# Using discrete choice experiment to investigate public preferences for osteoporosis community-level management strategies in China

## TL;DR

This study explores what Chinese community residents prefer in osteoporosis management, finding that lower costs and specialist-led screening are most valued.

## Contribution

The study introduces public preferences for osteoporosis management in China using a discrete choice experiment, highlighting key attributes influencing utility.

## Key findings

- Out-of-pocket costs had the largest impact on utility in community-level osteoporosis management.
- Suburban residents showed higher preference for shorter screening duration and specialist-led services.
- Combining specialist screening with general-practitioner management increased predicted utility.

## Abstract

Osteoporosis is highly prevalent in China and imposes a substantial economic burden. Early community-level management is pivotal and community health centers play an important role in prevention and management. As shared decision-making in medication expands, understanding public preferences can help improve community health services. This study investigated public preferences of osteoporosis community-level management in China, considering access to screening information, screening duration, service supplier, mode of administration, management approach and out-of-pocket costs.

A discrete choice experiment (DCE) was conducted in Shanghai among community-dwelling adults. We constructed a mixed logit model with a total of 14 levels of the above 6 attributes. Willingness-to-pay (WTP) and scenario predictions were performed. Exploratory subgroup analyses assessed heterogeneity by age, income, geographic location and self-reported osteoporosis.

A total of 170 valid questionnaires were collected from 6 communities in Shanghai. OOP costs had the largest impact on utility, followed by screening duration, service supplier and access to screening information. Subgroup analyses revealed that shorter screening duration and specialist-provided screening services had greater positive impact on utility among suburban residents than among urban sample. Scenario predictions suggested that the combination of shorter screening duration, service supplied by tertiary-hospital specialists and management supplied by general practitioners meaningfully increased predicted participants’ utility.

Public preferences favored lower costs, convenient screening, clear information and specialist-led screening with general-practitioner-delivered management. Understanding the impact of attributes in community-level management strategies on residents’ utility and willingness to pay is important for optimizing community-level management strategies.

The online version contains supplementary material available at 10.1007/s00774-025-01659-y.