Preference Variation: Where Does Health Risk Attitude Come Into the Equation?

Samare P.I. Huls*, Jorien Veldwijk, Joffre D. Swait, Jennifer Viberg Johansson, Mirko Ancillotti, Esther W. de Bekker-Grob

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
44 Downloads (Pure)


Objectives: Decisions about health often involve risk, and different decision makers interpret and value risk information differently. Furthermore, an individual's attitude toward health-specific risks can contribute to variation in health preferences and behavior. This study aimed to determine whether and how health-risk attitude and heterogeneity of health preferences are related. Methods: To study the association between health-risk attitude and preference heterogeneity, we selected 3 discrete choice experiment case studies in the health domain that included risk attributes and accounted for preference heterogeneity. Health-risk attitude was measured using the 13-item Health-Risk Attitude Scale (HRAS-13). We analyzed 2 types of heterogeneity via panel latent class analyses, namely, how health-risk attitude relates to (1) stochastic class allocation and (2) systematic preference heterogeneity. Results: Our study did not find evidence that health-risk attitude as measured by the HRAS-13 distinguishes people between classes. Nevertheless, we did find evidence that the HRAS-13 can distinguish people's preferences for risk attributes within classes. This phenomenon was more pronounced in the patient samples than in the general population sample. Moreover, we found that numeracy and health literacy did distinguish people between classes. Conclusions: Modeling health-risk attitude as an individual characteristic underlying preference heterogeneity has the potential to improve model fit and model interpretations. Nevertheless, the results of this study highlight the need for further research into the association between health-risk attitude and preference heterogeneity beyond class membership, a different measure of health-risk attitude, and the communication of risks.

Original languageEnglish
Pages (from-to)2044-2052
Number of pages9
JournalValue in Health
Issue number12
Early online date22 Jun 2022
Publication statusPublished - 1 Dec 2022

Bibliographical note

Funding Information:
Funding/Support: Dr Swait reported receiving funding from University of Padova, Italy for consulting work outside of the submitted work.

Publisher Copyright:
© 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc.


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