Using a web-based survey tool to undertake a Delphi study: application for nurse education research

Role of the health literacy assessment in healthcare: Content validation of "Health Literacy Behaviour" nursing outcome

PURPOSE

To validate the content of the "Health Literacy Behaviour" nursing outcome (NO).

METHODS

A content validation study was conducted during 2022. Each indicator was included in the NO, and its response levels were operationally defined. The initial version of each indicator and its response levels were refined and validated through the Delphi method. A panel of health literacy (HL) and nursing taxonomies experts evaluated the content through two content validity indicators. The content validity of the NO and each index was determined by calculating the content validity index (CVI). A qualitative analysis of the recommendations provided by the experts was carried out to improve the understanding of the indicators and their levels.

FINDINGS

A total of 108 experts participated in this study. Mostly females with more than 10 years of professional experience. The results demonstrated a high CVI of the indicators and the NO "Health Literacy Behaviour." All indicators achieved excellent (CVI ≥ 0.80) relevance and clarity. The CVI universal average method (CVI-p) of the NO achieved an excellent result of 0.90.

CONCLUSIONS

The indicators included in the NO "Health Literacy Behaviour" have content validity.

IMPLICATIONS FOR NURSING PRACTICE

These findings provide evidence-based indicators to measure the patient's actions to obtain, process, and understand information about health and disease, interact with the health system, and make informed health decisions. The validation of this NO would identify populations with low HL, allowing the health of this community to be promoted. Health literacy should be a priority objective of health management and policies.

Working mechanisms of imagery rescripting (ImRs) in adult patients with childhood-related PTSD: a pilot study

Background: Imagery rescripting (ImRs) has shown to be an effective treatment for posttraumatic stress disorders (PTSD) resulting from childhood-related trauma. The current theory is that the change of meaning of the trauma memory is central to the treatment. Several authors have suggested that the expression of needs, feelings and actions may act as potential healing factors, but little specific research aimed at (in)validating this hypothesis has been done so far.Objective: In this study we investigated to what extent the expression of inhibited action tendencies and the fulfilling of needs lead to the reduction of PTSD symptoms in clients with early childhood trauma.Method: Recordings of 249 therapy sessions of 24 ImRs treatments were rated with an observation instrument developed for this purpose, after which the scores were related to pre and posttreatment symptoms, assessed with the Impact of Events Scale-Revised (IES-R).Results: Scores on the IES-R decreased from pretreatment to posttreatment. The two subscales of the NATS (At-scale and N-scale)significantly predicted the posttreatment scores on the IES-R after controlling for the influence of pretreatment IES-R scores: the better the expression of inhibited action tendencies and the better the fulfilling of needs, the lower the symptoms after treatment.Conclusions: This pilot study on the underlying mechanisms of ImRs in PTSD treatment has shown that the expression of action tendencies and fulfilling basic needs during ImRs are associated with a decrease in PTSD symptoms after treatment, and that actions and basic needs cannot be viewed separately. Follow-up research could focus on which of the six domains of the Needs and Action tendencies Scale (NATS) has the greatest effect on the reduction of PTSD symptoms. With this information we can further improve the ImRs protocol.

New consensus definition on defining and measuring care for children with paediatric feeding disorder

AIM

This study addresses the absence of a definition of care for children with feeding disorders, limited agreement on key performance indicators (KPIs), and the lack of data linked to those KPIs.

METHODS

Clinicians, consumers and researchers involved in outpatient feeding care in New South Wales (NSW), Australia were invited to participate in a two-Phase study. In Phase 1, a modified Delphi method was used. Two rounds of voting resulted in a new consensus definition of a multidisciplinary paediatric feeding clinic. Three further rounds voting determined relevant KPIs. In Phase 2, the KPIs were piloted prospectively in 10 clinics.

RESULTS

Twenty-six clinicians, consumers and researchers participated in Phase 1. Participation across five voting rounds declined from 92% to 60% and a valid definition and KPI set were created. In Phase 2, the definition and KPIs were piloted in 10 clinics over 6 weeks. Data for 110 patients were collected. The final KPI set of 28 measures proposed covers clinical features, patient demographics and medical issues, parent-child interaction and outcome measures.

CONCLUSIONS

A new definition of a multidisciplinary paediatric feeding clinic is now available, linked to a standardised KPI set covering relevant performance measures. These proved viable in baseline data collection for 10 clinics across NSW. This sets a foundation for further data collection, systematic measurement of care provision and outcomes, and research needed to deliver care improvement for children with paediatric feeding disorder.

Identification and Prioritization of Canadian Society of Nephrology Clinical Practice Guideline Topics With Multidisciplinary Stakeholders and People Living With Kidney Disease: A Clinical Research Protocol

Background

Despite efforts to provide evidence-based care for people living with kidney disease, health care provider goals and priorities are often misaligned with those of individuals with lived experience of disease. Coupled with competing interests of time, resources, and an abundance of suitable guideline topics, identifying and prioritizing areas of focus for the Canadian nephrology community with a patient-oriented perspective is necessary and important. Similar priority-setting exercises have been undertaken to establish research priorities for kidney disease and to standardize outcomes for kidney disease research and clinical care; however, research priorities are distinct from priorities for guideline development. Inclusion of people living with health conditions in the selection and prioritization of guideline topics is suggested by patient engagement frameworks, though the process to operationalizing this is variable. We propose that the Canadian Society of Nephrology Clinical Practice Guideline Committee (CSN CPGC) takes the opportunity at this juncture to incorporate evidence-based prioritization exercises with involvement of people living with kidney disease and their caregivers to inform future guideline activities. In this protocol, we describe our planned research methods to address this.

Objective

To establish consensus-based guideline topic priorities for the CSN CPGC using a modified Delphi survey with involvement of multidisciplinary stakeholders, including people living with kidney disease and their caregivers.

Study design

Protocol for a Modified Delphi Survey.

Setting

Pilot-tested surveys will be distributed via email and conducted using the online platform SurveyMonkey, in both French and English.

Participants

We will establish a group of multidisciplinary clinical and research stakeholders (both within and outside CSN membership) from Canada, in addition to people living with kidney disease and/or their caregivers.

Methods

A comprehensive literature search will be conducted to generate an initial list of guideline topics, which will be organized into three main categories: (1) International nephrology-focused guidelines that may require Canadian commentary, (2) Non-nephrology specific guidelines from Canada that may require CSN commentary, and (3) Novel topics for guideline development. Participants will engage in a multi-round Modified Delphi Survey to prioritize a set of "important guideline topics."

Measures

Consensus will be reached for an item based on both median score on the Likert-type scale (≥ 7) and the percentage agreement (≥ 75%); the Delphi process will be complete when consensus is reached on each item. Guideline topics will then be given a priority score calculated from the total Likert ratings across participants, adjusted for the number of participants.

Limitations

Potential limitations include participant response rates and compliance to survey completion.

Conclusions

We propose to incorporate evidence-based prioritization exercises with the engagement of people living with kidney disease and their caregivers to establish consensus-based guideline topics and inform future guidelines activities of the CSN CPGC.

Surgeon educator perspectives of implementing a national undergraduate curriculum in otolaryngology

OBJECTIVE

The General Medical Council will be implementing a national medical licensing assessment for all UK medical students by 2024-25. Surgeon educator perceptions on a national undergraduate curriculum in otolaryngology were reviewed accordingly.

METHOD

A mixed methods study was undertaken within a UK school of surgery assessing ENT surgeon educators. Perspectives on teaching content, quality and student experience were assessed with degree of agreement assessed (Likert scoring). Associated qualitative focus group sessions underwent detailed thematic analysis according to grounded theory.

RESULTS

A response rate of 50 per cent was achieved involving 21 participants working across 14 hospitals. These showed strong agreement that implementation of a national curriculum would improve the standard of teaching delivered at a personal, institutional and national level. Further themes were identified relating to the personal, institutional and specialty related factors influencing practical delivery.

CONCLUSION

A series of practical recommendations are made to potentially assist the implementation of a national ENT curriculum.

Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study

PURPOSE

Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR.

MATERIALS AND METHODS

Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round.

RESULTS

Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice.

CONCLUSIONS

Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.

When theory beats practice: the implementation of competency-based education at healthcare workplaces : Focus group interviews with students, mentors, and educators of six healthcare disciplines

BACKGROUND

Work-integrated learning constitutes a large part of current healthcare education. During the last decades, a competency-based educational (CBE) approach has been introduced to reduce the theory-practice gap and to promote continuous competency development. Different frameworks and models have been developed to support CBE implementation in practice. Although CBE is now well-established, implementation at healthcare workplaces remains complex and controversial. This study aims to explore how students, mentors, and educators from different healthcare disciplines perceive the implementation of CBE at the workplace. The six-step model of Embo et al. (2015) was used as a base: (1) competency selection, (2) formulating learning goals, (3) self-monitoring performance, (4) self-assessing competency development, (5) summative assessment of individual competencies, and (6) summative assessment of global professional competence.

METHODS

Three semi-structured focus group interviews were conducted with (1) five students, (2) five mentors, and (3) five educators. We recruited participants from six different educational programs: audiology, midwifery, nursing (associate degree and bachelor), occupational therapy, or speech therapy. We used thematic analysis combining an inductive and deductive approach.

RESULTS

An overview of the predefined competencies was hard to find which complicated CBE implementation and resulted in a lack of consistency between the steps; e.g., the link between the selection of relevant competencies (step 1) and the formulation of learning goals based on these selected competencies (step 2) was absent. Furthermore, the analysis of the data helped identifying seven barriers for CBE implementation: (1) a gap between the educational program and the workplace, (2) a lacking overview of predefined competencies, (3) a major focus on technical competencies at the expense of generic competencies, (4) weak formulation of the learning goals, (5) obstacles related to reflection, (6) low feedback quality, and (7) perceived subjectivity of the assessment approach.

CONCLUSION

The present barriers to CBE implementation lead to a fragmentation of current work-integrated learning. In this way, theory beats practice when it comes to CBE implementation as the theory of CBE is not effectively implemented. However, the identification of these barriers might help to find solutions to optimize CBE implementation. Future research seems critical to optimize CBE so that theory can meet practice and the opportunities of CBE optimize healthcare education.

Self-management in heart failure using mHealth: A content validation

AIM

To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity.

METHODS

Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed.

RESULTS

The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI ≥ 0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851.

CONCLUSIONS

mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation.

Use of Delphi in health sciences research: A narrative review

The use of the Delphi technique is prevalent across health sciences research, and it is used to identify priorities, reach consensus on issues of importance and establish clinical guidelines. Thus, as a form of expert opinion research, it can address fundamental questions present in healthcare. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Advantages of the use of Delphi include anonymity, controlled feedback, flexibility for the choice of statistical analysis, and the ability to gather participants from geographically diverse areas. Areas of methodological uncertainty worthy of further discussion broadly include experts and data management. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. For data management, there are issues with data collection, defining consensus and methods of data analysis, such as percent agreement, central tendency, measures of dispersion, and inferential statistics. Overall, the use of Delphi addresses important issues present in health sciences research, but methodological issues remain. It is likely that the aggregation of future Delphi studies will eventually pave the way for more comprehensive reporting guidelines and subsequent methodological clarity.

Nursing Care for Patients With Acute Mania: Exploring Experiential Knowledge and Developing a Standard of Good Care-Results of the Delphi Study

BACKGROUND

When patients diagnosed with bipolar disorder are suffering from acute mania (involuntary), hospitalization is often necessary. Patients are often quite disruptive, which makes it difficult to regulate their behavior and manage them in their current condition. The nursing team must also ensure the safety of the other patients on the ward. Nursing practice in this domain appears to draw primarily on tradition and experience.

AIMS

To achieve consensus on a standard for nursing practice for patients suffering from mania who are admitted to a closed psychiatric ward.

METHODS

Previously, professionals, patients, and informal caregivers in the Netherlands were interviewed about the nursing care and their lived experiences. Based on these findings and on the results of a literature review, 89 statements were formulated. A three-round Delphi study among professionals, patients, and informal caregivers was carried out. The accepted statements were summarized.

RESULTS

In the first round, 71 statements were accepted, none were rejected, and for 18 statements, no consensus could be reached. These were reformulated and presented in a second round. Thirteen of these statements were accepted, none were rejected, and five statements needed to be reformulated and were presented in the third and final round of this Delphi study. In this final round, all statements were accepted.

CONCLUSIONS

Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.

The Use of a Two-Phase Online Delphi Panel Methodology to Inform the Concurrent Development of a School-Based Ovulatory Menstrual Health Literacy Intervention and Questionnaire

Introduction

There are a high prevalence of ovulatory-menstrual (OM) dysfunction and low levels of menstrual health literacy in adolescents, yet few evidence-based OM health education resources for schools.

Method

This two-phase study used an online Delphi methodology to build consensus across thirty-five purposively selected professionals from the diverse professions of health and education. The panellists were tasked to inform the development of a school-based OM health literacy resources.

Results

In Round One, 86% of panellists determined the scope of these resources using guided and open-ended questions. The study then split into two phases which ran concurrently. In the first phase informing the intervention's development, 57% of panellists participated in Round Two, and 29% reviewed selected lessons. In the second phase informing the questionnaire's development, 51% of panellists participated in Round Two, and 69% in Round Three. The overall consensus reached for the intervention phase and questionnaire phase were 82% and 84%, respectively. The Panel's recommendations included a strengths-based position to counter menstrual stigma, teaching accurate self-report of cycle biomarkers, addressing multiple menstrual dysfunctions and adopting a whole-school approach.

Conclusion

Although time-consuming and requiring a sustained interest, this two-phase Delphi methodology offered anonymity to panellists from distinct professions which facilitated their independent contribution to developing OM health literacy school resources.

Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study

OBJECTIVE

Conservative management of cervical radiculopathy (CR) is a first treatment option because the risk-benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute, or chronic) of CR using the Delphi method approach.

METHODS

Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, interquartile range value of ≤1, and/or a percentage of agreement ≥70%.

RESULTS

Data analysis produced a consensus list of effective treatment modalities in different stages of recovery.

CONCLUSION

According to experts, the focus of multimodal management in the acute stage should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises, and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises, and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered.

IMPACT

Multimodal conservative management of individuals with CR should take the stage of the condition into consideration. The focus of therapeutic interventions should shift from passive pain-relieving intervention in the acute stage to increasingly more individualized physical activity and self-management in the chronic stage.

An online Delphi study to investigate the completeness of the CanMEDS Roles and the relevance, formulation, and measurability of their key competencies within eight healthcare disciplines in Flanders

BACKGROUND

Several competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.

METHODS

A three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n = 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.

RESULTS

After round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts' remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.

CONCLUSIONS

The CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.

Analyzing the Implementation of Lean Methodologies and Practices in the Portuguese Industry: A Survey

The mass production paradigm on which much of the industry was based has changed. The market is increasingly demanding, requesting diversity and products that are more and more adapted to personal wishes and requirements. This implies producing a greater diversity of products in smaller quantities. Competitiveness is enormous, which forces most companies to be truly effective and efficient, taking care of product quality, delivery time, and final cost. Lean methodologies have been a valuable aid in this field. The diversity of Lean tools has been shown to have answers to the most diverse challenges, and companies are aware of this, increasingly adopting methodologies and processes that aim to progressively reduce waste and adapting their production paradigm to what the market requires. This work intends to provide a vision, as global as possible, of the pathway of Lean implementation in the Portuguese industry. For this purpose, a survey was carried out with a significant sample of Portuguese industrial companies from a wide range of activity sectors. The data collected through the survey were treated statistically, and then a SWOT analysis of the results was performed, which provided a collection of precious information on the evolution of industrial companies in Portugal.

Development of an integrated competency framework for postgraduate paediatric training: a Delphi study

Competency-based education (CBE) has transformed medical training during the last decades. In Flanders (Belgium), multiple competency frameworks are being used concurrently guiding paediatric postgraduate CBE. This study aimed to merge these frameworks into an integrated competency framework for postgraduate paediatric training. In a first phase, these frameworks were scrutinized and merged into one using the Canadian Medical Education Directives for Specialists (CanMEDS) framework as a comprehensive basis. Thereafter, the resulting unified competency framework was validated using a Delphi study with three consecutive rounds. All competencies (n = 95) were scored as relevant in the first round, and twelve competencies were adjusted in the second round. After the third round, all competencies were validated for inclusion. Nevertheless, differences in the setting in which a paediatrician may work make it difficult to apply a general framework, as not all competencies are equally relevant, applicable, or suitable for evaluation in every clinical setting. These challenges call for a clear description of the competencies to guide curriculum planning, and to provide a fitting workplace context and learning opportunities.Conclusion: A competency framework for paediatric post-graduate training was developed by combining three existing frameworks, and was validated through a Delphi study. This competency framework can be used in setting the goals for workplace learning during paediatric training. What is Known: •Benefits of competency-based education and its underlying competency frameworks have been described in the literature. •A single and comprehensive competency framework can facilitate training, assessment, and certification. What is New: •Three existing frameworks were merged into one integrated framework for paediatric postgraduate education, which was then adjusted and approved by an expert panel. •Differences in the working environment might explain how relevant a competency is perceived.

Establishing consensus on key elements and implementation enablers of community-based pain programs to support primary health network decision making: an eDelphi study

To address the growing burden of chronic pain, there is a need for national scale-up of community-based pain programs. Primary health networks (PHNs) are best placed to support this scale-up as commissioning bodies of health services. The aim of this eDelphi study was to establish expert consensus on best practice key elements of community-based pain programs and enablers important for program implementation and sustainability to support PHN decision making. A panel of experts was invited to complete three online survey rounds as part of a reactive eDelphi approach to provide feedback on the relevance and importance of proposed key elements and implementation enablers of community-based pain programs. Consensus of 70% agreement by experts was required for each survey round for items to remain, with comments from experts considered by the research team to agree on wording changes and the addition of new items. Ten experts (62.5%) completed all three survey rounds. Expert feedback resulted in a list of 18 best practice key elements of community-based pain program design and 14 program implementation enablers. Changes suggested by experts included the moving of items between lists, rephrasing of items and the addition of new items. The eDelphi results will serve as a resource for PHNs considering the commissioning of community-based pain programs and inform future research to assess the suitability and scalability of existing programs.

Towards Consensus on Good Practices for the Use of New Technologies for Intervention and Support in Developmental Dyslexia: A Delphi Study Conducted among Italian Specialized Professionals

The use of new technologies for intervention in developmental dyslexia is steadily growing. In order to better understand the needs, the expectations, and the attitudes of Italian expert health professionals concerning such technologies, a national survey was conducted applying the Delphi methodology. Ad-hoc questionnaires were sent out to a group of eighteen experts over three successive rounds, and anonymously collected responses were aggregated and shared with the group after each round, aiming to reach a consensus on the proposed response. The goal was to define a series of statements that could form the basis for international "good practices" in the use of technologies for intervention to support dyslexia in children and adolescents. In the first round, the experts' general opinions were collected with both multiple choice and open questions, and in the second round consensus was assessed on a series of statements based on the first replies. The cut-off of 75% consensus on each statement was reached after three rounds. Fifteen experts completed all the rounds of the process, and a final version of the statements regarding good practice in the use of technologies for dyslexia could be defined.

Development and validation of a new tool to identify factors that influence users' motivation toward the use of teleconsultation systems: A modified Delphi study

BACKGROUND

Healthcare providers have improved consumer access to healthcare services by the adoption of information communication technology and the use of telemedicine. With the current COVID-19 pandemic, consumers are shifting to remote teleconsultation. There are several studies regarding consumers' acceptance and satisfaction with telemedicine among healthcare providers and a few among patients at healthcare facilities. However, studies about patients' motivation toward the use of teleconsultation systems are very few.

AIM

The aim of this study was to validate an instrument of a newly developed framework to identify factors that motivate patients to use a teleconsultation system.

METHOD

This study used a modified eDelphi method incorporating content validity index and content validity ratio procedures to validate the instrument among fifteen experts from different disciplines. The eDelphi consisted of three rounds to review each item's relevance, clarity, importance and the overall validity of the instrument.

RESULT

The result showed a significant level of agreement among experts for individual items' relevance, clarity and importance. For relevance, all items had excellent I-CVI above 0.889, except one item with I-CVI = 0.78, which is still acceptable. For clarity, all items had an excellent I-CVI > 0.889, except one with I-CVI = 0.667. For importance, most items had CVR above the threshold value of 0.778, except 5 items. Also, the result showed moderate to high content validity of the overall instrument (S-CVI/UA = 0.694; S-CVI/Ave = 0.996).

DISCUSSION

These findings support the validity and reliability of the developed instrument, which can be used to identify factors that motivated patients to use a teleconsultation system. Future testing of the instrument should be conducted with a larger population that uses a teleconsultation system.

CONCLUSION

An instrument was developed to identify factors that motivated consumers to use teleconsultation, using a modified eDelphi method among experts. The eDelphi method consisted of three rounds and the results showed that the instrument is a valid and reliable tool.

The P.O.S.T Guidelines for Nutrition Blogs: A Modified e-Delphi Study

BACKGROUND

Blogs are being used increasingly to disseminate nutrition information to consumers, including by registered dietitians (RDs). Guidelines in authoring blogs are important for dietetics professionals so that they effectively communicate evidence-based nutrition information in this format.

OBJECTIVE

The aim of this study was to obtain consensus from experts comprising RDs with active blog-writing experience on a set of guidelines for use by RDs when authoring a healthy eating or nutrition information blog.

DESIGN

A modified e-Delphi technique with a consensus-based approach was used in this study undertaken between June and October 2019. The purpose-built, pilot-tested e-Delphi survey was informed by a literature review and included statements from 3 domains comprising blog readers and communication; purpose and healthy eating messages; and structure, voice, and tone. Expert participants were identified purposively and via snowballing. In each survey round, statements that achieved 80% consensus were accepted.

PARTICIPANTS/SETTING

A total of 19 experts consented to participate. Experts resided in the United States, Australia, and United Kingdom. Experts were mainly women aged between 30 and 49 years and working in private practice and/or research or teaching areas of nutrition and dietetics.

RESULTS

Across 3 domains, a total of 33 statements were accepted, comprising a final set of guidelines named the P.O.S.T (purpose, community, structure, and tone) Guidelines for Nutrition Blogs.

CONCLUSIONS

Consensus from a panel of dietetics experts resulted in the P.O.S.T Guidelines for Nutrition Blogs, which can support RDs in authoring healthy eating blogs. This will ensure that evidence-based nutrition messages provided to consumers are engaging and effective.

Nurse-perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey

Background

The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision‐making. To deliver patient‐centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach.

Objective

This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease.

Design

An e‐Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales.

Participants and Measurements

A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries.

Results

Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items.

Conclusions

Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease.

Exploring healthcare professionals' perceptions of artificial intelligence: Validating a questionnaire using the e-Delphi method

Objective

The aim of this study was to draw upon the collective knowledge of experts in the fields of health and technology to develop a questionnaire that measured healthcare professionals' perceptions of Artificial Intelligence (AI).

Methods

The panel for this study were carefully selected participants who demonstrated an interest and/or involvement in AI from the fields of health or information technology. Recruitment was accomplished via email which invited the panel member to participate and included study and consent information. Data were collected from three rounds in the form of an online survey, an online group meeting and email communication. A 75% median threshold was used to define consensus.

Results

Between January and March 2019, five healthcare professionals and three IT experts participated in three rounds of study to reach consensus on the structure and content of the questionnaire. In Round 1 panel members identified issues about general understanding of AI and achieved consensus on nine draft questionnaire items. In Round 2 the panel achieved consensus on demographic questions and comprehensive group discussion resulted in the development of two further questionnaire items for inclusion. In a final e-Delphi round, a draft of the final questionnaire was distributed via email to the panel members for comment. No further amendments were put forward and 100% consensus was achieved.

Conclusion

A modified e-Delphi method was used to validate and develop a questionnaire to explore healthcare professionals' perceptions of AI. The e-Delphi method was successful in achieving consensus from an interdisciplinary panel of experts from health and IT. Further research is recommended to test the reliability of this questionnaire.

Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol

INTRODUCTION

Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk-benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach.

METHODS AND ANALYSIS

Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery.

ETHICS AND DISSEMINATION

Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.

Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study

AIM

To achieve profession-wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties).

DESIGN

Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three-round Delphi study (Survey Phase).

METHODS

Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in-depth interviews of purposeful sample of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web-based Delphi surveys), with draft standards reviewed profession-wide. Responses comprised scoring using Likert scales to calculate content validity indexes for individual standards with qualitative responses supporting decision-making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of individual and group feedback. The study was conducted 2014-2017.

RESULTS

Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy-three standards were validated, with final content validity indices of 92-100%. Scale-level indices were 98%, strongly validating metaspecialty taxonomy.

CONCLUSION

A research-derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education.

IMPACT

The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.

A Clinical Tool (CUE-tool) for Health Care Professionals to Assess the Usability and Quality of the Content of Medical Information Websites: Electronic Delphi Study

Background

As patients are increasingly searching for information about their medical condition on the internet, there is a need for health professionals to be able to guide patients toward reliable and suitable information sources on the internet.

Objective

The aim of the study was to develop a clinical tool for health care professionals to assess the usability and quality of the content of websites containing medical information that could be recommended to patients.

Methods

A 3-round modified electronic Delphi (eDelphi) study was conducted with 20 health care professionals.

Results

In round one of the eDelphi study, of the 68 items initially created, 41 items (29 on usability and 12 on content) were rated as important or very important by more than half of the panel and thus selected for further evaluation in round two. In round two, of the 41 items chosen from round 1, 19 were selected (9 on usability and 10 on content) as important or very important by more than half of the panel for further evaluation. As a result of round three, 2 items were combined as a single item, leaving the instrument with 18 items in total (8 on usability and 10 on content). The tool is freely accessible online.

Conclusions

The CUE-tool can be used to (1) evaluate the usability and reliability of the content of websites before recommending them to patients as a good information source; (2) identify websites that do not have reliable content or may be difficult for patients to use; (3) develop quality websites by using the criteria in the CUE-tool; and (4) identify different qualities between different websites.

Using the Delphi Method to Evaluate the Appropriateness of Urban Freight Transport Solutions

Before implementing an Urban Freight Transport (UFT) solution, certainty is required about the effectiveness of the considered alternatives. Selecting an effective solution necessitates the engagement of all stakeholders involved in the management of the UFT system. The aim of the study is the formulation of a common assessment platform for facilitating the selection of the most appropriate UFT solution, taking into account the solutions’ effectiveness and the stakeholder perceptions and consensus. Solution maturity, social acceptance, and user uptake, which are considered as the main drivers of stakeholders’ engagement, are evaluated based on a real time Delphi survey, in parallel with solutions’ sustainability dimensions (economy and energy, environment, society, transport, and mobility). The Delphi method emerges as a suitable tool in this direction as stakeholders’ subjective judgments, and not analytical techniques, are required. The platform is demonstrated through the assessment of ten UFT solutions by 184 stakeholders (public authorities, supply chain operators, and other interested groups) who reside in cities across the world. The results of the demonstration showed that Intelligent Transportation Systems (ITS) for freight monitoring and electric vehicles are the highest rated solutions, while drone deliveries are the lowest, reaching respectively the highest and lowest consensus levels.

A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations

BACKGROUND AND OBJECTIVES

Many patients, providers, and potential living donors perceive the living kidney donor evaluation process to be lengthy and difficult to navigate.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We sought consensus on key terms and process and outcome indicators that can be used to measure how efficiently a transplant center evaluates persons interested in becoming a living kidney donor. Using a RAND-modified Delphi method, 77 participants (kidney transplant recipients or recipient candidates, living kidney donors or donor candidates, health care providers, and health care administrators) completed an online survey to define the terms and indicators. The definitions were then further refined during an in-person meeting with ten stakeholders.

RESULTS

We identified 16 process indicators (e.g., average time to evaluate a donor candidate), eight outcome indicators (e.g., annual number of preemptive living kidney donor transplants), and two measures that can be considered both process and outcome indicators (e.g., average number of times a candidate visited the transplant center for the evaluation). Transplant centers wishing to implement this set of indicators will require 22 unique data elements, all of which are either readily available or easily collected prospectively.

CONCLUSIONS

We identified a set of indicators through a consensus-based approach that may be used to monitor and improve the performance of a transplant center in how efficiently it evaluates persons interested in becoming a living kidney donor.

Bridging research integrity and global health epidemiology (BRIDGE) statement: guidelines for good epidemiological practice

BACKGROUND

Research integrity and research fairness have gained considerable momentum in the past decade and have direct implications for global health epidemiology. Research integrity and research fairness principles should be equally nurtured to produce high-quality impactful research-but bridging the two can lead to practical and ethical dilemmas. In order to provide practical guidance to researchers and epidemiologist, we set out to develop good epidemiological practice guidelines specifically for global health epidemiology, targeted at stakeholders involved in the commissioning, conduct, appraisal and publication of global health research.

METHODS

We developed preliminary guidelines based on targeted online searches on existing best practices for epidemiological studies and sought to align these with key elements of global health research and research fairness. We validated these guidelines through a Delphi consultation study, to reach a consensus among a wide representation of stakeholders.

RESULTS

A total of 45 experts provided input on the first round of e-Delphi consultation and 40 in the second. Respondents covered a range of organisations (including for example academia, ministries, NGOs, research funders, technical agencies) involved in epidemiological studies from countries around the world (Europe: 19; Africa: 10; North America: 7; Asia: 5; South-America: 3 Australia: 1). A selection of eight experts were invited for a face-to-face meeting. The final guidelines consist of a set of 6 standards and 42 accompanying criteria including study preparation, protocol development, data collection, data management, data analysis, dissemination and communication.

CONCLUSION

While guidelines will not by themselves guard global health from questionable and unfair research practices, they are certainly part of a concerted effort to ensure not only mutual accountability between individual researchers, their institutions and their funders but most importantly their joint accountability towards the communities they study and society at large.

Development of consensus-based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study

OBJECTIVE

To generate consensus-based guidelines for outpatient dietetic treatment of patients with an eating disorder (ED) using Delphi methodology.

METHOD

A modified Delphi method was used to develop consensus-based guidelines in several categories: referral to a dietitian; essential components of outpatient dietetic treatment; strategies to promote collaboration between dietitians and other healthcare professionals; and skills dietitians should possess if treating patients with an ED. Participants (n = 162) were coded into three panels: ED specialists (n = 79), non-ED specialists (n = 28), and consumers and carers with lived experience of an ED (n = 55). A total of 122 statements were rated across three rounds.

RESULTS

Eighty-one statements reached consensus level (66.4%). A high proportion of endorsed statements were consistent with current guidelines for ED treatment, though some statements for which evidence exists were not endorsed as essential components of dietetic treatment. Compared to consumers and carers, ED specialists were less likely to endorse assessment or involvement by a dietitian as a standard component of treatment, and a number of discrepancies between ED specialists and consumers and carers were observed regarding essential components of dietetic treatment.

DISCUSSION

This study provides consensus-based guidelines in the current absence of clinical practice guidelines for dietetic treatment of EDs. It also highlights the importance of further research into: (a) the effectiveness of different components of dietetic intervention in this population and (b) how dietetic assessment and intervention is best incorporated into outpatient treatment.

Development and Validation of the Operational Definitions of the Defining Characteristics of the Nursing Diagnosis of Insomnia in the Occupational Health Setting

PURPOSE

To develop and validate the operational definition (ODs) for each defining characteristic (DC) contained in the Nursing Diagnosis (ND) "insomnia" (00095) in the occupational health context.

METHODS

Methodological study carried out in two stages, including a consensus of experts to develop the ODs (Stage 1) and an online Delphi panel, performed in two rounds, to validate them (Stage 2).

FINDINGS

The 15 ODs proposed in Stage 1 were narrowed down to six validated ODs in the first round (diagnostic content validity index [DCVI] = 0.80-0.89). In the second round, five ODs were validated (DCVI = 0.80-0.94). Finally, the remaining four ODs were validated by the general consensus of experts.

CONCLUSIONS

The ODs were validated, although there remains some doubt as to whether some of the DCs can be applied to the field of occupational health.

IMPLICATIONS FOR NURSING PRACTICE

The ODs developed and validated could improve the diagnostic accuracy of the ND "insomnia" (00095) in the context of occupational health.

Child and adolescent mental health in Africa: A qualitative analysis of the perspectives of emerging mental health clinicians and researchers using an online platform

Objective: Using a social ecological framework, this study aimed to establish emerging mental health clinicians and researchers' perspectives about child and adolescent mental health (CAMH) in Africa. Method: Perspectives of 17 participants from Ethiopia, Kenya, South Africa, Tunisia, Uganda and Zambia, whose professional backgrounds ranged from psychiatry to speech-language therapy, were collected at an African CAMH conference. Data were gathered using open-ended questions, using an online survey. Data were analysed using theoretical thematic analysis. Results: An adapted social ecological framework highlighted: An increased need for commitment from governments to improve CAMH in Africa; and addressing mental health stigma and discrimination through community awareness. The need for specialised CAMH facilities were identified, particularly in the public health sector. The need for multi-sectoral, multi-disciplinary partnerships for advocacy, service delivery, and continuity of care were also identified. Participants emphasised the importance of CAMH awareness, and the role of governments in recognising CAMH needs and using policies to improve CAMH in Africa. Participants were hopeful about the transformation of CAMH on the continent. Conclusion: The participants prioritised government- and community-level awareness to increase the resources and support offered by CAMH services in Africa.

The 'Reality of Revalidation in Practice' (RRiP) project - Experiences of registrants and preparation of students in nursing and midwifery in the United Kingdom: A descriptive exploratory survey

BACKGROUND

Renewal of healthcare registration or license to practise is becomingly increasingly common, worldwide. Evidence regarding the experience of nursing and midwifery revalidation in the United Kingdom is limited. Preparation of students for the process has not yet been considered in the literature.

OBJECTIVES

To explore registrants' experiences of undertaking or supporting colleagues through revalidation. To consider preparation of pre-registration students for this future professional requirement.

DESIGN

A descriptive exploratory study comprising an on-line survey.

SETTING

A university in the southwest of England and associated clinical placements.

PARTICIPANTS

Nursing and Midwifery Council registrants, comprising 40 university staff and 40 clinicians; 36 pre-registration nursing and midwifery students.

METHODS

Participation in an anonymous on-line survey was invited via university databases. Descriptive statistical analysis of quantitative data used a combination of software and manual methods. Qualitative data were manually coded and categorised into themes through inductive reasoning.

FINDINGS

Most experiences of revalidation were positive. Reflective discussions resulted in mutual learning, particularly if partners were chosen by the registrant. External scrutiny was welcomed. Some registrants questioned involvement of line managers and alignment with performance review, seeking to avoid a 'tick-box exercise' and conflicts of interest. University staff felt better prepared and more positive than clinicians. Pre-registration curriculum activities preparing students included writing reflections, maintaining portfolios, practice assessment and discussions about the revalidation process. Midwifery students seemed better prepared than nursing peers. Key themes of 'Professional values', 'Preparation', 'Process' and 'Purpose' and a range of positive influences and potential hazards informed development of a conceptual model.

CONCLUSIONS

The purpose and process of revalidation is enhanced if confirmation is undertaken by a registered nurse or midwife of the individual's choice. Preparation of students for future revalidation is facilitated by role-modelling of positive attitudes and explicitly linking relevant pre-registration curriculum activities to this process and purpose.

The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework

BACKGROUND

Policy analysis is considered essential for achieving successful reforms in health promotion and public health. The only framework for physical activity (PA) policy analysis was developed at a time when the field of PA policy research was in its early stages. PA policy research has since grown, and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. This study developed a new conceptual framework for PA policy analysis - the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework.

METHODS

The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two-rounds of consultations with PA policy stakeholders.

RESULTS

The CAPPA framework specifies 38 elements of a comprehensive analysis of PA policies in the following six categories, which comprise the building blocks of the framework: (i) purpose of analysis (including auditing and assessment of policies); (ii) policy level (including: international; national; subnational; local; and institutional policies); (iii) policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); (iv) type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); (v) stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and (vi) scope of analysis (including availability; context; processes; actors; political will; content; and effects). Based on the CAPPA framework, we also proposed broad and inclusive definitions of PA policy and PA policy analysis.

CONCLUSION

The CAPPA framework may be used to guide future studies related to PA policy and to provide a context for the analysis of its specific components. The framework could be used in the same way for sedentary behaviour policy research. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework and analyse the elements for which evidence is lacking. Future studies should also determine whether the existing tools allow for auditing and assessment of all the CAPPA elements and develop new tools if needed to allow for a more comprehensive PA policy analysis.

Development of a list of high-risk perioperative medications for the elderly: a Delphi method

Objectives: There is a lack of direct evidence for the management of perioperative medications in elderly patients. Therefore, the authors aimed to develop a list of high-risk medications for the elderly population in China to provide indicators for clinicians to identify medication-related factors contributing to potential adverse events during the perioperative period. Methods: The initial list of high-risk perioperative medications was developed by studying all the publications that described specific high-risk medications and their risk profiles in the elderly. Delphi consultations were performed to form a consensus among the group of experts and the list was finalized. Results: The expert panel consisted of 36 experts from 29 tertiary hospitals and 18 provinces or municipalities. The consensus was reached after two Delphi rounds. Finally, a total of 86 medications of 13 medication classes and 120 screening items were included in the final list, along with perioperative risk profiles and risk aversion recommendations for each drug. Conclusion: This is the first study to establish a high-risk perioperative medication list in China, which can be used as a reference for intervention and evaluation of perioperative medications for the elderly population.

Teaching undergraduate medical students Child and Adolescent Psychiatry (CAP): a Delphi study on curriculum content

BACKGROUND

The prevalence of psychiatric disorders in children and young people is high but despite this, many doctors have difficulty identifying and managing psychiatric disorders presenting in this age group. The purpose of this study was to determine appropriate curriculum content in Child and Adolescent Psychiatry (CAP) for a Graduate Entry Medicine (GEM) course. Doctors with a background in primary care who were also involved in undergraduate teaching rated how necessary they considered a number of knowledge, skills and attitudes items were for inclusion in the CAP curriculum.

METHODS

An online questionnaire study was carried out using modified Delphi methodology in two rounds. The questionnaire was derived from a list of CAP learning objectives and/or curricular content obtained from a thorough review of the literature. 23 of the 24 doctors who had agreed to participate went on to complete the round one questionnaire (95.8% response rate) with 19 also completing round 2 (82.6%). Where there was high agreement (70% or more) amongst participants, items were considered as having sufficient consensus to either accept or reject them. Mean scores were then used as a way to prioritise items.

RESULTS

At the end of round two, there was consensus to consider including 26 of the 34 knowledge items, 16 of the 20 skills items and three of the four attitudes items in the CAP curriculum. The most highly rated knowledge, skills and attitudes items were depression/ suicide; communicating with children, young people and families; and rapport building. The majority (83.3%) of round two responders, considered that the current amount of CAP teaching time was "too little".

CONCLUSIONS

Delphi methodology proved useful for determining consensus and the priority rankings of the CAP knowledge, skills and attitudes items can now be used to help educators determine which topics to focus upon. The study findings support the need for additional CAP teaching time in the GEM curriculum and will help to shape new CAP content. Additional formal CAP teaching time has already been incorporated into the psychiatry speciality attachment, a new clinical skills session has been developed and CAP topics have been introduced into written and clinical examinations.

Achieving consensus on the undergraduate curriculum of public health nursing in Turkey

OBJECTIVE

The aim of this study was to construct a consensus on the undergraduate learning objectives and topics for public health nursing (PHN) in Turkey.

DESIGN

A three-round e-mail-based Delphi study was conducted between May and July 2015 with a national sample.

SAMPLE

Ninety-one academics from 54 universities were invited as experts to participate by e-mail. Fifty-nine academics from 43 universities participated in the study.

MEASUREMENTS

Data were analyzed by computing the median, quartiles one and three, and the interquartile range for each learning outcome and topic. Consensus was considered as less than the interquartile range of 1.2.

RESULTS

Experts who participated in the study added 70 learning outcomes, eight main topics, and 278 sub-topics during the first round. Round I generated 170 learning outcomes, 28 main topics, and 385 sub-topics. At the end of Round II, consensus was reached on 126 learning outcomes, 22 main topics and 168 sub-topics. At the end of Round III, consensus was achieved for 126 learning outcomes, 22 main topics, and 169 sub-topics.

CONCLUSION

The learning outcomes and topics that were decided upon through a consensus process will contribute to the standardization and development of PHN education.

Supporting parental caregivers of children living with life-threatening or life-limiting illnesses: A Delphi study

BACKGROUND

The impact of a child s life-limiting or life-threatening illness is significant on parents who experience a great deal of emotional, physical, and spiritual upheaval. Hope has been identified as an important inner resource for parental caregivers. Specifically, parental hope has been described as having four subproceses including Accepting Reality, Establishing Control, Restructuring Hope, and Purposive Positive Thinking.

PURPOSE

The purpose of this Delphi study was to gather expert opinions from parents and formal care providers about the four subproceses essential to parental hope, to increase understanding of parental caregivers current support needs. As Phase one of a three-phase study, the findings provided direction in the development of a theory-based hope intervention.

DESIGN AND METHODS

A Delphi study consisting of three rounds of survey questions and controlled feedback to experts was employed. Experts suggested strategies for each subprocess and ranked them in order of highest to lowest according to feasibility and effectiveness.

RESULTS

Sixty-eight experts consisting of parental caregivers of children diagnosed with life-limiting or life-threatening illnesses and those who care for them (community members, nurses, social workers, and physicians) were recruited to participate. Through three rounds of survey questions, response rates ranged from 92-97%. A consensus revealed eight major themes that support parental hope: Organize Basic Needs; Connect with Others; Prioritize Self-care; Obtain Meaningful Information; Take Things Day by Day; Advocate for Parental Participation; Manifest Positivity; and Celebrate Milestones.

PRACTICE IMPLICATIONS

This study identified a wide variety of psychosocial needs for parental caregivers. Results also offered direction for a theory-based hope intervention while highlighting the need for additional research in this area. These results will provide the foundation for a booklet parents can work through in their journey of caring for a child with a life-limiting or life-threatening illness.

Measuring What Matters: Achieving Consensus on a Positive Aging Indicator Set For Ireland

The objective of this study was to measure consensus among expert stakeholders on a set of positive aging outcome indicators in Ireland. Stakeholders from academic, public, and voluntary sectors and older people participated in a 3-round, online Delphi study to evaluate indicators for participation, security, healthy aging, attitudes to aging, and information access. Evaluation criteria included: acceptability, utility, accessibility, ranking, and balance and coherence. Consensus was achieved on 56 key indicators that are aligned with action areas in the National Positive Ageing Strategy. These indicators will be reported on a biannual basis to monitor progress in positive aging in Ireland.

Developing a shared decision support framework for aortic root surgery in Marfan syndrome

OBJECTIVE

The study is an early phase of development of a decision support framework for people with Marfan syndrome who are anticipating prophylactic aortic root surgery. Implications of the timing and the nature of the operation chosen were previously elicited in focus groups. In this step, we explored the range of relative values placed by individuals on the implications of decisions made about surgery.

METHODS

Following the principles of the Ottawa Decision Support Framework, eight questions in the general form 'How important is it to you …' were framed by a panel. Marfan people, families and specialist doctors answered online. Quantitative and qualitative analyses were performed.

RESULTS

Worldwide, 142 responses were received including 25 specialist doctors. Respondents were 55% female and 46% had previous aortic root surgery. Overall, active lifestyle was more important to males (p=0.03). Patients placed more importance than doctors on not deferring surgery (p=0.04) and on avoidance of anticoagulation in the interests of childbearing (p=0.009). Qualitative analysis showed differing but cogently reasoned values that were sometimes polarised, and mainly driven by the wish to maintain a good quality of life and active lifestyle.

CONCLUSIONS

Given the cogency of these viewpoints, people anticipating root replacement surgery should have ample opportunity to express them and to have them acknowledged ahead of a consultation when they can then be fully explored in a mutually informed forum. If they differ from local medical practice, they can then be discussed in the process of reaching shared and individualised decisions.

Using the Delphi Technique to Explore Complex Concepts in Speech-Language Pathology: An Illustrative Example From Children's Social Communication

PURPOSE

In recent years, there has been an increasing interest in expanding the research approaches that speech-language pathologists utilize, particularly for addressing complex questions. Consensus-building techniques can be useful for addressing such questions. The Delphi technique is a consensus-building process involving structured communication among members of an expert panel via independent responses to iterative rounds of questionnaires. The purpose of this research note is to describe and demonstrate the Delphi technique using an application to a complex problem in speech-language pathology, that is, the bases of social communication and pragmatics.

METHOD

The Delphi technique was described and illustrated via the following study: 10 expert speech-language pathologists participated in a 3-round Delphi study. Participants were asked to list the key features of social communication and pragmatics in Round 1. Questions for Rounds 2 and 3 were developed on the basis of the participants' responses to previous rounds.

RESULTS

The Delphi technique was useful in bringing participants to consensus on the key features of social communication and pragmatics and offered a starting point for the continued exploration of this complex problem.

CONCLUSION

A discussion of the benefits and limitations of the technique is included, highlighting the utility of the technique to the field of speech-language pathology.

The use of advanced web-based survey design in Delphi research

AIM

A discussion of the application of metadata, paradata and embedded data in web-based survey research, using two completed Delphi surveys as examples.

BACKGROUND

Metadata, paradata and embedded data use in web-based Delphi surveys has not been described in the literature. The rapid evolution and widespread use of online survey methods imply that paper-based Delphi methods will likely become obsolete. Commercially available web-based survey tools offer a convenient and affordable means of conducting Delphi research. Researchers and ethics committees may be unaware of the benefits and risks of using metadata in web-based surveys.

DESIGN

Discussion paper.

DATA SOURCES

Two web-based, three-round Delphi surveys were conducted sequentially between August 2014 - January 2015 and April - May 2016. Their aims were to validate the Australian nurse practitioner metaspecialties and their respective clinical practice standards. Our discussion paper is supported by researcher experience and data obtained from conducting both web-based Delphi surveys.

IMPLICATIONS FOR NURSING

Researchers and ethics committees should consider the benefits and risks of metadata use in web-based survey methods. Web-based Delphi research using paradata and embedded data may introduce efficiencies that improve individual participant survey experiences and reduce attrition across iterations. Use of embedded data allows the efficient conduct of multiple simultaneous Delphi surveys across a shorter timeframe than traditional survey methods.

CONCLUSION

The use of metadata, paradata and embedded data appears to improve response rates, identify bias and give possible explanation for apparent outlier responses, providing an efficient method of conducting web-based Delphi surveys.

Developing an instrument to measure emotional behaviour abilities of meaningful learning through the Delphi technique

AIM

To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy.

BACKGROUND

Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments.

DESIGN

A Delphi Study technique was implemented in four phases by means of e-mail.

METHODS

The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established.

RESULTS

After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored.

CONCLUSIONS

This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process.