To position consumers and carers early in the decision making processes, an approach that recognises consumer expertise as equally important to that of other stakeholders is required. The current research program will therefore adopt a Customer (end-user) Relationship Management Framework (CRM), which is typically used for gaining competitive advantage by optimising customer value and business value [
20]. The use of CRM requires an understanding of how customer engagement or equity is built during the design and delivery of a service and how this links to its business value. CRM therefore necessitates an understanding of [
21]:
1.
The customer’s attitude towards the service/s or brand and perceptions of its subjective value (brand equity);
2.
The customer’s assessment of quality, convenience and price (value equity); and
3.
The customer’s loyalty, recognition, affinity, and sense of connection with the service/s or brand (retention equity).
In the current research, these CRM questions will be used to guide data collection via qualitative focus groups and a quantitative Discrete Choice Experiment (DCE) [
22] preference survey with consumers and their carers. A sequential process of undertaking qualitative data collection (Study 1) followed by quantitative data collection (Study 2) as proposed by Morgan [
23] will identify, understand and quantify consumer expectations and preferences in relation to inclusive housing (Objective 1).
CRM and discrete choice models are rarely applied in the disability sector, where consumers are more likely to be passive rather than active recipients of services. CRM achieves competitive advantage by engaging end-users in the design and delivery process; whilst, the hypothetical nature of DCEs makes them ideal to evaluate preferences in a regulated and restricted market. Apart from reflecting principles of good practice, the involvement of consumers in the design and delivery of services also creates economic value to organisations [
24‐
26]. In this sense, consumers are considered to be
partners [
27] or
co-creators [
28] of service systems, thereby enhancing consumer cooperation, satisfaction and motivation in product development, use, and future design. These theoretical insights from CRM have valuable, but as yet untested, potential for use in the housing and health sector. Combined with the quantitative DCE, they will provide a holistic understanding of consumer housing preferences.
Proposed participant sample
Individuals with complex (neurological) disability and the people who care for them will be eligible to participate in the qualitative and/or quantitative data collection provided they meet the following inclusion criteria:
i.
Consumers: Younger adults aged 18–64 years (i.e., pre-retirement age) with a principal neurological diagnosis (for example, brain injury, spinal cord injury, Multiple Sclerosis, Cerebral Palsy);
ii.
Severity of injury: Adults with mild, moderate or severe acquired neurological impairment are eligible, provided they have a need for inclusive housing either at the time of the study or anticipated in the future.
iii.
Time post-injury: People with disability who are medically stable and currently living in the community (including care facilities) will be eligible. It is at this time post primary care that the person’s housing needs become more apparent.
Carers of people with a disability who meet the above inclusion criteria will also be invited to participate in the focus groups. They may be either paid or unpaid carers.
The following exclusion criteria will also apply to the current research:
i.
Individuals with a primary and pre-existing mental health condition without a neurological injury/illness (and their carers); and
ii.
Individuals who are unable to communicate either verbally or non-verbally.
The decision to exclude individuals with a mental health condition without a neurological injury is justified for two reasons. First, individuals with neurological disability have different care and support needs to those with a primary mental health diagnosis only [
29,
30]. Second, to date, no research has been conducted investigating the housing preferences of people with neurological disability, compared to several studies that have been undertaken exploring the residential preferences of those with mental illness [
31‐
33]. Consumer and carer health profiles will be recorded using items sampled from the Katz Index of Independence in Activities of Daily Living scale [
34], the Lawton Instrumental Activities of Daily Living Scale [
35], the EQ-5D-5L [
36,
37], and the RAND 36-Item Health Survey (Version 1.0) [
38].
Purposive sampling is deemed the most appropriate sampling approach for the qualitative and quantitative studies because the enlisted participants will have the potential to provide rich and diverse data relevant to the research aim [
39]. Interpreters will be used for non-English speaking participants, and professional sign translators will be consulted, if needed.
Recruitment and data collection
Participants will be recruited via third party recruitment procedures with existing research partner groups in Queensland, Australia (qualitative data collection), and Queensland, Perth, Sydney, and Victoria, Australia (quantitative data collection). Informed consent will be sought for those willing to participate in the qualitative and/or quantitative data collection phases. Informed consent will be obtained by all potential participants able to provide consent themselves, or from legal guardians where applicable, prior to the participation of any person in the research.
Study 1 (qualitative data collection) will be advertised to prospective participants in Queensland through: (a) a mail-out, (b) an e-newsletter, and/or (c) a post by the partner organisations on their social media page. Participants will also be recruited through snowballing methods. Potential participants who are mailed the recruitment materials (e.g., research flyer; Consent to Contact Form; and a reply-paid envelope) will complete and return the Consent to Contact Form to researchers, who will then contact them directly. Potential participants who receive the recruitment materials electronically will be asked to contact the researchers directly for more information.
Interested participants will then be mailed an Information Package consisting of a cover letter, a Guardian or Participant Information Sheet and Consent Form, demographic survey, and a reply-paid envelope in advance. Participants will be asked to return the consent form and demographic survey prior to the focus groups taking place.
It is envisaged that three focus groups will be held, with approximately 45 participants in total (i.e., 15 different participants per focus group). Each focus group will include people with disability, family carers, and paid carers in order to identify collective consumer experiences and wants/needs for housing. However, individual consumer group responses will also be recorded (i.e., person with disability vs. family member vs. non-family carer) for reference. Focus groups will be conducted at central, physically accessible locations, and each focus group will run for roughly 1–1.5 h. Participants may take as many breaks as they need during the focus group. Light refreshments will be provided and participants’ travel expenses to and from the location (within a 50 km radius) has been budgeted for in the research funds.
Between two and four researchers will facilitate the focus groups. During the focus groups, a Nominal Group Technique [
40] will be used to identify and prioritise relevant housing characteristics for evaluation in the DCE. These will include those that are most important to participants’ housing choices (i.e., the housing characteristics that would influence their decision regarding where they would like to live). A series of open ended questions will also be used to prompt group discussion regarding participants’ housing experiences and why certain housing characteristics may (or may not) be important to consider for future housing design and development. Focus groups will be audio-recorded, with at least one researcher also taking field notes. The audio recordings will be transcribed verbatim. The findings from Study 1 (qualitative data collection) will inform the materials to be used in Study 2 (quantitative data collection).
Data collection for Study 2 involves the design, development, and administration of the DCE preference survey. The aim of Study 2 is to systematically identify the preferred combinations of housing characteristics important to consumers and their carers, to guide future residential design and development decisions. Specifically, the relative importance of characteristics, and the trade-offs participants are willing to make between characteristics, will be tested. The characteristics to be tested and their levels will be informed by Study 1. Methods will follow the ISPOR Task Force checklist [
22]. A statistically efficient fractional factorial design will be created using NGENE software (Version 1.1.2, ChoiceMetrics, 2014), to guide the selection of housing profiles to show to participants. It is likely that choice sets will consist of two alternatives each, in attempting to minimize the cognitive burden on participants. The DCE survey will be pilot tested to ensure the face validity of the survey.
Similar to Study 1 (qualitative data collection), the DCE survey will be administered to prospective participants (n = 100+) in two states of Australia ( Queensland, and Perth), through: (a) a mail-out (paper-based survey); (b) an e-newsletter (hyperlink to online survey); and/or (c) a post by the partner organisations on their social media page (hyperlink to online survey). Participants will also be purposively recruited through snowballing methods. Assistance to complete the DCE survey may be provided by a participant advocate if needed, and confidentiality will be maintained at all times.
Data analysis
For the qualitative component (focus groups conducted in Study 1), analysis of the raw data followed by conceptual thematic analysis will be conducted using systematic text analysis software package, NVivo (Version 10, 2012). Qualitative analysis along with quantitative analysis from the Nominal Group Technique [
41] will identify the housing characteristics most important to consumers’ housing choices, and will subsequently inform the DCE survey items (i.e., the key housing attributes and associated levels) to be used in the quantitative study (Study 2). The quantitative analysis of the DCE data (Study 2) will be based on regression modelling techniques using specialist choice modelling software, NLogit (Version 5.0, Econometric Software Inc., 2012). Using the Random Utility Modelling framework [
42], the data will be analysed using two models: (a) Conditional logit models (Fixed effects) [
43], which assumes that all respondents have the same housing preferences (homoscedastic errors); and (2) Mixed logit models (Fixed and random effects) [
44] which allows for respondents to have different preferences. The final model will be chosen using Akaike’s information criterion (AIC) to guide optimal model fit. Consequently, once the coefficients of the models are estimated, a calculation indicating the relative strength of preference (preference weights) for improvements in each selected characteristic will be obtained. The mixed logit model will be used to explore the impact of key participant characteristics (e.g. consumer/carer status and health status) on housing preference.