Statement of Problem. Characterizing the public's preferential attitudes towards relatively more-/lessintense elective options in “preference-sensitive” health care situations is particularly relevant for the prioritization policies of publicly-funded systems. However, there are a number of issues that need to be considered when designing studies aimed at measuring these preferential attitudes in terms of strength-of-preference scores within community settings, including: whom to sample (since sub-groups might vary in their motives for preferring the same option); how many health care “scenarios” to present (since fewer are needed if preferential attitudes are consistent), and what evaluative techniques to use (since engaging techniques are costly). In three sub-studies, I explored whether strength-of-preference scores for elective health care options tend to be: (1) associated with particular “reasons” or “social influences”; (2) “state-like” or “trait-like”; and (3) influenced by prior use of an “engaging” evaluative technique.

Methods. 202 Medicare beneficiaries considered 8 preference-sensitive scenarios involving choices between relatively more-/less-intense elective options. For each, they reported: their favored option; a strength-of-preference score for that option; and the reasons, sources of social endorsement, and sources of social pressure affecting their choice of that option.

Results. Sub-study participation ranged from 196–199 individuals. In the first sub-study, for each of the relevant scenarios, sub-groups who strongly-/weakly favored the most-popular option did not differ in the reasons for choosing that option, and the social influences (endorsement and pressure) on their choice tended to be similar. In the second sub-study, preferential attitudes appeared to be state-like, in that there was little across-scenario consistency (using Kendall's coefficient of concordance) in the strength-of-preference scores. In the third sub-study, the engaging evaluative technique had no significant effect (using Kendall tau-b correlation coefficient) on the strength-of-preference scores elicited with the subsequent non-engaging technique.

Conclusions. In community-wide surveys, researchers: (1) need not assume that, because they differ in terms of their strength-of-preference scores, individuals have different motivational patterns for favoring the same option; (2) carefully select the sets of scenarios used to elicit strength-of-preference scores, since attitudes may vary depending on what's at stake; and (3) might safely use a non-engaging technique when eliciting strength-of-preference scores.