Abstract
BACKGROUND: Dental caries represents a significant global public health challenge, with particularly high prevalence rates observed among Chinese children. Pit and fissure sealing (PFS) has been established as an effective and cost-efficient preventive intervention, yet service coverage remains suboptimal in China. This study examines guardians' preferences and preference heterogeneity regarding PFS services, with the aim of informing tailored service delivery and policy interventions to enhance PFS uptake. METHODS: A discrete choice experiment was conducted through face-to-face interviews with 411 guardians. Four key attributes were included: preventive effectiveness, preventive service time, distance and out-of-pocket (OOP) service cost. Data were analysed using a mixed logit model, subgroup analyses and scenario analyses were performed to examine preference heterogeneity. RESULTS: Preventive effectiveness (41.31%) emerged as the most influential attribute, followed by distance (29.23%), OOP service cost (15.85%) and preventive service time (13.61%). Female guardians and guardians of children with poor oral health status placed greater emphasis on preventive effectiveness and distance. In contrast, male guardians were more focused on OOP service cost. Guardians with higher education levels and guardians of children with better oral health status were more inclined to schedule PFS services during vacations. The scenario analysis revealed that guardians prefer PFS services with general effectiveness but higher accessibility and lower OOP costs, rather than those offering superior effectiveness but compromised accessibility and higher financial burden. Notably, medical insurance coverage boosted service uptake from 18.3% to 71.0%, with guardians willing to pay 127 Chinese yuan more for insured services. CONCLUSION: These findings highlight substantial preference heterogeneity among guardians and underscore the transformative potential of insurance coverage in enhancing service accessibility. Policymakers should consider incorporating PFS services into medical insurance coverage and optimizing service arrangements to meet the needs of different guardian groups in order to improve the coverage and effectiveness of PFS services. CLINICAL TRIAL NUMBER: not applicable.