The value of choice: development of a new measurement tool.

BACKGROUND Current policy advocates individual choice across a number of domains, including healthcare provision. AIM To develop a new tool for measuring people's beliefs about the value of choice in the context of healthcare provision. DESIGN OF STUDY Cross-sectional survey. SETTING Four general practices in South East England. METHOD Nine items relating to health and general domains, derived from in-depth interviews with 22 participants, were collated into a questionnaire. This formed the measurement tool called the Choice Questionnaire (ChQ), which was completed by 823 consecutive patients (response rate = 81.2%). RESULTS Principal components analysis resulted in two factors: having choices (for example, 'I like to know all the possible ways in which I could be treated') and making choices (for example, 'I am happy for the doctor to make decisions for me'). These two constructs showed good internal consistency. One item was deleted, resulting in the 8-item ChQ. Beliefs about choice in health and general domains were not discrete. The vast majority of participants endorsed having choices as positive. In contrast, beliefs about the value of making choice were more mixed. A greater endorsement of both these aspects of choice was related to higher educational status. CONCLUSION Results from this study indicate that choice can be usefully conceptualised as consisting of two separate constructs: having choices and making choices. The 8-item ChQ has an interpretable factor structure and has been shown to be reliable. It could be used in research to assess beliefs about the value of choice or in the clinical setting to establish whether a patient would prefer to be provided with options or to be managed in a more paternalistic way.