Background
Methods
Participants
Discrete choice experiments
Attributes and attribute levels
Attribute | Levels for outpatient care (Option A) | Levels for enhanced inpatient care (Option B) | Levels for basic inpatient care (Option C) |
---|---|---|---|
Physical environment while you are waiting for gels to work |
● Basic accommodation with private bathroom, close to hospital |
● Twin hospital room with shared bathroom |
● Twin hospital room with shared bathroom |
● Single hospital room with shared bathroom | |||
● Your own home |
● Single hospital room with private bathroom | ||
Availability of pain relief or sleep medication while waiting for gels to work |
● Single dose of mild pain relief (eg panadeine forte) and sleep medication are provided |
● Non drug pain relief methods (eg warm baths) are NOT available. Other types of pain relief and sleeping medication available, but may have to wait for doctor for stronger pain medication (eg injection) |
● Non drug pain relief methods (eg warm baths) are NOT available. Other types of pain relief and sleeping medication available, but may have to wait for doctor for stronger pain medication (eg injection) |
● None provided, own pain relief methods can be used, including panadol, warm baths etc. |
● Non drug pain relief methods (eg warm baths) are NOT available. Mild pain relief (eg panadeine forte) and sleeping medication available from midwives | ||
● Non drug pain relief methods (eg warm baths) ARE available. Other types of pain relief and sleeping medication available, but may have to wait for doctor for stronger pain medication (eg injection) | |||
● Non drug pain relief methods (eg warm baths) and mild pain relief (egpanadeine forte) and sleep medication ARE available from midwives | |||
Who checks on you while you are waiting for gels to work |
● You can phone a midwife, then come in to the hospital, if you are concerned; if a doctor is needed, they will need to be called in from somewhere else |
● You will be checked once during the night by the midwife (& woken if you are asleep); a doctor will need to be called in from somewhere else if needed |
● You will be checked once during the night by the midwife (& woken if you are asleep); a doctor will need to be called in from somewhere else if needed |
● You will be checked once during the night by the midwife (& woken if you are asleep); a doctor is available onsite if needed | |||
● You can phone a midwife, then come in to the hospital, if you are concerned; a doctor is available onsite if needed | |||
How well you know the midwife | ■ A rostered midwife, with no guarantee that you know her |
● A rostered midwife, with no guarantee that you know her | |
■ One of a team of 4 or 5 midwives who you have met before | |||
■ One of a pair of midwives who you know already | |||
■ A midwife you already know well | |||
How many trips you need to make to the hospital |
● 2 trips |
● 1 trip |
● 1 trip |
● 3 trips | |||
The travel time to the closest hospital that provides this service | ■ 10 minutes |
● 40 minutes | |
■ 20 minutes | |||
■ 30 minutes | |||
■ 40 minutes |
Experimental design
Option A | Option B | Option C | |
---|---|---|---|
Physical environment | Your own home | Single hospital room with private bathroom | Twin hospital room with shared bathroom |
Pain relief and sleeping medications, while you wait | None are provided, own pain relief methods can be used including panadol, warm baths, etc. | Non drug pain relief methods (eg warm baths) and mild pain relief (eg panadeine forte) and sleep medication ARE available from midwives | Non-drug pain relief (eg warm baths) methods are NOT available. Other types of pain relief and sleeping medication available but may have to wait for doctor for stronger pain medication eg injection or tablets |
Who checks on you while you wait | You can phone a midwife and then come in to the hospital at any time if you are concerned; a doctor is available onsite | You will be checked once during the night by the midwife (& woken if you are asleep); a doctor is available onsite if needed | You will be checked once during the night by the midwife (& woken if you are asleep); a doctor will need to be called in from somewhere else if needed |
How well you know the midwife | A midwife you already know well | One of a team of 4 or 5 midwives who you have met before | A rostered midwife, with no guarantee that you know her |
Number of trips to hospital | 2 trips | 1 trip | 1 trip |
Travel time to the closest hospital that provides these services | 10 minutes | 40 minutes | 40 minutes |
Please pick one
| Choose Option A | Choose Option B | Choose Option C |
□ | □ | □ |
Analysis
Results
Respondents
N | % | |
---|---|---|
Volunteers (hospital clinics) | 102 | 28% |
OPRA Trial participants | 260 | 72% |
Total participants | 362 | 100% |
OPRA Trial Participants (n = 260)*
| ||
Randomised to inpatient | 132 | 51% |
Randomised to outpatient | 127 | 49% |
Age Mean (SD) | 29.6 (5.2) | |
Non-English speaking background (yes) | 41 | 11% |
Highest level of education | ||
High school | 107 | 30% |
Post-high school course | 112 | 31% |
Bachelor degree or higher | 140 | 39% |
Household combined annual income2
| ||
Up to $35,000 | 53 | 15% |
$35,000 to $65,000 | 119 | 33% |
$65,000 to $95,000 | 113 | 31% |
more than $95,000 | 62 | 17% |
Self-rated health | ||
Good/very good | 325 | 80% |
Neither good nor bad | 29 | 8% |
Poor | 5 | 1% |
Driving distance to hospital (Median (range)) | 9 km (1–49 km) | |
Estimated travel time (Median (range)) | 15 minutes (<5 to 45 minutes) | |
Private health insurance? (yes) | 124 | 34% |
Number of children at time of survey completion | ||
None (clinic participants only) | 55 | 15% |
One | 216 | 60% |
Two or more | 90 | 25% |
First pregnancy (either during OPRA trial, or currently pregnant with first child (clinic)) | 239 | 66% |
Type of care with pregnancy/past pregnancies3
| ||
Obstetric clinic with doctors | 103 | 29% |
Midwives clinics | 91 | 25% |
Midwife group practice/birth centre | 86 | 24% |
Other | 12 | 3% |
Have you ever experienced induction of labour? (yes) | 185 | 51% |
Time since giving birth4? | ||
2 months ago | 124 | 34% |
3-12 months ago | 41 | 11% |
> 1 year ago | 88 | 24% |
Discrete choice preferences
Attributes | Beta | p value | OR* | (95% CI) |
---|---|---|---|---|
Preferences for outpatient priming (compared to basic inpatient care)
| ||||
Constant | 1.051 | 0.0542 | ||
Program characteristics
| ||||
Environment while waiting for gels to work | 0.572 | <0.00001 | 1.771 | (1.445-2.178) |
Own home (vs basic accommodation close to hospital) | ||||
Availability of pain relief and sleep medication | −0.029 | 0.4643 | 0.972 | (0.901-1.050) |
Given single dose of mild pain relief and sleep medication (vs providing own pain relief) | ||||
Who checks on you while waiting for gels to work | −0.019 | 0.7962 | 0.981 | (0.853-1.131) |
Availability of doctor on the phone (vs having to wait for doctor to arrive) | ||||
Increasing familiarity with midwife (vs rostered midwife only) | 0.095 | 0.021 | 1.099 | (1.016-1.191) |
Extra trips made to hospital | −0.402 | <0.00001 | 0.669 | (0.563-0.7960 |
Travel time for each trip to closest hospital providing service (per minute) | −0.019 | 0.0005 | 0.981 | (0.971-0.992) |
Patient characteristics
| ||||
Previous care model experienced | ||||
Obstetrics clinic with doctors | −0.815 | <0.00001 | 0.443 | (0.331-0.594) |
Midwife clinic | 0.172 | 0.165 | 1.188 | (0.935-1.515) |
Midwife group practice | 0.056 | 0.6499 | 1.058 | (0.833-1.349) |
Age (per year) | 0.090 | <0.00001 | 1.094 | (1.061-1.128) |
Non-english speaking background (vs english speaking) | −1.934 | <0.00001 | 0.145 | (0.105-0.201) |
Previous experience of induction (vs not) | −0.457 | 0.0041 | 0.633 | (0.465-0.865) |
Highest education -university or college degree (vs not) | 0.451 | 0.0052 | 1.570 | (1.150-2.155) |
Private health insurance (vs not) | −0.070 | 0.5964 | 0.932 | (0.722-1.209) |
First pregnancy (vs second or subsequent pregnancy) | 0.844 | <0.00001 | 2.325 | (1.703-3.190) |
Preferences for enhanced inpatient priming (compared to basic inpatient care)
| ||||
Constant | 0.090 | 0.8519 | ||
Program characteristics
| ||||
Environment while waiting for gels to work | −0.031 | 0.4631 | 0.970 | (0.895-1.053) |
Private hospital room, but shared bathroom (vs shared room & bath) | ||||
Private hospital room with private bathroom (vs shared room & bath) | 0.498 | <0.00001 | 1.646 | (1.503-1.805) |
Availability of pain relief and sleep medication | 0.079 | 0.0351 | 1.083 | (1.007-1.166) |
Stronger pain relief and sleep medication available but may have to wait (vs mild pain relief from midwives), when hot baths not available | ||||
Stronger pain relief and sleep medication available but may have to wait (vs mild pain relief from midwives), when hot baths are available | 0.077 | 0.1746 | 1.080 | (0.968-1.208) |
Who checks on you while waiting for gels to work | 0.111 | 0.115 | 1.117 | (0.975-1.282) |
Availability of doctor onsite (vs having to wait for doctor to arrive) | ||||
Increasing familiarity with midwife (vs rostered midwife only) | 0.130 | 0.0113 | 1.139 | (1.031-1.259) |
Travel time for each trip to closest hospital providing service (per minute) | −0.009 | 0.0474 | 0.991 | (0.982-1.000) |
Patient characteristics
| ||||
Previous care model experienced | ||||
Obstetrics clinic with doctors | −0.498 | 0.008 | 0.608 | (0.456-0.813) |
Midwife clinic | 0.117 | 0.3419 | 1.125 | (0.886-1.433) |
Midwife group practice | 0.101 | 0.4151 | 1.106 | (0.871-1.410) |
Age (per year) | 0.090 | <0.00001 | 1.095 | (1.085-1.105) |
Non-english speaking background (vs english speaking) | −0.987 | <0.00001 | 0.373 | (0.273-0.511) |
Previous experience of induction (vs not) | −0.186 | 0.2418 | 0.831 | (0.612-1.133) |
Highest education -university or college degree (vs not) | 0.271 | 0.0925 | 1.311 | (0.961-1.796) |
Private health insurance (vs not) | −0.255 | 0.0539 | 0.775 | (0.600-1.004) |
First pregnancy (vs second or subsequent pregnancy) | 0.834 | <0.00001 | 2.303 | (1.689-3.156) |
Preferences for outpatient priming (compared with basic inpatient care)
Preferences for enhanced inpatient priming (compared with basic inpatient care)
Trade-offs between benefits and downsides of alternative priming strategies
Preferred attribute level | Number of extra trips women prepared to accept to have preferred attribute levela
| Extra travel time per trip women prepared to accept to have preferred attribute levelb
| Total extra minutes of travel time women prepared to accept to get preferred attribute level |
---|---|---|---|
Environment while waiting for gels to work
| |||
Own home | 1.42 extra trips (2.42 trips total) | 30.6 minutes per trip | 73.3 minutesc
|
Private room with private bath | n/a | 54.7 minutesd
| |
Familiarity with midwife
| |||
One of a team of 4–5 midwives met before (vs rostered midwife) | |||
Outpatient | 0.24 extra trips (1.24 trips total) | 5.1 minutes per trip | 6.3 minutesc
|
Enhanced inpatient | n/a | 14.2 minutesd
| |
One of a pair of midwives met before (vs rostered midwife) | |||
Outpatient | 0.47 extra trips (1.47 trips total) | 10.1 minutes per trip | 14.9 minutesc
|
Enhanced inpatient | n/a | 28.5 minutesd
| |
A midwife that they know well (vs rostered midwife) | |||
Outpatient | 0.71 extra trips (1.71 trips total) | 15.2 minutes per trip | 26.0 minutesc
|
Enhanced inpatient | n/a | 42.7 minutesd
|
Overall value of alternative priming options
Outpatient | Enhanced inpatient | Basic inpatient (from Table1) |
---|---|---|
● Own home |
● Private room with private bathroom (8 of 18 labour rooms have a bath) |
● Twin room with shared bathroom |
● Single dose mild pain relief and sleeping medication provided |
● mild pain relief provided, stronger pain relief and sleeping medication available, but may have to wait for doctor |
● mild pain relief provided, stronger pain relief and sleeping medication available, but may have to wait for doctor |
○ 45% of rooms have a bath (non-drug pain relief available) | ○ no rooms have a bath (non-drug pain relief not available) | |
○ 55% of rooms do not have a bath (non-drug pain relief not available) | ||
● Doctor available onsite if telephone |
● Doctor available on site if needed |
● Doctor will have to be called in from elsewhere if needed |
● Rostered midwife |
● Rostered midwife |
● Rostered midwife |
● On average 2 trips to hospital (1 extra trip to hospital) | ||
● Median travel time 15 minutes. | ||
● Previous care: 29% obstetrics clinic with doctors; 25% midwife clinic; 24% midwife group practice. | ||
● Mean age 29.6 yrs. | ||
● 11% Non-english speaking background. | ||
● 51% induction experience. | ||
● 39% university educated. | ||
● 34% private health insurance. | ||
● 66% first pregnancy. |