Developing Discrete Choice Experiments for Populations with Non-Dominant Language Preference: A Methodological Framework and Case Example

Abstract Background:Discrete choice experiments (DCEs) are widely used to elicit patient preferences for health interventions and implementation strategies. However, individuals with non-dominant language preference (NDLP) are frequently excluded from DCE studies due to language and literacy needs. As health systems increasingly serve linguistically diverse populations, there is an critical need to adapt DCE methods for inclusion of NDLP populations.Objective:To develop and pilot a practical methodology for designing and conducting DCEs in high-diversity, multilingual settings. We use a case example focused on tailoring a hospital discharge intervention for Spanish and Haitian Creole speakers with NDLP to illustrate the methodology.Methods: We adapted a five-step DCE development framework, including evidence synthesis, end-user input, expert review, pretesting and pilot testing, for use with NDLP populations. Modifications focused on pretesting using cognitive interviews with patients and professional interpreters, and a rapid-cycle approach to iterative revision in two languages. The DCE focused on hospital discharge preferences and included four attributes with visual and text-based levels. Pilot testing assessed comprehension, cognitive burden, and usability of the final DCE instrument.Results:We identified multiple barriers to DCE participation for patients with NDLP, including difficulty grasping the critical task of elicitation (making tradeoffs) in a DCE choice set, misinterpretation of abstract attributes, and inconsistent understanding of visual materials. Tailored solutions included bilingual interviewer-led administration, integration of a “warm-up” elicitation task, use of labeled photos to describe levels, and iterative revision of wording and decisional context to improve comprehension. Pilot testing showed high acceptability and comprehension, with no evidence of cognitive fatigue. Participants were able to articulate tradeoffs and report decision-making strategies aligned with stated preferences.Conclusions:This study provides a practical, equity-centered methodology for conducting DCEs with linguistically diverse populations. Our findings demonstrate the feasibility of rigorous DCE administration in NDLP populations and offer a replicable framework for implementing DCEs high diversity contexts. Future work should explore adaptation across additional languages, cultures, and settings and evaluate the impact of preference-informed tailoring on intervention outcome.