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PubMed2002

What does health literacy mean to children?

This study employed the Delphi technique to define the meaning of health literacy to children and to investigate possible ways lead to them to become health literate. According to the experts' perspectives, the meaning of health literacy to children is "to perform physical and psycho-social activities with appropriate standards; being able to interact with people; cope with necessary changes and demand reasonable autonomy so as to achieve complete physical, mental and social well-being". In order to assist children develop healthy physical, psycho-social well-being so as to demonstrate that they are health literate, parents, teachers and significant others have to support and guide the children by demonstrating good practices regarding health-related behaviors. The study serves as a reference for developing healthy childhood that leads to healthy adulthood and healthy elderly.

Age Factors↗

PubMed2000

A consensus statement on critical thinking in nursing.

The purpose of this study was to define critical thinking in nursing. A Delphi technique with 5 rounds of input was used to achieve this purpose. An international panel of expert nurses from nine countries: Brazil, Canada, England, Iceland, Japan, Korea, Netherlands, Thailand, and 23 states in the U.S. participated in this study between 1995 and 1998. A consensus definition (statement) of critical thinking in nursing was achieved. The panel also identified and defined 10 habits of the mind (affective components) and 7 skills (cognitive components) of critical thinking in nursing. The habits of the mind of critical thinking in nursing included: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Skills of critical thinking in nursing included: analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. These findings can be used by practitioners, educators and researchers to advance understanding of the essential role of critical thinking in nursing.

Affect↗

PubMed1997

Opinions of physical therapy education program directors on essential functions.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the opinions of directors of physical therapy education programs concerning the essential functions physical therapist students must be able to complete, with or without reasonable accommodation. SUBJECTS: Fifty-eight physical therapy education program directors participated. METHODS: Participants completed surveys as part of a three-round Delphi technique. They had the opportunity to modify or make additions to the initial list in the first round and rate the items in the last two rounds using an ordinal scale. RESULTS: All participants rated communication skills and practicing in a safe, ethical, and legal manner as definitely essential functions. Nearly universal agreement (95%-99%) was present for determining physical therapy needs of patients with movement dysfunction and demonstrating the ability to apply universal precautions. Performance of treatment procedures and performance of assessment procedures were rated essential by 90% to 95% of the participants. The least agreement was found for participation in the process of scientific inquiry. CONCLUSION AND DISCUSSION: There is agreement among the physical therapy education program directors concerning the essential functions that should be required of students. The results of this study should serve as a reference for physical therapy education programs for developing the essential functions required of students.

Administrative Personnel↗

PubMed2005

Estimates of disease burden due to land-snake bite in Sri Lankan hospitals.

Snake bite is a common cause of hospital admission in Sri Lanka. Despite this, there have been no countrywide studies or national estimates of disease burden due to snake bites in Sri Lankan hospitals. We assessed the disease burden due to snake bite in our hospitals and estimated the frequency of admissions due to bites by different snake species. Sri Lanka was divided into four zones based on climate and topography. Hospital morbidity and mortality data, which are available on an administrative district basis, were collated for the four zones. A survey of opinion among specialist physicians (the Delphi technique) was used to estimate the proportion of bites by different species, and requirements for anti-venom (AV) and intensive care facilities for management of snake bites in hospitals in each of the four zones. A study of hospital admissions due to snake bites in seven selected hospitals was also performed to validate the opinion survey. There was a clear difference in the incidence of hospital admissions due to snake bites in the different zones. Estimates of hospital admissions due to bites by different species also varied considerably between zones. These trends corresponded to estimates of requirements of AV and other supportive health care. Health care planning using data based on environmental information, rather than merely on political boundaries, could lead to targeted distribution of AV and intensive care requirements to manage snake bites.

Animals↗

PubMed1993

Academic nurse leaders' interpretation of concepts and priorities related to the examination of scientific short papers, dissertations and theses--Part 1.

The purpose of this study was to establish whether there is agreement among academic nurse leaders in their interpretation of aspects and criteria related to the examination of scientific short papers, dissertations and theses. The Delphi technique was selected as the most appropriate method of data-collection for this type of study. The target population identified for this study consisted of the Heads of Nursing Departments or their delegates from the 18 universities of the four provinces of the RSA, self-governing and independent states of Southern Africa and Namibia, which offer nursing degrees. Three rounds of questionnaires were sent to all heads of the 18 identified nursing departments. Participation was poor (nine participated in first round, nine in second the third round, no further rounds of questionnaires were sent due to the waning interest and poor participation. Many divergent responses were received to most of the aspects included in the study. This indicates that with a few exceptions there is little or no agreement among academic nurse leaders in their interpretation of aspects and criteria relating to the examination of post-graduate scientific or academic treatises.

Academic Dissertations as Topic↗

PubMed2001

Development of a self-directed learning readiness scale for nursing education.

Self-directed learning is a method of instruction used increasingly in adult education. A scale was developed in response to a need for a valid and reliable instrument to measure self-directed learning readiness. Such a scale will allow nurse educators to diagnose students' attitudes, abilities and personality characteristics, necessary for self-directed learning. This study was undertaken in two stages. In the first, the Delphi technique utilizing a panel of 11 nurse educator experts was used to assess the content and construct validity of a number of items perceived to reflect self-directed learning readiness. Each panel member was asked to independently rate the relevance of each item on a Likert scale. The second stage involved the administration of the questionnaire to a convenience sample of 201 undergraduate nursing students. The questionnaire was analysed using principal components factor analysis with varimax rotation, Chronbach's coefficient alpha, and item-to-total correlations to measure the scale's construct validity, internal consistency (reliability), and unidimensionality, respectively.The resulting self-directed learning readiness scale appears homogeneous and valid. The scale will assist nurse educators in the diagnosis of student learning needs, in order for the educator to implement teaching strategies that will best suit the students. Furthermore the development of this scale will provide valuable data for curriculum development.

Attitude of Health Personnel↗

PubMed2001

Research Priorities Project, year 2000: establishing a direction for infection control and hospital epidemiology.

BACKGROUND: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). METHODS: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. RESULTS: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities. Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. CONCLUSIONS: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

Adult↗

PubMedDate not supplied

Persistent vegetative state: which sensory-motor variables should the physiotherapist measure?

This study used a modified Delphi technique to establish a list of core items which should be included in the measurement, by the physical therapist, of sensory-motor capacities of persons in a persistent vegetative state. Twenty-eight physical therapists with a mean of 5.9 years of experience working with this clientele participated in the study and identified 105 items as being important in the evaluation of the PVS patient (Round I). The study planning committee reduced these to 20 categories and asked the therapists to rate each category of items (a 5-point scale) as to it's importance (Round II). Physiotherapists identified 14 variables as being 'extremely' or 'very important' to include in such an evaluation. These included: tonus, voluntary movement on request, postural reactions, passive range of motion, tolerance to verticalization and postural status. These results are being used to develop a quantitative assessment instrument to be used by the physical therapist working with the PVS patient.

Arousal↗

PubMed2002

Occupational therapy practice in acute care neurology and orthopaedics.

The purpose of this research was to develop a consensus description of occupational therapy practice in acute care orthopaedics and neurology by Australian therapists. The Delphi technique was used to develop consensus concerning therapists' aims for their patients, the interventions they used, and the factors affecting their practice in acute care. Therapists' primary aim was to conduct a thorough assessment for referral and further treatment purposes. Therapists in acute hospital neurology focus on developing maximal independence in self-care activities and preventing deformities, followed by preparations for discharge or transfer to rehabilitation. Therapists with an orthopaedic caseload state independence in self-care as their second most important aim, but the ranking of intervention methods indicates preparation for discharge in various ways takes precedence over direct self-care retraining. This difference may indicate a disparity between practice ideals and the realities of the acute care setting. The most important factor affecting practice in acute care is early referral for occupational therapy services. Recommendations are made for managers and educators to ensure the most effective practice in acute care are made.

Acute Disease↗

PubMed1998

Assessing nursing problems of importance for the development of nursing care in a radiation therapy department.

The challenges to nurses working in the rapidly changing milieu of radiotherapy in cancer care are great. New treatment regimens continually require reexamination of old assumptions about patients' needs and communication between colleagues. In order to continue the development of the nursing care in the radiation therapy department, the purpose of this study was to assess the nursing problems experienced in the care of the cancer patients and the nursing problems experienced in work with other professionals from the nurse's perspective. Eighteen of the 38 nurses in the radiation therapy department were invited to participate in the study. The mean age of the nurses was 39 years (range 25-57 years). The study was carried out by using a three-phase, structured, communication-process method according to the Delphi technique. The nurses reported "poor follow-up of patients who have completed radiation therapy," closely followed by "finding time to document the nursing care" and "finding time to treat the scheduled patients" as the most problematic areas of importance for the development of nursing care. The nursing problems considered to be the most difficult in the work with other professionals were "lack of communication," "lack of knowledge of our work and competence," and "lack of comprehension of each other's professions." With the present trend in the health care system toward smaller financial resources, it is necessary to find new ways of organizing nursing care in order to find time to take care of the patient's problems during and after the radiation therapy. This study constituted the base for organizing a nursing care clinic in the department with sufficient time to assess and monitor side effects, patient education, sexual counselling, and coping assistance.

Adult↗

PubMed2002

Current trends in restorative dentistry in the UK: a Delphi approach.

OBJECTIVES: The purpose of the study was to obtain insight into current trends in restorative dentistry in the UK by means of a Delphi technique. METHODS: A panel of nine experts was convened to define areas where changes were thought to occur in contemporary restorative dentistry. The defining statements obtained were circulated amongst the Panel to reach consensus on the content and wording, and then formatted into a questionnaire which was distributed amongst 407 clinical academic staff in Restorative Dentistry in UK dental schools. Good agreement with a statement was defined as a score of > or =70%, statements that received such scores were taken as indicating possible trends. RESULTS: The Expert Panel reached consensus on the wording of 21 defining statements, which were formatted into a 23-item questionnaire. The questionnaire achieved a useable response rate of 70%, and the academic respondents reached good agreement on 15 (65%) of the statements. CONCLUSIONS: The 15 statements which received scores of 70% or greater were considered to be possible indicators of trends in aspects of the clinical practice of restorative dentistry in the UK.

Consensus↗

PubMed2002

Core competencies in cancer genetics for advanced practice oncology nurses.

PURPOSE/OBJECTIVES: To determine core competencies in cancer genetics for advanced practice nurses (APNs) in oncology. DESIGN: Survey. SAMPLE: Expert panel of 9 nursing educators or researchers, 9 general genetics experts, 9 genetics experts with specialties in oncology, and 10 oncology APN nurse consumers (N = 37). METHODS: Utilizing the Delphi Technique, two rounds of surveys were conducted. Round 1's survey required open-ended responses to identify skills, attitudes, and competencies specific to cancer genetics. Round 2 requested ranking of the importance of identified competencies. MAIN RESEARCH VARIABLES: Skills, attitudes, and competencies specific to cancer genetics. FINDINGS: Recommended genetics competencies and knowledge for oncology APNs were identified for the categories of direct caregiver (6 items), coordinator (6 items), consultant (7 items), educator (6 items), researcher (8 items), and professional attitudes (16 items). CONCLUSIONS: Identified competencies provide a foundation and direction for development of the education curriculum recommended for all practicing oncology APNs. IMPLICATIONS FOR NURSING: Integrating genetic concepts into clinical practice is essential. Oncology APNs must have an expanded knowledge base in genetics to enable them to incorporate advances in genetics into practice to ensure quality outcomes. Development of genetics education is crucial to ensure future competency. Research that determines the impact of such education is warranted

Adult↗

PubMed1998

A conceptual model of the food and nutrition system.

The food system is a widely used concept, but few systematic frameworks model the full scope and structure of the food and nutrition system. Bibliographic searches, a modified Delphi technique, focus groups and interviews with experts on the topic were conducted to identify existing models of agriculture, food, nutrition, health and environmental systems. These models were examined, classified and synthesized into an integrated conceptual model of the food and nutrition system. Few existing models broadly described the system and most focused on one disciplinary perspective or one segment of the system. Four major types of models were identified: food chains, food cycles, food webs and food contexts. The integrated model developed here included three subsystems (producer, consumer, nutrition) and nine stages (production, processing, distribution, acquisition, preparation, consumption, digestion, transport, metabolism). The integrated model considers the processes and transformations that occur within the system and relationships between the system and other systems in the biophysical and social environments. The integrated conceptual model of the food and nutrition system presents food and nutrition activities as part of a larger context and identifies linkages among the many disciplines that deal with the food and nutrition system.

Agriculture↗

PubMed2000

Validation of an instrument for injury data collection in rugby union.

OBJECTIVE: To provide the basis for collecting rugby union injury data using a rigorously validated injury report form. METHODS: Seven stages were used to assess face, content, and criterion validity of the rugby union injury report form. A 22 member panel plus four sporting bodies assessed the form for face validity, and an expert panel assessed it for content and criterion validity. Panel members were consulted until consensus was reached. A yardstick developed by an expert panel using the Delphi technique was used to assess the reliability of the form. An independent panel of 10 viewed a series of five videotaped injuries, three times over a five week period to assess inter-rater and intrarater reliability. The form was then trialed by 40 people in situ during four games. RESULTS: The rugby union injury report form for games and training was developed, and the face, content, and criterion validity successfully assessed. A seven step protocol to create a yardstick was also developed to assist in the validation process. Both inter-rater and intrarater reliability results indicated a 98% agreement. The 40 trialists who completed forms in situ during four games were found to have an inter-rater reliability agreement of 98% for nine injuries. CONCLUSIONS: A measurement instrument for injury data collection in rugby union was successfully developed and validated, providing researchers with a basis for future studies in this area. A procedure to develop future injury data collection instruments in other sports was also developed.

Data Collection↗

PubMed1992

Development of indicators for quality assurance in public health medicine.

OBJECTIVES: To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN: Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING: Five Scottish health boards. SUBJECTS: Public health physicians in the five health boards. MAIN MEASURES: Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS: Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION: Measurable indicators of quality for public health medicine can be developed.

Data Collection↗

PubMed1999

Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses.

BACKGROUND: Previous estimates of the national economic burden of allergic rhinoconjunctivitis (AR/AC) have relied on data analyses in which AR/AC was the primary International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM)-coded diagnosis. These studies ignore the costs when AR/AC was a secondary diagnosis to other disorders such as asthma and sinusitis. OBJECTIVE: We sought to determine the national direct cost of illness for AR/AC. METHODS: An expert panel used the Delphi technique to estimate the proportion of visits coded by other primary ICD-9-CM diagnoses in which AR/AC was a significant secondary comorbid condition. The costs of this proportion were deemed to be "attributable" to AR/AC and were added to the costs when allergic rhinitis and allergic conjunctivitis were the primary diagnoses. RESULTS: The cost when AR/AC was the primary diagnosis was $1.9 billion (in 1996 dollars). The cost when AR/AC was a secondary diagnosis was estimated at $4.0 billion, giving an estimate of $5.9 billion for the overall direct medical expenditures attributable to AR/AC. Outpatient services (63%, $3.7 billion), medications (25%, $1.5 billion), and inpatient services (12%, $0.7 billion) accounted for the expenditures. Children 12 years and younger accounted for $2.3 billion (38.0%). CONCLUSION: Upper airway allergy is an expensive disease process because of its readily apparent manifestations as AR/AC and its contribution to other airway disorders.

Adult↗

PubMed1996

Screening of health risk factors prior to exercise or a fitness evaluation of adults with traumatic brain injury: a consensus by rehabilitation professionals.

A modified Delphi technique was used to obtain group consensus among 31 rehabilitation professionals (RPs) from nine rehabilitation centres throughout the province of Québec (Canada) to ascertain their expert opinion on the health risk factors (HRF) to be verified prior to beginning an exercise programme or evaluation for patients with traumatic brain injury (TBI). From the initial survey 87 items were generated, which were later regrouped into 27 HRFs. The relative importance of each HRF in regard to being screened before exercise in a population with TBI was then assessed by each RP using a five-point ordinal scale (1 = not important to 5 = extremely important). HRFs that were considered extremely important by at least 50% of HPs include: angina pectoris, aortic stenosis, exertional syncope, musculoskeletal sequelae which are exacerbated by exercise, outward aggressivity, pulmonary embolism, uncontrolled epilepsy (seizures), and ventricular arrhythmias. Professionals involved in exercising patients with TBI may find these factors useful to the efficient conduct of their rehabilitation programme.

Adult↗

PubMed2005

Reflections on expert consensus: a case study of the social trends contributing to obesity.

BACKGROUND: In Australia, as elsewhere in the developed world, researchers and policy makers have expressed concern about rising rates of obesity. Explanations for the increasing weight of the Australian population have focused on both declining levels of physical activity and changes in food consumption patterns. METHODS: The primary aim of our study was to determine the views of obesity, dietary and physical activity experts, about the most important social trends that have contributed to Australia's obesogenic environment over the last 50 years. We used a modified Delphi technique to successfully contact 50 such experts to obtain their views on this topic. The process involved a semi-structured interview with each expert to identify the trends and then a round of ranking of the trends by these experts. A second aim was to comment on the utility of expert opinion in public policy. RESULTS: The experts identified the most important social trends as 'escalating car reliance', 'increasing "busy-ness" and lack of time' and 'rising use of convenience and pre-prepared food'. Because we asked experts to explain their responses, a diversity of opinion emerged on both the aetiology of these trends and how the environment is embodied to produce rising levels of obesity. CONCLUSION: We reflect on the implications of this dissensus for the utility of expert opinion in public policy and argue that one way through the smorgasboard of competing expert explanations for health differentials, including obesity levels, is practice-based evidence gathered through community level action research.

Australia↗