Understanding what women want: eliciting preference for delivery health facility in a rural sub-County in Kenya, a discrete choice experiment

Objective: To identify what women want in a delivery health facility and
how they rank the attributes that influence the choice of a place of
delivery. Design: A Discrete Choice Experiment was conducted to elicit
rural women’s preferences for choice of delivery health facility. Data
were analyzed using both a conditional logit model to evaluate relative
importance of the selected attributes. A mixed multinomial model evaluated
how interactions with sociodemographic variables influence the choice of
the selected attributes. Setting: Six health facilities in a rural
sub-County. Participants: Women aged 18-49 years who had delivered within
six weeks. Primary outcome: The DCE required women to select from
hypothetical health facility A or B or opt-out alternative. Results: A
total of 474 participants were sampled, 466 participants completed the
survey (response rate 98%).The attribute with the strongest association
with health facility preference was having a kind and supportive
healthcare worker (β=1.184, p<0.001), second availability of
medical equipment and drug supplies (β=1.073, p<0.001) and
third quality of clinical services (β=0.826, p<0.001).
Distance, availability of referral services and costs were ranked 4th, 5th
and 6th respectively (β=0.457, p<0.001), (β=0.266
p<0.001), and (β=0.000018, p<0.001). The opt-out
alternative ranked last suggesting a disutility for home delivery.
(β=-0.849, p<0.001). Conclusion: The most highly valued
attribute was a process indicator of quality of care followed by technical
indicators. Policy makers need to consider women’s preferences to inform
strategies that are person-centered and lead to improvements in quality of
care during delivery.