Exploring mental health service needs for the elderly: results of a modified Delphi study

Unlocking the potential for digital mental health technologies in the UK: a Delphi exercise

BACKGROUND

Digitally enabled services can contribute to the support, treatment and prevention of mental health difficulties; however, questions remain regarding how we can most usefully harness such technology in primary and secondary mental healthcare settings.

AIMS

To identify barriers and facilitators to enable the potential of digital mental health in England, Scotland, Wales and Northern Ireland.

METHOD

A three-round Delphi exercise was carried out online with 16 participants from across the four nations of the UK representing the following stakeholder groups: service providers, health professionals, policymakers, lived experience, small and medium enterprises and academics. Qualitative data were collected in the first round (80 fragments) that were then coded to produce a 26-item round-two questionnaire for participant rating. Participants were given the opportunity to reconsider their scores in light of the group responses in round three.

RESULTS

Eight statements under the following five themes reached consensus with median scores between 8 and 10 (i.e. important/very important): co-production; the human element; data security; funding; and regulation.

CONCLUSIONS

The Delphi process allowed consensus to be achieved regarding the factors that experts consider important for harnessing technology in primary and secondary mental healthcare. Knowledge of these factors can help users and providers of mental health services negotiate how best to move forward with digitally enabled systems of care.

What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study

PURPOSE

The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented.

DESIGN/METHODOLOGY/APPROACH

A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments.

FINDINGS

The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people.

RESEARCH LIMITATIONS/IMPLICATIONS

Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input.

PRACTICAL IMPLICATIONS

The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems.

ORIGINALITY/VALUE

This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities

BACKGROUND

In both developing countries and in relation to cultural minorities there have been calls to scale up mental health services and for evidence-informed policy and practice.

EVIDENCE BASED MEDICINE

The evidence based medicine movement has had a major influence in improving practice. However, implementation of this approach has some major difficulties. One that has been neglected is the situation where there is no relevant evidence. This situation is more likely to occur for healthcare decisions in developing countries or for cultural minorities within developed countries, because resources do not exist for expensive research studies.

CONSENSUS METHODS

Consensus methods, such as the Delphi process, can be useful in providing an evidence base in situations where there is insufficient evidence. They provide a way of systematically tapping the expertise of people working in the area and give evidence that is readily applicable for a particular country and culture. Although consensus methods are often thought of as low in the hierarchy of evidence, consensus is central to the scientific process. We present four examples where the Delphi method was used to assess expert consensus in situations where no other evidence existed: estimating the prevalence of dementia in developing countries, developing mental health first aid guidelines in Asian countries, mental health first aid guidelines for Australian Aboriginal people, and modification of the concept of 'recovery' for Australian immigrant communities.

CONCLUSION

Consensus methods can provide a basis for decision-making and considered action when there is no evidence or when there are doubts about the applicability of evidence that has been generated from other populations or health system settings.

Forging e-health partnerships: strategic perspectives from international executives

International executives underscore the key management frontiers of strategic e-health partnerships between information and communication technology and health care sectors for innovative growth, systems integration, and social responsibility.