frew et al 2003), and results in considerably higher
WTP valuations relative to the payment scale design which offers respondents
a choice of values (Donaldson et al 1997b). The objective of this analysis is to
test whether these approaches generate different WTP values.
f) Another objective of the CVM involves predicting preferences for consultant-
led care. In particular, this research explores the extent that preferences are influenced by previous obstetric experience, knowledge of a service’s availability, among other demographic characteristics including income, PHI
status, and ethnicity.
g) As this thesis employs two SP techniques to elicit monetary valuations of
maternity care, a key objective of this research is to assess the validity of the
WTP data. The CVM data in particular are compared and placed in the context
of private care in Ireland, which is the only package of care that has a market
price.
Aim #3: Perform a CBA on consultant- and midwifery-led care for a low risk woman
availing of maternity care in Ireland.
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a) A key objective of this research is to perform a cost analysis of consultant- and
midwifery-led care. This involves costing all aspects of maternity care,
including antenatal, intrapartum and postnatal care. The cost analysis
represents the most up to date information on the cost of a package of care for
a low risk woman in Ireland.
b) The final research objective involves comparing the costs and benefits of
consultant- and midwifery-led care in Ireland for a low risk woman availing of
maternity care within a net benefit framework. This analysis is designed to
inform policy makers on the worthwhileness of the two major models of
maternity care in Ireland.
The remainder of this chapter is set up as follows. In section 1.5, the structure of the
thesis is outlined and the sequence in which the above aims are addressed. Section 1.6
presents a summary of the main findings of this research. The chapter concludes in
section 1.7.