Using mixed methods research to explore the effect of an adaptation exercise on general population valuations of health states

To understand the effect of an adaptation exercise (AE) on general population values for rheumatoid arthritis (RA) states.

A sequential mixed methods design was employed: an analysis of a dataset to develop RA states for valuing in later phases
of the study; a qualitative interview study with members of the general population to identify how an AE affected valuing
of the RA states and to help design a questionnaire for the final phase; and a quantitative quasi-experimental study to identify
factors that influence change in values after being informed about adaptation.

Three RA states were developed using Rasch and cluster analyses. Participants in the qualitative phase identified a range
of ways in which information about adaptation affected their values. For example, they realized they could adapt to RA because
their family and friends who had RA, or similar conditions, could cope. A 25-item questionnaire was developed and used during
the final phase to identify that younger and healthier individuals were more likely to increase their values after being informed
about disease adaptation. The qualitative findings were revisited and found to support the quantitative results.

This approach facilitated understanding of whether and how an AE affected valuing of health states. Each phase affected the
next phase of the study, leading to the conclusion that general population respondents who have little experience of disease
will likely increase their health state values after being informed about adaptation because they understand that they could
cope with the disease.