Discrete Choice Experiments in Nursing Workforce Research: A Methodological Review

Keywords

discrete choice experiment, nursing workforce, methodological review, job preferences

Abstract

Background: Discrete Choice Experiments are a widely used stated preference method that simulates real-world decision-making by presenting individuals with hypothetical choice sets that vary across attributes. In healthcare, and increasingly in nursing workforce research, discrete choice experiments offer valuable insights into job preferences and inform strategies for recruitment, retention, and policy development. This review examines the application of discrete choice experiments in nursing workforce research, evaluates methodological practices across studies, and identifies areas for improvement to guide future applications.

Methods: We conducted a literature search across Medline, CINAHL, Web of Science, and Google Scholar using keywords related to nursing and discrete choice experiments. Empirical studies published in English through December 2024 were included if they used discrete choice experiments to examine nurses' or midwives' job preferences. Non-empirical articles and studies that included other professionals were excluded. Twelve studies met the inclusion criteria and were analyzed.

Results: Most studies were conducted in low- and middle-income countries, with half focusing on rural–urban job preferences. Choice task designs varied widely; while most used binary choice formats, only a few included labeled designs or opt-out options. Attribute and level selection methods often relied on literature review or focus groups, but few studies used a comprehensive approach. Experimental designs were inconsistent, with half employing D-efficient designs and limited use of versioning to reduce respondent burden. Pilot testing was conducted in most studies, but it was typically small-scale and lacked representation of subgroups. Econometric analysis varied, including conditional logit, mixed logit, and multinomial logit models. About half of the reviewed studies estimated willingness to pay and conducted counterfactual simulations. Several studies lacked transparency in analytic reporting.

Conclusions: This review highlights both the promise and limitations of current discrete choice experiment practices in nursing workforce research. While discrete choice experiments are increasingly used to quantify nurses' job preferences, methodological rigor remains inconsistent, particularly in attribute development, experimental design, piloting, and analytic transparency. Future studies should adopt more systematic approaches, leverage advanced modeling techniques, and use simulations to enhance policy relevance. Standardizing best practices will improve the comparability and utility of discrete choice experiments for informing nursing workforce planning and health system policy.

Original Publication Citation

John R. Howell, Yin Li, "Discrete Choice Experiments in Nursing WorkForce Research: A Methodological Review", International Journal of Nursing Studies, 2026.

Document Type

Peer-Reviewed Article

Publication Date

2026

Publisher

International Journal of Nursing Studies

Language

English

College

Marriott School of Business

Department

Marketing

University Standing at Time of Publication

Assistant Professor

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