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PubMed2004

[A study by the Delphi technique of expected competencies of public health nurses working in government organizations].

PURPOSE: The purpose of this study was to clarify, using the Delphi technique and by the consensus of Experts, the expected competencies of Public Health Nurses (PHNs) working in government organizations according to their number of years' experience. METHODS: Experts were nurses who had a PHN license in academic, administration and service areas. The criteria for selecting are as follows: Academic: professors of community nursing department, in nursing college. Administration: chief PHNs working in prefectural government organization, with the role of supervising and controlling PHNs. Service: recommended by each administration Expert and fulfilling all the following 3 points; (1) PHN experience of 10 years or more in a government organization, (2) a supervisory position over at least one junior PHN, and (3) an effective practical record as a PHN. 209 Experts who were chosen by the specified criteria were approached for their participation. At Round 1, Experts were asked to list competencies important for PHN under 3 headings: knowledge, skills and attitudes. From the response in Round 1, competency items were categorized. A list was obtained and used in Round 2, when Experts were asked to select and rate the importance of competencies for 4 ranges of PHN years of experience. At Round 2, these competencies were analyzed on the basis of importance. At Round 3, Experts were asked whether they agree or not with the results of Round 2. The criterion for consensus was set as an agreement rate of 90%. RESULTS: Of the total, 63 agreed to participate; 14 in the academic, 23 in the administration and 26 in the service area. Response were turned 63 from all at Round 1, 52 at Round 2 and 44 at Round 3. The result clarified the expected competencies into 47 items and 7 categories related to their importance in the experience year ranges. The 7 categories were: Conducting nursing processes; Conducting community health activities; Providing health care; Management; Information application; Human relations; and Personal characteristics. The very important competencies PHNs should have were regarded as follows: (1) At 1-3 years' experience, PHNs should have 2 categories (2) At 4-10 years, they should have the 5 categories (3) At 11-20 years they should have all 7 categories (4) At 21 or more years they should have at least 6 categories. At all levels PHNs were required to have the 2 categories of Providing health care and Personal characteristics. CONCLUSIONS: It was expected as PHNs gain experience they should obtain wider and more faranding competencies stepwise, from basic nursing care to community care, and on to administration.

Attitude of Health Personnel↗

PubMed2001

Using the Delphi technique to identify the cancer education requirements of general practitioners.

UNLABELLED: Continuing education for the general practitioner (GP) is in need of revision. Much of today's continuing education is based upon a traditional didactic approach, which is believed to be inappropriate and inefficient for the learning needs of the increasingly stretched GP. OBJECTIVE: To investigate the educational needs of a group of GPs, using the response to cancer to construct an appropriate model for the provision of care in general practice. METHOD: The Delphi technique was adopted to reach "expert" consensus. PARTICIPANTS: 49 GPs currently practising within two health authorities within the north-west region of England. DESIGN: Three waves of data collection were employed, with the same sample and the inclusion of an additional reference group. RESULTS: Many issues relating to the difficulties experienced by GPs regarding care of cancer patients were identified, along with associated training needs. Successive rounds of this Delphi survey enabled consensus to be reached about the level of importance to be assigned to these issues. This technique avoided some of the problems associated with a conventional committee approach (e.g. time, expense and potential bias in decision-making process). CONCLUSIONS: First, the Delphi technique provided a relatively quick means of gaining a consensus on the complex task set for participants. Second, continuing training for GPs would benefit from the adoption of a problem-based learning approach rather than traditional didactic methods.

Adult↗

PubMed2003

Using the Delphi technique to select items for use in assessing patients' satisfaction with dysphagia services.

Items for potential use in a survey for the assessment of patients' satisfaction with dysphagia services was developed using the Delphi technique. A panel of speech-language pathologists was provided with 105 potential survey items. They were asked to rate the items with respect to perceived importance in assessing patients' satisfaction. 45 items were rated as "very important." Items concerning the issues of information giving and the conduct and characteristics of the clinician were most common among the selected items. No items focusing on accessibility of services or quality of the treatment environment were in the "very important" group.

Choice Behavior↗

PubMed1999

Delphi technique: one cycle of an action research project to improve the pre-registration midwifery curriculum.

Facilitating a unified interpretation of new or re-designed curricula can be problematic in multi-sited universities. This paper discusses the use of the Delphi technique when implementing an innovative pre-registration midwifery curriculum. It formed one of the action research cycles of the author's doctoral study and was used in an attempt to seek the views of all midwife teachers and achieve a critical mass consensus. The most important issues that emerged from the Delphi process were grouped into four categories. These four categories (the teacher's base site, communications, staff development and administration issues) formed the agenda for a staff away day. The outcome of the process was the generation of a list of priorities and actions for curriculum implementation and the identification of ways in which staff development needs might be met more effectively. An unexpected, but equally important, outcome was the way it helped with team building and agreement on positive actions for its further development.

Attitude of Health Personnel↗

PubMed1995

[Consensus process in the field of health inequalities. The Delphi technique].

OBJECTIVE: An approach to finding the determinants of the risk of health inequality among foreign immigrants living in the city of Barcelona. DESIGN: A descriptive study done by interviewing a group of key informers, using the Delphi technique. SETTING: Barcelona city Health Region. PARTICIPANTS: 20 professionals from different sectors and levels of care were selected because of the relationship of their work area to the immigrant population. Primary Care, specialist, hospital, Family Planning and Public Health professionals took part from the health field; Primary Care, planning and non-governmental organisations from the social field. MEASUREMENTS AND MAIN RESULTS: A series of mailed questionnaires were used to elicit the participants' opinions and perceptions of the determinants of foreign immigrants' health inequalities. The final reply figure was 90%. Of the overall points granted to the agreed situations, 52.4% concerned aspects relating to their general living situation, 25.1% to health care and 22.4% to socio-cultural questions. CONCLUSIONS: The results show that, in addition to the health-care field, general living situation and socio-cultural questions play a fundamental part in determining foreign immigrants' health inequalities. We considered that the Delphi was a useful and rapid technique for obtaining qualitative information on the determinants of health inequalities and that it permitted us to contribute information which was complementary to other studies of inequalities which used classical health indicators.

Delphi Technique↗

PubMed1980

Choice of preventive treatment for isoniazid-resistant tuberculous infection. Use of decision analysis and the Delphi technique.

Proper care of persons infected with isoniazid-resistant tubercle bacilli is controversial because there are few data on the risks and benefits of the preventive treatment alternatives. Decision analysis was used to facilitate a comparison of outcomes using different strategies and the Delphi technique to obtain estimates of relevant probabilities. For all probabilities of isoniazid resistance, the observation and no-drug alternative is unsatisfactory because it sould result in a twofold to sevenfold greater number of tuberculosis cases than any of the drug regimens. With a low probability of isoniazid resistance, isoniazid is the preventive treatment of least cost and proved efficacy. As the probability of isoniazid resistance increases, more cases are prevented by rifampin-containing regimens, but at added cost. These findings can be used to formulate appropriate preventive treatment recommendations.

Adolescent↗

PubMed1999

[Delphi technique: identifying the generic competence required for doctors and nurses working in a primary health care].

This study aims to identify the generic competence required of doctors and nurses working in a primary health care. It was based on a series of 3 round of the Delphi technique which identified 8 generic competencies: ability to communicate, ability to be community oriented, ability in teamwork, management skills, educational skills, ability to problem solving, professional skills, ability to make-decision. Only the competence management skills there was not consensus by doctors. They disagree that this competence is required by them working in primary health care.

Attitude of Health Personnel↗

PubMed2006

Defining the Bobath concept using the Delphi technique.

BACKGROUND AND PURPOSE: The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. Although they recognize that over the last half-century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes. The aim of the present study was to use the Delphi technique to enable experts in the field to define the current Bobath concept. METHOD: A four-round Delphi study design was used. The sample included all members of the British Bobath Tutor's Association, who are considered experts in the field. Initial statements were identified from the literature, with respondents generating additional statements during the study. The level of agreement was determined using a five-point Likert scale. The respondents were then provided with feedback on group opinions and given an opportunity to re-rate each statement. The level of group consensus was set at 80%. RESULTS: Fifteen experts took part. The response rate was 85% in the first round, and 93% in each subsequent round. Ten statements from the literature were rated with a further 12 generated by the experts. Thirteen statements achieved consensus for agreement and seven for disagreement. CONCLUSIONS: The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens.

Central Nervous System Diseases↗

PubMed1997

"How do you remember you ate...?": a Delphi technique study to identify retrieval categories from fourth-grade children.

OBJECTIVE: To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch. DESIGN: A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students' self-reported lunch intake with observation. STATISTICAL ANALYSES: For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category. RESULTS: After round 3, we found that 23 "near-consensus" categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used "taste/smell/texture" and "visual" in deference to "order items consumed" and "oral cue still present." APPLICATIONS: These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet.

Child↗

PubMed2003

Management of the injured patient: identification of research topics for systematic review using the delphi technique.

BACKGROUND: Systematic reviews of controlled clinical trials in the form of meta-analyses can serve as an important guide to direct clinical practice. This study identifies the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve consensus of expert opinion. METHODS: Experts in trauma care from the United States and Canada (n = 68) were asked to generate structured research questions and were then required to rank these questions in order of importance and estimate the amount of research currently published. RESULTS: The questions ranking in the highest tertile are presented along with an estimate of their importance and the amount of research published using an ordinal scale. Only 9 of 16 (56%) questions had some or a substantial amount of research available on which to perform a systematic review. CONCLUSION: This study identifies the areas of trauma care in which research efforts might best be directed. In the absence of sufficient data for systematic reviews, these research topics represent important areas for the design and implementation of clinical trials.

Humans↗

PubMed1991

Changes: the Delphi technique adapted for classroom evaluation of clinical placements.

Too frequently during the post-allocation evaluation of clinical areas, some student psychiatric nurses displayed varying degrees of negativism towards or lack of involvement with the clinical area. The design of a classroom exercise 'Changes' was an attempt to overcome these undesirable features. The exercise was an adaptation of the Delphi technique and involved the student nurses in identifying changes that they would wish to make if returning to the clinical areas. Some simple manipulation of the ideas generated allowed a group consensus to be achieved. On closer inspection an additional interesting aspect of the suggestions was the large proportion of desirable changes that could be achieved with no financial implications. Alternatively changes in attitudes or work practices were implicated. Having achieved the original intention and moreover, generated suggestions for potential improvements it was decided to retain and repeat the exercise with future groups of student nurses. A similar pattern was obtained. Finally, the results were presented to representatives of the clinical areas and the technique along with facilitation time, offered to and accepted by ward managers as a means of quickly identifying ward team priorities, and generating ideas for improving their areas.

Attitude of Health Personnel↗

PubMed1999

Professional attitudes toward denture adhesives: A Delphi technique survey of academic prosthodontists.

STATEMENT OF PROBLEM: The use of denture adhesives and their role in prosthodontics has been an intriguing and conflicted topic, both in clinical practice and dental education. PURPOSE: This study generated discussion, and if possible, obtained a consensus on a series of issues related to denture adhesives among a group of leading academic prosthodontists. MATERIAL AND METHODS: The Delphi Technique survey method was used. It consists of a series of survey questionnaire rounds to a panel of experts to either develop a consensus (>70% agreement) or to clarify the reasons for multiple schools of thought on a topic. A 24-item Delphi questionnaire was sent to an expert panel that consisted of a 33% regionally stratified random sample of program directors of undergraduate complete denture courses in US dental schools. The 5 major topic areas on denture adhesives addressed by the questionnaire items were (1) general perceptions, (2) specific clinical uses/misuses, (3) patient education, (4) inclusion in dental curricula, and (5) overall opinions of utility. RESULTS: Of the 18 randomly selected panelists, 94% (n = 17) agreed to participate, with either 16 or 17 fully participating in each of the 3 survey rounds. The panel achieved consensus and clearly concluded that denture adhesives: (1) are a useful adjunct in denture prosthesis services, having specific roles in both the fabrication and postinsertion phases; (2) had the potential for misuse, both by dentists and by patients; and (3) should be an integral part of patient education for all denture patients and of the undergraduate dental curriculum. However, the panel was unable to achieve consensus on whether denture adhesives should be used at the postinsertion phase for immediate denture patients and whether, on the whole, they were a beneficial adjunct in denture patient management (59% agreed they were). The panelists also clearly expressed their concerns that neither dentists nor patients should use denture adhesives as a substitute for either good clinical practices or proper denture maintenance routines. CONCLUSIONS: This panel of leading academic prosthodontists concluded that denture adhesives are a useful adjunct in denture prosthesis services, with specific roles in both fabrication and postinsertion phases. They also indicated that only through education, for dentists and patients, would the dual goals of maximizing the beneficial aspects of denture adhesive use while minimizing the misuse of denture adhesives be achieved.

Adhesives↗

PubMed1997

Economic evaluation in schistosomiasis: using the Delphi technique to assess effectiveness.

The limited resources allocated to Schistosomiasis Control Programme in Kenya are not adequate to implement and sustain all technically efficacious interventions simultaneously. This fact has dawned upon both policy-makers and medical personnel who hitherto advocated a multi-faceted approach to 'eradicate' schistosomiasis. Given that Kenya cannot afford to implement all interventions that might conceivably be of some benefit, it is necessary to establish priorities based on considerations of both costs and benefits. An important part of the benefit of any health intervention is its effect on health (quality and quantity of life) of potential beneficiaries. The objectives of this study were to: identify relevant types of data needed in estimating impacts of schistosomiasis interventions on health status; develop an instrument which can be used to obtain subjective probabilistic impacts of interventions; test its operational feasibility; develop a conceptual framework within which impacts of interventions can be estimated; illustrate how the probabilities could be used in calculating the 'expected quality adjusted life years' (EQALY); and identify obstacles that need to be overcome within a developing country context. In this study, a 'modified Delphi' approach was used to elicit expert subjective judgements on the effectiveness of ten schistosomiasis interventions. The paper compares and contrasts the expected quality adjusted life years estimated using values obtained from two local schistosomiasis experts with those obtained from a foreign expert. The panelists appeared to be consistent in their ranking of the effectiveness of treatment vs. non-treatment options. However, there were large differences in the magnitudes of estimates obtained from the local and the foreign experts. Given that the Delphi technique has been widely and fruitfully used in industry and commerce (among other areas) in developed countries, African countries health policy-makers cannot possibly do worse (than the current practice where decisions to commit resources are based on 'what we did last time' and 'gut feelings') by using systematic decision analyses based on data from such a technique.

Cost-Benefit Analysis↗

PubMedDate not supplied

In pursuit of excellence via the Delphi technique.

The pursuit of excellence has become the catch concept for organizations as they strive to be winners in the competitive healthcare marketplace. As part of its marketing effort, the Ohio University Osteopathic Medical Center (OUOMC) undertook a series of assessments designed to enhance strengths and improve upon areas of identified weakness. With the involvement of all medical center staff, the Delphi technique was employed to bring about a consensus of opinion. Through this process, the group identified the characteristics of the best medical center, determined how OUOMC measured up to these, and improved upon areas of weakness highlighted in the assessment.

Data Collection↗

PubMed2004

How do stakeholder groups vary in a Delphi technique about primary mental health care and what factors influence their ratings?

BACKGROUND: While mental health is a core part of primary care, there are few validated quality measures and little relevant internationally published research. Consensus panel methods are a useful means of developing quality measures where evidence is sparse and/or opinions are diverse. However, little is known about the dynamics of consensus techniques and the factors that influence the judgements and ratings of panels and individual panelists. OBJECTIVES: (1) To describe differences in panel ratings on the quality of primary mental health care services by patient, carer, professional and managerial panels within a Delphi procedure; and (2) to explore why different panels and panelists rate quality indicators of primary mental health care differently. DESIGN: Two round postal Delphi technique and exploratory semi-structured interviews. PARTICIPANTS: 115 panelists across 11 panels. Eleven panelists were subsequently interviewed. RESULTS: 87 of 334 indicators (26%) were rated face valid by all 11 panels. There was little disagreement within panel ratings but significant differences between panels. The GP panel rated the least number of indicators valid (n = 138, 41%) and carers the most (n = 304, 91%). The way in which panelists interpreted and conceptualised the indicators and their definition of quality of mental health care affected the way in which participants made their ratings. CONCLUSIONS: Stakeholders in primary mental health care have diverse views of quality of care and these differences translate into how they rate quality indicators. Exploratory interviews suggest that ratings are influenced by past experience, expectations, definitions of quality of care, and perceived power relationships between stakeholders.

Attitude of Health Personnel↗

PubMed2002

Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments: use of the Delphi technique.

The provision of telephone advice to members of the general public from staff based in accident and emergency departments is common practice. However, it is largely conducted on an ad hoc basis without the use of formal guidelines or decision support. The evidence base from which to derive guidelines for the telephone assessment and advice of many common conditions is lacking. This study, using the Delphi technique, was undertaken to develop a number of benchmarks for use as objective measures against which the comprehensiveness of telephone assessments could be tested. Consensus views on the essential and desirable items to be considered for each of 10 presenting complaints was achieved. It is argued that establishing consensus views on clinical topics provides an effective means of developing an evidence base where other sources of evidence are lacking.

Benchmarking↗

PubMed2006

Creation of an innovative laser incident reporting form for improved trend analysis using the Delphi technique.

With expanding numbers of laser applications, there is greater potential for laser radiation exposures. Proper surveillance and evaluation of laser incidents can lead to better injury prevention and more efficient medical treatment. Current laser incident databases do not provide sufficient information for surveillance and analysis of laser trends. A laser incident reporting form (LIRF) was created for U.S. Air Force applications by using the Delphi technique. To create the LIRF, four expert panels were formed by 40 health and safety professionals experienced with laser systems and medical evaluation of laser incidents. After three rounds of surveys, the final LIRF contained 100 data collection fields identifying the most valuable items for injury trend analysis. Although the LIRF was initially developed to collect USAF laser incident information, it could potentially act as the cornerstone for a new system serving the entire military system.

Data Collection↗

PubMed1999

A Delphi technique to identify and evaluate criteria for construction of PBL problems.

INTRODUCTION: In the process of PBL implementation, faculty members often ask what are the criteria for constructing problems and subsequently evaluating them. Although experts agree on a fundamental theoretical basis for developing problems, mostly prototypical, it is difficult to find specific criteria that could be used in constructing PBL problems. METHOD: A Delphi technique using six independent judges from the Rouen School of Medicine, France, answered this question. It took four rounds and five months. RESULTS: Nine criteria were identified and rank-ordered according to their relative importance: 1. stimulating thinking, analysis, and reasoning (openness 6.8 points); 2. assuring self-directed learning (autonomy 6.5); 3. using previous basic knowledge (richness 6.2); 4. proposing a realistic context (attractiveness 5.7); 5. leading to the discovery of learning objectives (coverage 5.0); 6. arousing curiosity (inquisitiveness 5.0); 7. choosing topics related to public health (relevance 5.0); 8. assuring contextual breadth (comprehensiveness 4.8); and 9. choosing an appropriate vocabulary (medical encoding 4.7). DISCUSSION: The identification represents a fresh outlook on the PBL process, from judges who had recent experience in constructing PBL problems. Related to Barrow's dimensions, these criteria could be seen as a more concrete and specific level of conceptualization. Paired with those found in the literature, they match six out nine already identified, although not prioritized criteria. CONCLUSION: Judges from a school just having implemented PBL, found that Reasoning and Autonomy are the most important criteria for constructing PBL problems.

Delphi Technique↗