Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method

BACKGROUND

Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021.

OBJECTIVE

To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida.

METHODS

This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation.

RESULTS

Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes.

CONCLUSIONS FOR PRACTICE

Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.

IsletSwipe, a mobile platform for expert opinion exchange on islet graft images

We previously developed a deep learning-based web service (IsletNet) for an automated counting of isolated pancreatic islets. The neural network training is limited by the absent consensus on the ground truth annotations. Here, we present a platform (IsletSwipe) for an exchange of graphical opinions among experts to facilitate the consensus formation. The platform consists of a web interface and a mobile application. In a small pilot study, we demonstrate the functionalities and the use case scenarios of the platform. Nine experts from three centers validated the drawing tools, tested precision and consistency of the expert contour drawing, and evaluated user experience. Eight experts from two centers proceeded to evaluate additional images to demonstrate the following two use case scenarios. The Validation scenario involves an automated selection of images and islets for the expert scrutiny. It is scalable (more experts, images, and islets may readily be added) and can be applied to independent validation of islet contours from various sources. The Inquiry scenario serves the ground truth generating expert in seeking assistance from peers to achieve consensus on challenging cases during the preparation for IsletNet training. This scenario is limited to a small number of manually selected images and islets. The experts gained an opportunity to influence IsletNet training and to compare other experts' opinions with their own. The ground truth-generating expert obtained feedback for future IsletNet training. IsletSwipe is a suitable tool for the consensus finding. Experts from additional centers are welcome to participate.

A Risk Management Perspective on Climate Change: Lessons Learned from the Nuclear Industry

Despite the widely acknowledged role of the anthropogenic drivers of climate change, there has been little success in developing a clear overview of the strengths and weaknesses of counter-measures or developing a consensus on their application. Problems with conventional approaches arise from the strongly coupled, multidisciplinary issues involved and the long timescales (centuries or more) over which some key processes operate. Here we outline an alternative approach based on experience gained in risk assessment for an area with similar challenges-the geological disposal of radioactive waste. Utilization of such risk assessment approaches and tools to facilitate a holistic, top-down synthesis of the interactions between the key features, events and processes driving climate change and constraining responses to it, are illustrated. We especially focus on visual presentations that encourage dialog between both specialists and non-technical stakeholders. These can thus form a basis to assist balancing responses in terms of energy policy, modified socio-economic boundary conditions and environmental management.

Two different invitation approaches for consecutive rounds of a Delphi survey led to comparable final outcome

OBJECTIVES

There are two different approaches to involve participants in consecutive rounds of a Delphi survey: (1) invitation to every round independent of response to the previous round ("all-rounds") and (2) invitation only when responded to the previous round ("respondents-only"). This study aimed to investigate the effect of invitation approach on the response rate and final outcome of a Delphi survey.

STUDY DESIGN AND SETTING

Both experts (N = 188) and patients (N = 188) took part in a Delphi survey to update the core outcome set (COS) for axial spondyloarthritis. A study with 1:1 allocation to two experimental groups (ie, "all-rounds" [N = 187] and "respondents-only" [N = 189]) was built-in.

RESULTS

The overall response rate was lower in the "respondents-only group" (46%) compared to the "all-rounds group" (61%). All domains that were selected for inclusion in the COS by the "respondents-only group" were also selected by the "all-rounds group." Additionally, the four most important domains were identical between groups after the final round, with only minor differences in the other domains.

CONCLUSION

Inviting panel members who missed a round to a subsequent round will lead to a better representation of opinions of the originally invited panel and reduces the chance of false consensus, while it does not influence the final outcome of the Delphi.

Creating consensus-based practice guidelines with 2000 nurses

Medical professionals follow evidence-based practice guidelines to achieve effective patient outcomes. Traditionally, to develop guidelines, a small group of experts examine evidence then agree on a set of statements, which are then published in journals. However, more than 7000 primary care journal articles are published monthly. This study examined a different way of drawing up practice guidelines, which involved large numbers of nurses from different countries directly in developing then disseminating the guidelines to speed up acceptance and the implementation of best practice. The results were consensus-based best practice guidelines for the treatment of patients with ostomies, which have received a high level of acceptance and enthusiasm from practitioners in 27 countries.

Getting past the blame game: Convergence and divergence in perceived threats to salmon resources among anglers and indigenous fishers in Canada's lower Fraser River

This article examines threat perception as a potential dimension of inter-group conflict over salmon fisheries in Canada's Fraser River watershed. Environmental changes and the entry of new user groups are putting pressure on both the resource and regulators, as well as threatening to exacerbate conflicts, notably between First Nation (indigenous) fishers and non-indigenous recreational anglers. While resource conflicts are often superficially conceptualized as cases of competing interests, we build on recent studies suggesting that conflicts are associated with deeper cognitive and perceptual differences among user groups. We report findings from 422 riverbank interviews with First Nation fishers and recreational anglers focusing on perceptions of threat to the fisheries. Responses reveal both substantial agreement and disagreement in threat perceptions between the two groups. These patterns provide a potential roadmap for consensus building, and suggest possible avenues for policy-makers to defuse the "blame game" that often dominates this type of conflict.

The influence of social status and network structure on consensus building in collaboration networks

In this paper, we analyze the influence of social status on opinion dynamics and consensus building in collaboration networks. To that end, we simulate the diffusion of opinions in empirical networks and take into account both the network structure and the individual differences of people reflected through their social status. For our simulations, we adapt a well-known Naming Game model and extend it with the Probabilistic Meeting Rule to account for the social status of individuals participating in a meeting. This mechanism is sufficiently flexible and allows us to model various society forms in collaboration networks, as well as the emergence or disappearance of social classes. In particular, we are interested in the way how these society forms facilitate opinion diffusion. Our experimental findings reveal that (i) opinion dynamics in collaboration networks is indeed affected by the individuals’ social status and (ii) this effect is intricate and non-obvious. Our results suggest that in most of the networks the social status favors consensus building. However, relying on it too strongly can also slow down the opinion diffusion, indicating that there is a specific setting for an optimal benefit of social status on the consensus building. On the other hand, in networks where status does not correlate with degree or in networks with a positive degree assortativity consensus is always reached quickly regardless of the status.