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