Preferences for neurodevelopmental follow-up care for children

Authors: Pakhi Sharma1, Sanjeewa Kularatna1,2, Bridget Abell1, Steven M McPhail1,3, Sameera Senanayake1,2
Affiliations:
1 Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
2 Health Services and Systems Research, Duke-NUS Medical School, Singapore.
3 Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia.

Summary:

Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services are common. The design and delivery of these services may improve if service provision aligns with families’ needs and preferences for receiving care. Our study suggests that policymakers, particularly those designing and commissioning neurodevelopmental follow-up services for children, may prioritise enhancing face-to-face follow-up in local clinics, reducing wait times and costs, providing mental health and educational resources, and improving care coordination to optimise service delivery.

To understand families’ preferences for neurodevelopmental follow-up care for children, we used a preference research method called a Discrete Choice Experiment (DCE). A DCE explores what people value most when making choices, using questions or ‘choice tasks’ made up of different options with various features. For this study, the features were selected through a systematic review, family interviews, and expert panel discussions. The choice tasks were designed to represent different combinations of features. After pilot testing, we administered the survey to families of children with neurodevelopmental delays. For analysis, we used a latent class model, which helps in identifying ‘latent’ or ‘hidden’ groups within the sample who may have different preferences. We also estimated which features were most important to families’ decisions and explored potential outcomes under different hypothetical scenarios.

We received 301 responses. Two latent classes were observed (Table 1).

Table 1. DCE survey results

Latent class 1 Latent class 2
Respondent features
More families with full-time employees, higher incomes, and those living in metropolitan areas were likely to be in class 1 compared with class 2. More families with part-time or casual employees, slightly lower income,  and a higher representation of individuals from regional areas were likely to be in class 2 when compared with class 1.
Preferences identified from DCE analysis
Preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting less than three months. Disliked city hospitals, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. No significant differences were noted in follow-up modality, receiving educational information, or appointment management.
Most influential attribute when selecting an alternative
Location Cost
Hypothetical uptake of follow-up care, estimated under three different hypothetical scenarios, if an ‘ideal’ scenario taking into account preferences was implemented
2% 24%

Integrating families’ preferences may foster greater engagement and potentially increase care uptake, particularly if services are tailored to various demographic groups. Health insurance policymakers may use our findings to expand coverage for education and mental health support for families. These insights may be particularly relevant for Child Health Services and Child Development Services in Queensland, the main public providers of neurodevelopmental follow-up care, which may improve long-term outcomes for children with neurodevelopmental needs and their families.

Source: Photo by Upsplash