Treatment preferences for CALD AoD clients: Developing attributes and attribute-levels for a discrete choice experiment.

Background:

Almost 50% of Australians are of culturally and linguistically diverse (CALD) background. CALD populations who are faced with acculturation problems, limited social supports, trauma, and experiences of stigma, are at increased risk of alcohol and other (AoD) harms. 

The Australian National Framework for AoD treatment (2019-2029) specifies that treatment services should work within a framework that recognises and respects the central importance of culture and identity. However, there is no CALD specific framework that guides the provision of culturally appropriate AoD treatment services. 

This study forms part of a wider study using a mixed-method multi-phase approach to co-design a standardised AoD treatment framework. The aim of this sub-study is to assess the client preferences, value, and trade-offs between characteristics of a CALD treatment program that will be incorporated in the co-designed treatment framework.  

Method:

Applied economic methods using a discrete choice experiment (DCE) to elicit client preferences, value, and trade-offs for AoD treatment. During this initial stage of the DCE, attributes and levels for the DCE were generated through four focus group discussions with AoD CALD clients in Southwest and Western Sydney. Using an experimental design, the final list of attributes and levels will be used to generate a questionnaire for a DCE survey whose results will be incorporated into a co-designed AoD treatment framework.

Results:

Clients collectively agreed on principles of a treatment service that they would appreciate, and these included: a culturally sensitive welcoming environment, no racial profiling or discrimination, confidentiality, and being treated with respect and dignity. Six attributes and their levels were generated with clients having different preferences over the attribute levels. Treatment attributes (and their levels) included: Type of provider (With or without a CALD background), Support (Peers, someone with lived experience, religious or community leader, CALD community/family), Treatment type (Education/Information, individual psychotherapy, group psychotherapy, pharmacotherapy, treatment outcome (Reduced AoD use, improved relationships, no contact with the justice system, employment opportunities), Cost per appointment (None, $25, $50, $100), Travel time to appointment (15 minutes, 30 minutes, 45 minutes, 60 minutes). The quantitative DCE will be used to test the strength of these attributes, the value clients place on them, and the differences in preference between CALD groups.

Discussion:

Involving CALD clients in the process of designing a treatment framework will increase its feasibility and acceptability and therefore increase service uptake. Assessing client preferences and value for treatment characteristics will contribute to the wider study and strengthen the design of the CALD specific AoD framework.