Public attitudes to compulsory health programmes: generating questions from a focus group to support a willingness to pay study

Background The willingness to pay approach to valuing goods has been heavily criticised due to perceived biases in their resultant valuations. Recently, attempts have been made to use data relating to respondent attitudes to produce better informed preferences and remove "warm glow". This paper reports a study that uses rigorous methods by which salient attitudes can be identified and measured for use in a subsequent willingness to pay study. The topic area is that of compulsory health programmes (CHPs).

Methods Six focus groups were undertaken among members of the public using a questioning route designed to highlight different attitudes between CHPs. Framework analysis was used, including thematic and contrast charting, to identify themes that described the issues raised by participants. The resultant coding framework was translated into a set of scales which were then used in a survey of 831 members of the general population. Factor analysis was applied to identify latent themes.

Results Analysis of the focus group transcripts highlighted seven themes relating to the effects of policy, alternatives, the role of government, uncertainties, coherence of policy, rights and responsibilities, and other issues. These themes were translated into 48 statements that were used as attitude scales. The factor analysis of the general population survey identified 4 latent factors: "common sense", "government", "warm glow" and "rights and responsibilities".

Conclusions The focus group work described in this paper shows that across individuals, coherent themes relating to public health and compulsion can be identified. It also demonstrates sophisticated thinking by participants about public health issues. This study shows that the work of Nunes (2002) and Pouta (2004) is potentially generalisable to other topic areas and that their methods can be improved upon. This work has been used in a subsequent analysis of WTP responses by using the attitudinal scales in an attempt to elicit better informed preferences and explain responses in terms of underlying attitudes and "warm glow".