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Exploring stakeholders’ views in the context of collaborative, public health research:
a mixed methods approach
Teresa Jones on behalf of the EQUIPT consortium
Please treat this presentation as confidential as the work is still in progress.
3 May 2023 2
Overview
• Summary• Background to the EQUIPT project
Aims of the UK mixed methods study• Methods used• Results – Qualitative & Quantitative• What would we have missed by not using a
mixed methods approach?• Conclusions
T Jones Brunel University London
SummaryEQUIPT - The development of a viable, practical, decision-support aid for
use by decision makers across five European countries and investigation of its transferability beyond those countries. The inclusion of stakeholders’
views is considered to be a very important aspect of the project.
Mixed methods study – to explore the additional information obtained by including both quantitative and qualitative findings from the UK
stakeholder interviews
Funding: We have received funding from the European Community’s Seventh Framework Programme under grant agreement No. 602270 (EQUIPT)
Ethics approval was received from Brunel University London Research Ethics Committee
3 May 2023 4
Background: the EQUIPT project
• Development of a decision-support aid to inform decisions on tobacco control spending
• For use initially in five European countries – Germany, Hungary, Netherlands, Spain & UK
• To investigate the transferability of economic evaluations beyond those five countries to other Central and Eastern European countries
3 May 2023 5
Background:aims of the mixed methods study
• To investigate the UK stakeholders’ needs for, and views of, the proposed decision aid
• To conduct a quantitative analysis to provide the overall picture of stakeholders’ perspectives and also those of the UK stakeholders
• To collect qualitative data to help understand the context for UK stakeholders
• Merging of results to provide enriched detail to help understanding and enable creation of more effective, country specific, bespoke decision aid.
3 May 2023 6
MethodQuantitative & Qualitative data
collection via semi-structured face to face interview
Quantitative data analysis Qualitative data analysis
Quantitative results Qualitative results
Merge results
ExcelSPSS
CodingExcel
Interpretation
Double Data entryExcel
Transcription of audio files
3 May 2023 7
Methods (1)• Introduction of stakeholders to decision aid via
custom-built video• Collection of views via questionnaire survey• Countries: Germany, Hungary, Netherlands, Spain & UK• Stakeholders (purposive sample): – decision makers; – purchasers of services/pharma products; – professionals/service deliverers; – evidence generators; – advocates of health promotion
3 May 2023 8
Method (2): Questionnaire survey
• Specifically developed by EQUIPT team members from all 5 countries
• Initially developed in English and then translated into the language of each country for the survey
• Conducted generally face to face, otherwise by Skype or telephone
• Conducted by native speaker in each country
3 May 2023 9
Method (3):Questionnaire survey(contd)
Question typesQuantitative• 7-point Likert scale
(1=strongly disagree, 7=strongly agree)
Survey method• Interviewee’s place of
work• Face to face
• Paper based• Audio recorded
Qualitative• Open questions at the
end of each section
3 May 2023 10
Method (4): Questionnaire survey (contd)
Questions included:• Basic knowledge in health economics• Needs assessment• Risk perception• Advantages & disadvantages of the decision aid• Social support• Self-efficacy• Intention to use the decision aid• Availability of smoking cessation interventions
3 May 2023 11
Method (5):Data collection
Quantitative• Total for 5 countries & the UK• Double data-entry – Excel• Analysis – SPSS
Qualitative• The UK• Transcription of UK audio recordings - Word• Transfer of relevant text extracts - Excel
3 May 2023 12
Results (1):Quantitative - Stakeholders
Total (5 countries) UK
Number of stakeholders 93 14
Role of stakeholders
- Decision makers 29 9
- Purchasers of services/pharma
7 2
-Professional/service providers
18 1
- Evidence generators 15 1
- Advocates of health promotion
14 1
Intenders 81% 79%
EQUIPT WP1 stakeholder interview data
3 May 2023 13
Results (2)Q1a – Who would support you in using the Tobacco
ROI tool?Quantitative (7-point Likert scale)
Total (5 countries) UK
Overall score: mean(SD) 5.26(1.98) 6.26(2.09)
Intenders: mean (SD) *5.53(0.92) 6.30(1.48)
Non-intenders (SD) *3.28(1.30) 6.08(1.08)
*statistically significant difference
EQUIPT WP1 stakeholder interview data
3 May 2023 14
Results (2)Q1b – Who else would support you in using the Tobacco ROI tool?
Qualitative (open question)
Government organisations: • NHS; • NICE; • local authority directors of public
health; • local politicians; • local authority elected members; • Local Government Association ;
health service mangers; • health & social, care boardResearch: • Wider research community;
Voluntary/advocacy: • advocacy organisations; • ASH; • voluntary sector; • Smoke Free board
Other: • some employer organisations eg
CBI, Federations of Small Businesses;
• the public; • an education setting; • patient interest groups; • patient client organisations
3 May 2023 15
Results (3)Q2a – I would encounter resistance using the
Tobacco ROI toolQuantitative (7-point Likert scale)
Total (5 countries) UK
Overall score: mean(SD) 2.93(2.08) 2.92(2.27)
Intenders: mean (SD) 2.85(2.06) 3.18(2.32)
Non-intenders (SD) 3.53(2.00) 1.50(0.71)
EQUIPT WP1 stakeholder interview data
3 May 2023 16
Results (3)Q2b – Who else would not support you in using the Tobacco
ROI tool?Qualitative (open question)
Government organisation: • local government associations; • NHS beyond public health; • people with other health priorities
eg obesity or alcohol; • those with commissioning
priorities; • some council members concerned
about the nanny state;
• some public health staff who are more qualitatively stronger;
• possibly too much based on numbers and costs for the public health arena
Others: • Retailers; • licensed traders; • smokers
3 May 2023 17
Results (4)Q3a – How confident are you about using the Tobacco
ROI tool?Quantitative (7-point Likert scale)
Total (5 countries) UK
Overall score: mean(SD) 5.28(1.98) 5.42(1.53)
Intenders: mean (SD) 5.33(0.80) 5.48(1.47)
Non-intenders (SD) 5.11(0.71) 5.19(1.47)
EQUIPT WP1 stakeholder interview data
3 May 2023 18
Results (4)Q3b– What other difficulties would using such a tool have
for you?Qualitative (open question)
Current model: • details of how the modelling has
been put together; • data entry; • confidence in and access to the
service level data; • mismatch of data; • clarity about the underlying data
and processing;
Updating: • certainty that the most up to
date data is used; • inclusion of new intervention
effects; • capacity for the inclusion of local
data; • introduction of e-cigarettes; Other: • Time; • relevance to my role; • a contact; • targeting of a subset of the
population
3 May 2023 19
What would we have missed by not using a mixed methods approach?
Quantitative only• Specific details on support from
organisations/groups• Some organisations have been listed as
providing support and also resistance• Specific detail on concerns about data quality,
updating of the decision aid, etc.
3 May 2023 20
What would we have missed by not using a mixed methods approach?
Qualitative only• Opinions from a broader group• Non-intenders (all 5 countries) had less support • But no significant difference in the level of
resistance between intenders/non-intenders• Overall and in the UK, stakeholders were confident
about using the decision aid• No significant difference between intenders/non-
intenders
3 May 2023 21
Preliminary conclusions
Mixed methods analysis:• Beneficial to understanding the variations in
contexts & needs of stakeholders within UK• Provides comparisons of stakeholder views
across 5 countries• Enables development of a more effective aid• Provides valuable information for
transferability
3 May 2023 22
Next steps
• Further integration of UK data • Potentially explore data for Germany, Hungary,
Netherlands and Spain using similar methods• Combination of data from all 5 countries to identify
similarities and differences• Use combined data to further inform development
of the decision aid