Measuring and understanding older people's preferences for health interventions

Abstract

This thesis enhances understanding on how patients’ preferences can influence participation, adherence and the effectiveness of health interventions, with a special focus on physical activity programs. The systematic review of qualitative studies presented in Chapter Two describes the experiences and perceptions of community-dwelling older people on facilitators and barriers to physical activity participation. Chapter Three presents a systematic and critical review investigating how patients’ preferences have been measured and analysed in randomised controlled trials evaluating treatments for musculoskeletal conditions. Chapter Four presents a best- worst scaling study aiming to identify the relative value older people attach to different exercise attributes and levels. Finally, Chapter Five and Chapter Six present the protocol and the full report of a study designed to determine the smallest worthwhile effect of exercise programs designed to reduce the risk of falling among older people using these two approaches, the benefit-harm trade-off method and discrete choice experiments. In addition, we sought to compare the estimates of the smallest worthwhile effect derived from the two different methods.