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. 2025 Sep 18.
doi: 10.1007/s40271-025-00774-2. Online ahead of print.

Attribute Development and Level Selection for a Discrete Choice Experiment to Elicit Care Preferences of Older Adults and Informal Caregivers Aging in Place in The Netherlands

Isabelle Vullings  1   2 , Luis Pilli  3   4 , Marie-Julie C H Russchen  5 , Nanon H M Labrie  6   7 , Joffre Swait  3   4 , Özgül Uysal-Bozkir  8 , Joost Wammes  5   9   10 , Janet L MacNeil Vroomen  5   9
Affiliations

Attribute Development and Level Selection for a Discrete Choice Experiment to Elicit Care Preferences of Older Adults and Informal Caregivers Aging in Place in The Netherlands

Isabelle Vullings et al. Patient. .

Abstract

Background: The Netherlands reformed its long-term care policy to encourage older adults to age in place with the support of informal caregivers. It remains unclear whether the available care and support options align with the needs and preferences of older adults and caregivers. Discrete choice experiments (DCE) are increasingly used to identify individual preferences. This study describes the development of attributes (e.g., emotional support) and attribute levels (e.g., psychologist and case manager) for a DCE on aging-in-place preferences among older adults and informal caregivers in The Netherlands.

Methods: Semi-structured interviews were conducted with older adults and informal caregivers to identify key components for successful aging in place. Interviews were transcribed, and reflexive thematic analysis identified patterns that led to a list of attributes. Visuals of these attributes were created and presented to a new sample of informal caregivers and older adults in focus groups to rank attributes and define attribute levels.

Results: Attributes identified through the interviews (N = 28) included housing, personal care, household tasks, transportation, social activities, digital skills, and help navigating the healthcare system. Focus groups (N = 35) found that older adults prioritized housing, while informal caregivers prioritized navigating the healthcare system. Transportation and digital skills were ranked as the least important and were excluded from the final list of attributes.

Conclusions: Our findings provide a detailed understanding of aging-in-place preferences of older adults and informal caregivers. These insights will inform a DCE to quantify preferences and provide evidence for policymakers. This study increases transparency about the process of attribute development and level selection, contributing to the quality of the final DCE study.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests to report. Ethics: On the basis of the study protocol, the Ethics Committee (METC) of the Amsterdam University Medical Centre waived the obligation for the study to undergo formal ethical approval as is described under Dutch law in the Medical Research in Humans Act, January 2019 (ref. no. W23_112 #23.137). Consent to participate: All participants provided written informed consent prior to the interviews and focus group discussions. Consent for publication: All authors have read and approved the final version of the manuscript and consent to its publication. Informed consent: Written informed consent was obtained from participants. Data availability: Owing to the nature of this qualitative study, the interview and focus group transcripts contain sensitive information. To protect participant confidentiality, these data are not publicly available. Code availability: Please contact the corresponding author for requests regarding study materials and analysis code. Author contributions: J.M.V. conceptualized the study and developed the study design together with the other researchers. I.V. contributed to the development of the study design and data collection and analysis. The authors provided input for the study design from their own area of expertise; inclusive research (Ö.U.B.), qualitative research (N.L. and J.W.), and discrete choice experiments (E.G.B. and J.S.). M.J.C.H.R. contributed to data collection and analysis. I.V. wrote the manuscript, and the co-authors read, edited, and approved the final version.

References

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