Co-designing a joint protection program for hand osteoarthritis: a latent-class discrete choice experiment of patient preferences

Objectives: To quantify patient preferences for key joint protection program (JPP) delivery components and identify preference segments to inform a patient-centred, technology-enabled program. Methods: Attributes and levels were developed via three focus groups with 16 people living with hand osteoarthritis (HOA). A discrete choice experiment (six attributes with two levels each; 16 choice tasks; three unlabelled alternatives; no opt-out) was fielded online. Choices were analysed using latent class choice models with effects coding. One to six class solutions were compared by Akaike Information Criterion/Bayesian Information Criterion and segment sizes. Within-class relative attribute importance was calculated from part-worth ranges and overall (class-adjusted) importance was computed using class membership probabilities. Results: A total of 150 participants with HOA completed the survey (89% women; mean age 68 years). Latent class modelling identified five distinct preference segments (segment sizes: 34%, 18%, 10.7%, 21.3% and 16%). Across segments, clinician-led question and answer (Q&A; class-adjusted importance 23.7%) and clinician-delivered exercise demonstrations (21.5%) consistently drove choices. Other features showed marked heterogeneity: one large segment strongly preferred short (2-7 min) videos (importance 56.1%) while others were indifferent to video length; interaction mode split respondents between asynchronous forums and live monthly meetings; and lived-experience guest speakers were valued by some segments but actively traded off by others. Quizzes were conflicting, adding value in some classes and reducing it in others. Conclusion: Delivery preferences were heterogeneous, but clinician involvement Q&A and clinician-led demonstrations anchored preferences. The remaining features functioned as tuneable options. A configurable JPP that preserves clinician touchpoints and allows patients to select preferred formats is best aligned with revealed preferences.