Colbourn, TE; (2012) Investigating the benefits of women’s groups in Malawi: adapted quality of life measurement, best-worst scaling choice-experiments and contingent valuation. Doctoral thesis , UCL (University College London).

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Abstract

This Ph.D. aims to investigate how women’s groups, aimed at reducing maternal and neonatal mortality in Malawi, affect quality of life. Quality of life was measured in 534 women, com- prising 179 women’s group members in 36 different communities, 174 non-members in the same communities and 181 women in 36 control communities. The WHOQoL-BREF, a 26-item ques- tionnaire developed by the WHO to measure quality of life from a broad perspective, was used. The WHOQoL-BREF has the following six domains: overall quality of life, overall health, phys- ical, psychological, social relationships and environment; and is compatible with the capability approach of economic evaluation. It was first translated into Chichewa, the main local lan- guage of Malawi, and validated for future use as part of this Ph.D.. This Ph.D. also makes methodological contributions via adaptation of Discrete Choice Experiment best-worst scaling exercises for use in poor rural communities; and adapting Contingent Valuation techniques using time and maize flour as alternative payment methods to money. The choice experiments were employed to provide relative preference-weights to each WHOQoL-BREF attribute as an altern- ative to respondents indicating how important each attribute is on a scale not requiring them to trade-off attributes against each other. The results of the choice experiments were modelled using the newly-developed Sequential Best-Worst Multinomial Logit Model. The Contingent Valuation study contributes empirical data on whether, how much, and why the women in the three study arms value the women’s group intervention. This Ph.D. also explores philosoph- ical, political, psychological and economic literature surrounding measurement of quality of life, decision-making, economic evaluation and allocative efficiency. It hopes to contribute toward valuation of women’s groups in Malawi, and, more broadly, toward methods of cost-benefit ana- lysis of health interventions in low-income countries via the consideration of non-health costs and benefits.

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