Health and quality of life rely on many community systems and factors, not simply on a well-functioning health and

medical care system. Making changes within existing systems, such as improving school health programs and policies, can effectively improve the health of many in the community. For a community to improve its health, its members must often change aspects of the physical, social, organizational, and even political environments in order to eliminate or reduce factors that contribute to health problems or to introduce new elements that promote better health. [1] Settings such as the school, worksite, health care facility, and community are an integral part of this goal, supporting and facilitating the delivery of health promotion, prevention, and intervention programs. Each setting provides access to select populations using existing social structures. People often have high levels of contact with such settings, both directly and indirectly. This reduces the time and resources necessary for program development and maximizes the impact by reaching large populations repeatedly [2] Programs that combine several if not all four settings can have a greater impact than those utilizing one setting alone. Community-based programs are designed to reach all residents or particular target subgroups, such as the homeless, or other groups subject to greater risks that are not fully addressed by other providers or parties. Such programs may rely upon mass media or other broad information dissemination strategies. Some of these or other more effective community-wide programs employ partnerships with other organizations and settings like those noted above and/or others such as churches, boys/girls clubs, social service organizations, local government, fraternal organizations, and the like to initiate educational and prevention programs. Similar coalitions or networks can support policy interventions such as those that enact and enforce smoking ordinances in public places or limit tobacco and alcohol sales to minors. An example of an organization that collaborates with community based programs is health care organizations. Health care organizations have a responsibility for the health of their patient populations and for providing physicians, nurses, patient educators, social workers, and staff to serve patients. Patients tend to be dependent on professionals regarding their health status. Health care organizations are viewed as legitimate providers of primary, secondary, and tertiary prevention activities and supporters of patient compliance with treatment regimens or more extensive disease management protocols. [3] Evaluation of such programs, successful or unsuccessful is called for to better understand what factors contribute to success. An invididuals preference is a contributing factor in the success of health awareness program implementation. Understanding how patients and other stakeholders value various aspects of an intervention in health care is vital to both the design and evaluation of programs. Incorporating these values in decision making may ultimately result in clinical, licensing, reimbursement, and policy decisions that better reect the preferences of stakeholders, especially patients. Aligning health care policy with patient preferences could improve the effectiveness of health care interventions by improving adoption of, satisfaction with,and adherence to clinical treatments or public health programs [4-6]. Conjoint analysis is an effective way to evaluate individual preference on health awareness programs. Conjoint analysis provides a model of consumer utilities for various attributes of multifactor stimuli: the model is built by quantifying respondents preferences for a set of factorially designed alternatives (Green 1974). The conjoint analysis identies the combination of attributes that provide the consumer

with the highest utility, and corroborates the relative contribution of attributes to total utility (Ness and Gerhardy 1994). In a typical experiment, the attributes of interest are varied with a factorial design, and each consumer is asked to provide scores of their preference or purchase intent for various combinations of the attributes. The potential benets of conjoint analysis go beyond the valuation of health care interventions. Increasingly, conjoint analysis also is used as a means to understand patient preferences for health states and as a means to value the various health states described by patient-reported outcomes and health-related quality-of-life scales [7,8]. Licensing authorities recently have taken an interest in conjoint analysis to assess patients willingness to accept the therapeutic risks associated with more effective new treatments [9]. Conjoint analysis also offers a mechanism for patients to participate in decision making [10,11] and may facilitate shared decision making [12]. Conjoint analysis also can be used to understand clinical decision making [13] and how different stakeholders may value outcomes [14]. 1. 2. Institute of Medicine. The future of the publics health in the 21st century. Washington: National Academies Press; 2003. 15. Mullen, P.D.; Evans, D.; Forster, J.; et al. Settings as an important dimension in health education/promotion policy, programs, and research. Health Education Quarterly 22(3):329345, 1995. Gamm, L.; Castillo, G.; and Williams, L. (2004). Education and Community-Based Programs in Rural Areas: A Literature Review. Chong C, Chen I, Naglie C, et al. Do clinical practice guidelines incorporate evidence on patient preferences? Med Decis Making 2007; 27:E63 4. Khrahn M, Naglie G. The next step in guideline development. Incorporating patient preferences. JAMA 2008;300:436 8. Marshall DA, Johnson FR, Kulin NA, et al. How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? Comparison in Canada and the United States using a stated-choice survey. Health Econ 2009;18:1420 39 Weighting and valuing quality adjusted life years: preliminary results from the Social Value of a QALY project. 2008. Available from: http://www.ncl.ac.uk/ihs/research/publication/56274 [Accessed August 2, 2010]. Mohamed AF, Hauber AB, Johnson FR, et al. Patient preferences and linear scoring rules for patient reported outcomes. Patient 2010;3,217- 27. Johnson FR, zdemir S, Manseld CA, et al. Crohns disease patients benet-risk preferences: serious adverse event risks versus treatment efcacy. Gastroenterology 2007;133:769 79. Bridges J, Searle S, Selck F, et al. Engaging families in the design of social marketing strategies for male circumcision services in Johannesburg, South Africa. Soc Mar Q 2010,16:60 76. Opuni M, Bishai D, Gray GE, et al. Preferences for characteristics of antiretroviral therapy provision in Johannesburg, South Africa: results of a conjoint analysis. AIDS Behav 2010;14:807 15. Fraenkel L. Conjoint analysis at the individual patient level: issues to consider as we move from a research to a clinical tool. Patient 2008;1: 2513.

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13. Nathan H, Bridges J, Schulick RD, et al. Understanding surgical decision-making in early hepatocellular carcinoma. J Clin Oncol 2011 Jan 4. [Epub ahead of print]. 14. Shumway M. Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups. Schizophr Bull 2003;29:257 66