Client Preferences for Representation: A Conjoint Experiment Involving Symbolic Representation and Representative Role Acceptance Cues

The interventions consist of a within-subject conjoint experiment embedded in an electronic survey. The design is a paired profiles conjoint in which profiles for two therapists—A and B—are presented next to each other in a conjoint table.

The first column of the conjoint table lists a total of seven therapist attributes. The second and third columns list the therapist attribute values for therapists A and B, respectively. All therapist attribute values are assigned at random with equal probability for each attribute (with the restriction that Specialty 2 cannot take on the same value as Specialty 1, when specialty is shown, as explained below). The order of attributes is randomized by respondent (the order will not change from one conjoint to the next for the same respondent); the only constraint on order randomization is that when specialty is shown Specialty 2 always occurs directly after Specialty 1.

Each respondent is randomly assigned (with weights shown in parentheses) to one of three groups determining which set of attributes they will see: no specialty (50% probability), no session info (25% probability), or no professional info (25% probability).

The exact text for the eight therapist attributes and their respective attribute values appear below. Attributes 1-3 are shown to all respondents, while attributes 4-9 are only shown to certain respondents.

Attribute 1: Overall Rating
Attribute values (2):
- 4 stars
- 4.5 stars

Attribute 2: Sex/Gender
Attribute values (3):
- Female
- Male
- Non-Binary

Attribute 3: Race/Ethnicity
Attribute values (4):
- Black/African American
- White
- Hispanic/Latino
- Asian

Attribute 4 (not displayed for respondents selected into "no specialty" group): Specialty 1
Attribute values (6):
- Women's Issues
- Racial Identity
- LGBTQ+
- Life Transitions
- Anxiety
- Depression

Attribute 5 (not displayed for respondents selected into "no specialty" group): Specialty 2
Attribute values (6 - but cannot take on same value as Attribute 4):
- Women's Issues
- Racial Identity
- LGBTQ+
- Life Transitions
- Anxiety
- Depression


Attribute 6 (not displayed for respondents selected into "no session info" group): Next Available Session
Attribute values (2):
- One Week
- Four Weeks

Attribute 7 (not displayed for respondents selected into "no session info" group): Session Format
Attribute values (3):
- Secure Online Meetings
- In-Person Meetings
- Choice of Online or In-Person

Attribute 8 (not displayed for respondents selected into "no professional info" group): Years of Experience
Attribute values (2):
- 5 years
- 20 years

Attribute 9 (not displayed for respondents selected into "no professional info" group): Professional Degree
Attribute values (3):
- Licensed Professional Counselor (LPC)
- Master of Social Work (MSW)
- PhD, Psychology

2023-04-08

2023-04-30

The outcome is the forced choice made by the respondent between the two profiles in each conjoint. Effects of attributes on this choice are estimated as the average marginal component effect (AMCE) (Hainmuller et al. 2014). AMCEs are estimated using OLS with standard errors clustered at the level of the survey respondent (with data from three sets of paired profiles conjoints for each respondent).

We test H1a by estimating the moderating effect of being a woman respondent on the gender attribute for the counselor. Selection of a profile is estimated using the following predictors: gender of respondent, gender attribute values for the counselor, a woman match (coded as 1 if the respondent is a woman AND the gender attribute of the counselor is a woman), and a non-woman match (coded as 1 if the gender of the respondent is not a woman AND their gender matches the gender attribute of the counselor). The woman match variable is the variable of interest for H1a.

We test H1b by estimating the moderating effect of being a nonwhite respondent on the race attribute for the counselor, specifically focusing on a match with the respondent’s own racial identity. Selection of a profile is estimated using the following predictors: race of respondent, race attribute values for the counselor, a nonwhite race match (coded as 1 if the race attribute value of the counselor is not white AND the respondent self-identifies with the race of the counselor), and a white race match (coded as 1 if the race attribute value of the counselor is white AND the respondent self-identifies as white). Note: multiracial respondents can match with more than one race attribute; for example, a respondent who selects both Hispanic and Asian, will have the nonwhite race match variable coded as a 1 whenever the counselor race attribute value is either Hispanic or Asian. The nonwhite race match variable is the variable of interest for H1b.

Tests of H2a/H2b/H2c are conducted using the subsample of respondents who received information about the therapist Speciality attribute in the conjoint (i.e., respondents selected into the "no session info" or "no professional info" groups).

We test H2a by estimating the moderating effect of being a woman respondent on the specialty attributes for the counselor. Selection of a profile is estimated using the following predictors: gender of respondent, specialties of the counselor, and a respondent gender match with the Woman's Issues specialty (coded as 1 if the respondent is a woman AND one of the specialty attributes takes on the value of "Woman's Issues"). The gender-specialty match variable is the variable of interest for H2a.

We test H2b by estimating the moderating effect of being a person of color respondent on the specialty attributes for the counselor. Selection of a profile is estimated using the following predictors: race of respondent, specialties of the counselor, and a person of color matched with the Racial Identity specialty (coded as 1 if the respondent is a person of color AND one of the specialty attributes takes on the value of "Racial Identity"). The race-specialty match variable is the variable of interest for H2b.

We test H2c by estimating the moderating effect of being an LGBTQ+ respondent on the specialty attributes for the counselor. Selection of a profile is estimated using the following predictors: whether respondent indicates they are LGBTQ+, specialties of the counselor, and a match of an LGBTQ+ respondent with the LGBTQ+ speciality (coded as 1 if the respondent indicates they are LGBTQ+ AND one of the specialty attributes takes on the value of "LGBTQ+"). The gender/orientation identity-specialty match variable is the variable of interest for H2c.

We test H3a/H3b by considering how the key effects in H1a/H1b may be further moderated by the availability of information regarding therapist Specialty attributes. The following variables will be added as predictors to the models previously used to test H1a/H1b: selection into the "no specialty" group (for whom the Specialty attributes were not displayed) and an interaction of "no specialty" group x the variable of interest for H1a/H1b.
• For H2a, the key variable of interest is "no specialty" group x woman match.
• For H2b, the key variable of interest is "no specialty" group x nonwhite race match.

The conjoint survey experiment is carried out among a non-probability sample of US residents. Participants are recruited via Prolific, with enrollment limited to individuals with current residence in the US (using Prolific’s prescreening feature). In order to ensure a racially diverse sample of respondents, we will recruit 750 White respondents and 750 non-White respondents. This quota sampling approach is accomplished using Prolific’s prescreening feature. Specifically, two identical studies are created in Prolific, except that one study limits enrollment to only White participants (using Prolific’s demographic category “Ethnicity (Simplified)”) and the other study limits enrollment to non-White participants.

All survey respondents are tasked with selecting a prospective therapist. First, respondents are exposed to an introductory text describing the task and providing basic information about a new community health clinic offering a free initial consultation for mental health counseling. Next, respondents are exposed to a paired profiles conjoint in which two specific therapist profiles—A and B—are presented next to each other in a conjoint table.

The first column of the conjoint table lists seven therapist attributes. The second and third column list the attribute values (for those seven therapist attributes) for therapists A and B, respectively. All therapist attribute values are assigned at random.

The exact therapist attributes and values appear under ‘intervention (public)’.

As our outcome measures, all respondents are asked to indicate their choice between the two therapist profiles (“Which of the two therapists would you personally prefer?”). Response options are “Therapist A” and “Therapist B.” They are then asked how closely “Therapist A” and “Therapist B” reflect their ideal counselor on a scale from 1-7 ("Definitely not ideal" to "Definitely ideal").

Respondents are presented with similar paired profiles conjoints (i.e., involving the same attributes and random assignment of new attribute values for both therapist profiles) two more times. Thus, each respondent will see a total of three pairs of counselors.

We measure respondents' gender, sexual orientation, and race through simple single-item survey measures.

We test the following hypotheses:

H1 Symbolic representation preference:
H1a: Women respondents are more likely to select a woman provider
H1b: Respondents of color are more likely to select a co-ethnic provider

H2 Representative role acceptance cues:
H2a: Women respondents are more likely to select a provider who specializes in women’s issues
H2b: Respondents of color are more likely to select a provider who specializes in racial identity
H2c: LGBTQ+ respondents are more likely to select a provider who specializes in LGBTQ+

H3 Symbolic representation and representative role acceptance cues as substitutes:
H3a: Women's preference for gender congruence will be weaker when info on provider specialty is available
H3b: Respondents' of color preference for coethnic congruence will be weaker when info on provider specialty is available

Randomization is carried out by simple randomization by computer through code embedded in Qualtrics

The individual survey respondent

No

0

9000 observations at the respondent-profile-conjoint level: 1,500 planned survey respondents, each providing an outcome for two paired profiles for three separate conjoints (1500x2x3=9000). As noted above, the survey collection will aim to enroll 750 White respondents and 750 non-White respondents.

As noted above, respondents are randomly assigned to one of three groups (which determines which therapist attributes they will see in the conjoint experiments): a "no specialty" group (n=750 respondents), a "no session info" group n=375), and a "no professional info" group (n=375).

For the conjoint experiments, providing an exact sample size estimate for all potential constellations of job attribute values across job attributes is not meaningful given our conjoint design and research focus.

Below is our expected sample size by treatment arms for each of our three key attributes of interest:

1): “Sex/Gender”
Attribute values: 3 with n = 3,000 in each.

2): “Race/Ethnicity”
Attribute values: 4 with n = 2,250 in each.

3): “Specialty” (only assigned among respondents selected into the "no session info" or "no professional info" groups)
Attribute values: 6 (with 2 values selected for every profile) with n = 1,500 in each.