Unveiling Preferences in Closed Communities: Development of a Discrete Choice Experiment (DCE) Questionnaire to Elicit Ultra-Orthodox Women Preferences for Video Consultations in Primary Care

Background: Video consultations in primary care settings demonstrate substantial benefits, including improved accessibility, reduced waiting times, and enhanced health management. These services could particularly benefit ultra-Orthodox women in Israel, who typically manage large families and face unique healthcare access challenges as primary caregivers. However, eliciting preferences within this closed religious community presents distinct methodological challenges because of cultural sensitivities and religious restrictions regarding technology use. Objective: We aimed to develop and validate a culturally sensitive, discrete choice experiment questionnaire for eliciting ultra-Orthodox women’s preferences regarding video versus in-clinic consultations in primary care settings. Methods: A three-stage mixed-methods approach was employed: (1) 33 semi-structured interviews with key stakeholders (women, men, rabbis, and healthcare providers) to identify attributes and levels; (2) an attribute-ranking exercise with 88 ultra-Orthodox women to refine attributes; and (3) cognitive interviews with 15 women to validate the discrete choice experiment questionnaire. Results: Four key attributes emerged as most important for ultra-Orthodox women when choosing between video and in-clinic consultations: (1) consultation timing (regular hours/after 20:00); (2) travel time; (3) waiting time; and (4) familiarity with the healthcare provider. Importantly, the study revealed the necessity for a dedicated device exclusively for healthcare provider communication, closed to open Internet networks, as a fundamental prerequisite for implementing video consultations in this community. Additional unique findings emerged through this methodological process, contributing to the understanding of technological adoption in closed religious patients’ communities. Conclusions: This study provides a comprehensive example of implementing pre-discrete choice experiment stages while addressing unique considerations of a special population. The findings provide a framework for developing inclusive telemedicine services for traditionally underserved populations.