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Yeung A, Lisk R, Rana J, Guiang CB, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH, Burchell AN. Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study. J Med Internet Res 2023; 25:e40477. [PMID: 37384393 PMCID: PMC10365575 DOI: 10.2196/40477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. OBJECTIVE Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. METHODS The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ≥60% within a ±1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. RESULTS Of the community experts (CEs), 84% (43/51) completed all rounds; 19% (8/43) were living with HIV; 37% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95%), express testing (38/43, 88%), routine testing (36/43, 84%), an online booking app (36/43, 84%), online-based testing (33/43, 77%), and nurse-led testing (31/43, 72%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77% (37/48) completed all rounds; 59% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68%, to 39/39, 100%) but not for provider alerts (7/37, 19%) and provider audit and feedback (6/37, 16%). Express testing, online-based testing, and nurse-led testing were prioritized by >95% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. CONCLUSIONS Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13801.
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Affiliation(s)
- Anna Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | | | - Jayoti Rana
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | | | | | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Niederberger M, Homberg A. Argument-based QUalitative Analysis strategy (AQUA) for analyzing free-text responses in health sciences Delphi studies. MethodsX 2023; 10:102156. [PMID: 37025648 PMCID: PMC10070131 DOI: 10.1016/j.mex.2023.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Delphi methods are mostly used in the health sciences to reach agreement among experts on unclear issues. Generally, consensus is reached after several rounds of Delphi using standardized items. Additional open-ended questions offer respondents the opportunity to provide reasons for judgments. Although these free-text responses contribute substantially to the steering and result generation of the Delphi process, so far no analytical strategy has been established which takes into account the context and methodological principles of the Delphi procedure. Moreover, in already published Delphi studies the analysis of qualitative data is often not sufficiently disclosed.•We provide an overview of analytical strategies for free-text responses. We critically reflect on them with regard to their use and suitability in the context of Delphi procedures.•Following established qualitative methods of qualitative content analysis according to Mayring and thematic analysis according to Braun & Clarke, we developed the Argument-based QUalitative Analysis strategy (AQUA) for Delphi studies in the health sciences and presented it using a concrete project example.•This newly developed strategy can significantly support the rule-governed and intersubjective evaluation of free-text responses in Delphi processes, the integration of the results into the feedback design, and thereby also the quality of the results.
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MacKinnon KR, Grewal R, Tan DH, Rousseau R, Maxwell J, Walmsley S, MacPherson PA, Rachlis A, Andany N, Mishra S, Allen VG, Burchell AN. Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial. BMC Health Serv Res 2021; 21:625. [PMID: 34193138 PMCID: PMC8243864 DOI: 10.1186/s12913-021-06602-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. METHODS Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. RESULTS A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. CONCLUSIONS Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02019043; registered December 23, 2013.
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Affiliation(s)
- Kinnon R MacKinnon
- School of Social Work, York University, 4700 Keele Street, M3J 1P3, Toronto, Ontario, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
| | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Research Institute, University Health Network, Toronto, Canada
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Rodney Rousseau
- Department of Immunology, University of Toronto, 1 King's College Cir, M5S 1A8, Toronto, Ontario, Canada
| | - John Maxwell
- AIDS Committee of Toronto, 543 Yonge Street, 4th floor, M4Y 1Y5, Toronto, Ontario, Canada
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital, University Health Network, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada
| | - Paul A MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, 501 Smyth Road, L1H 8L6, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Anita Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Vanessa G Allen
- Public Health Ontario Laboratories, Public Health Ontario, 661 University Avenue, M5G 1M1, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
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Rana J, Guiang CB, Lisk R, Shahin R, Brunetta J, Mitterni L, Grewal R, Tan DHS, Gilbert M, Yeung A, Kwag M, Logie CH, Bacon J, Gesink D, Burchell AN. Survey of Health Care Providers' Practices and Opinions Regarding Bacterial Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men. Sex Transm Dis 2021; 48:94-102. [PMID: 33003183 DOI: 10.1097/olq.0000000000001287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rates of bacterial sexually transmitted infections (STIs) continue to rise among gay, bisexual, and other men who have sex with men (GBMSM) globally. Testing and treatment can prevent morbidity and transmission. However, testing rates remain suboptimal. METHODS In 2018, we conducted an online cross-sectional survey to explore STI testing ordering practices, 14 potential barriers for testing and 11 possible ways to improve testing from the perspective of health care providers in Toronto, Ontario. An estimated 172 providers were invited from primary care and sexual health clinic settings. Providers were eligible to complete the survey if they provided care for ≥1 GBMSM per week and were involved in the decision-making process in providing STI tests. We used descriptive statistics to summarize survey responses. RESULTS Ninety-five providers (55% response rate) participated, of whom 68% worked in primary care and 32% in sexual health settings. Most (66%) saw ≤10 GBMSM clients per week. In primary care (65%) and sexual health (40%) clinic settings, insufficient consultation time was the most common barrier to STI testing. In primary care, other common barriers included difficulty introducing testing during unrelated consultations (53%), forgetting (47%), and patients being sexually inactive (31%) or declining testing (27%). The following were most likely to improve testing: express/fast-track testing services (89%), provider alerts when patients are due for testing (87%), patient-collected specimens (84%), nurse-led STI testing (79%), and standing orders (79%). CONCLUSIONS Promising interventions to improve bacterial STI testing included initiatives that simplify and expedite testing and expand testing delivery to other health care professionals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Anna Yeung
- From the MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
| | | | | | | | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto
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Tacchini-Jacquier N, de Waele E, Urben P, Turini P, Verloo H. Developing an Evidence-Based Nursing Handover Standard for a Multi-Site Public Hospital in Switzerland: Protocol for a Web-Based, Modified Delphi Study. JMIR Res Protoc 2020; 9:e15910. [PMID: 31913133 PMCID: PMC6996777 DOI: 10.2196/15910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/02/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Poor communication processes create opportunities for errors when caregivers fail to transfer complete and consistent information. Inadequate or nonexistent clinical handovers or failures to transfer information, responsibility, and accountability can have dire consequences for hospitalized patients. Clinical handover is practiced every day, in a multitude of ways, in all health care settings. OBJECTIVE The goal of this study is to build a consensus, evidence-based nursing handover standard for inpatients during shift changes or internal transfers between hospital wards. The study will be based on papers published by Slade et al. METHODS This protocol describes a modified Delphi data-collection survey involving a targeted panel sample of 300 nurse experts. A multi-round survey will select an anonymous panel from a multi-site public hospital in Switzerland. Each survey stage will be described and will build on the previous one. The study will end with a focus group discussion involving a randomly selected panel to explain why items for the evidence-based clinical nursing handover standard were accepted or not accepted. An item must achieve a consensus of ≥70% for inclusion. RESULTS The present study's expected outcome is a consensus-built, evidence-based nursing handover standard for inpatients during shift changes or internal transfers between the wards of a multi-site public hospital in Switzerland. CONCLUSIONS This survey will enable us to develop an evidence-based nursing handover standard for use during shift changes and internal inpatient transfers in a multi-site public hospital in Switzerland. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15910.
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Affiliation(s)
| | - Els de Waele
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Peter Urben
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Pierre Turini
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Henk Verloo
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
- School of Health Sciences, Haute École Spécialisée de Suisse Occidentale Valais / Wallis University of Applied Sciences of Western Switzerland, Sion, Switzerland
- Service of Old Age Psychiatry, Cery, Lausanne, Switzerland
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Tacchini-Jacquier N, Hertzog H, Ambord K, Urben P, Turini P, Verloo H. An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study. JMIR Nurs 2020; 3:e17876. [PMID: 34345783 PMCID: PMC8279455 DOI: 10.2196/17876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. OBJECTIVE This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. METHODS We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion. RESULTS The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. CONCLUSIONS This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland.
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Affiliation(s)
| | | | | | | | | | - Henk Verloo
- Valais Hospital Sion Switzerland
- Haute École Spécialisée Suisse orientale HES-SO Valais / Wallis Sion Switzerland
- Service of Old Age Psychiatry University Hospital of Lausanne Prilly Switzerland
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