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PubMedDate not supplied

Assessing food system attitudes among youth: development and evaluation of attitude measures.

OBJECTIVE: To design and pilot a questionnaire for assessing youth attitudes about the food system. DESIGN: Nutrition educators provided important topics for food system education through a survey using the Delphi method. The resulting questionnaire of attitude scales was piloted with high school students. SETTING: The Delphi survey of nutrition educators was conducted through the mail and electronically. A paper and pencil questionnaire was administered to high school students in Family and Consumer Science classes. PARTICIPANTS: Delphi participants were members of the Society for Nutrition Education's Division of Sustainable Food Systems. A convenience sample of high school students completed the pilot questionnaire. VARIABLES MEASURED: Scales measured attitudes about farmland protection, participation in the local food system, hunger in the United States, organic agriculture, and environmental issues related to food. ANALYSIS: Factor analysis was used to identify constructs. The internal consistency of each resulting scale was assessed using Cronbach's alpha. RESULTS: Reliability of attitude scales ranged from .59 to .73. CONCLUSIONS AND IMPLICATIONS: Attitude scales were created for the purpose of assessing youth thoughts and beliefs about the local or regional food system. Such assessments can serve as a starting point for food system educators interested in developing effective curricula on food system topics.

Adolescent↗

PubMedDate not supplied

[Occupational risk factors in the sectors of economic activity of Barcelona].

The aim of the present study is to identify and prioritize the most important five occupational risk factors perceived by representatives of workers in each one of the economical activity branches (EAB) in Barcelona, by the Delphi Method. A Delphi survey was carried out for each EAB of Barcelona. 273 trade union delegates (from 21 to 28 by EAB) were consulted the three successive postal interviews. The typical risk factors (noise, toxics, and infections agents) appeared in the first and second place in the printing, food, textile, chemical and health branches of activity. However, risk factors related to work organization were pointed out in the first place in the rest of branches. The use of the Delphi method by the occupational health managers of a geographical area could let, in an easy and fast way, identify and prioritize the risk factors of this area in order to introduce effectiveness prevention measures.

Commerce↗

PubMed1999

Kentucky legislators' views on tobacco policy.

CONTEXT: Kentucky leads the nation in adult and teen smoking prevalence. Even though Kentucky is one of the most tobacco-dependent states, tobacco policy is subject to change in light of possible national tobacco legislation. OBJECTIVE: To describe the degree of agreement among Kentucky legislators regarding tobacco control and tobacco farming policy, and to discover whether use of the policy Delphi method produces a shift toward consensus on tobacco policy. DESIGN: A two-round policy Delphi study was conducted using in-person interviews. SETTING: Legislators' offices in Frankfort, Kentucky. PARTICIPANTS: Volunteer sample of 116 Kentucky legislators (84% response rate). MAIN OUTCOME MEASURES: Degree of agreement on tobacco control and tobacco farming policies. RESULTS: Lawmakers were highly supportive of policies to lessen the state's dependence on tobacco, and were favorable toward stronger tobacco control policies. There were discrepancies, however, between what policies legislators thought were desirable and what policies were realistic. Tobacco interests were identified as possible explanations for this disparity. Tobacco allotment ownership was associated with less support for tobacco control and tobacco farming policies. A shift toward consensus on tobacco policy was achieved in the second round for 45% of the interview items common to both rounds. CONCLUSIONS: Kentucky legislators were highly supportive of reducing the state's dependence on tobacco and more supportive of tobacco control policies than expected. The policy Delphi method has the potential for shifting opinions about tobacco policies among state legislators. The findings of this study identify opportunities for public health policy change in one of the most tobacco-dependent states in the United States.

Adult↗

PubMedDate not supplied

Pharmacists' perceptions of a set of pharmaceutical care practice standards.

OBJECTIVE: This study assessed pharmacists' perceptions of the feasibility and relevance of a set of community-based pharmaceutical care practice standards. DESIGN: Practice standards generated in a Delphi study were rated for feasibility of implementation and relevance to improving therapeutic outcomes by a randomized sample of 315 pharmacists on two 7-point Likert-type scales. These ratings were compared with assessments by Delphi panel experts. RESULTS: Pharmacists judged many of the standards favorably; however, Kruskal-Wallis ANOVA revealed that they were less confident in the standards' feasibility of implementation and relevance to improving patient outcomes than were the Delphi panel experts. CONCLUSION: Pharmacists appear ready to accept a majority of the practice standards used in this study. The lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes.

Analysis of Variance↗

PubMedDate not supplied

Role of exercises and drills in the evaluation of public health in emergency response.

INTRODUCTION: Public health agencies have been participating in emergency preparedness exercises for many years. A poorly designed or executed exercise, or an unevaluated or inadequately evaluated plan, may do more harm than good if it leads to a false sense of security, and results in poor performance during an actual emergency. At the time this project began, there were no specific standards for the public health aspects of exercises and drills, and no defined criteria for the evaluation of agency performance in public health. OBJECTIVE: The objective of this study was to develop defined criteria for the evaluation of agency performance. METHOD: A Delphi panel of 26 experts in the field participated in developing criteria to assist in the evaluation of emergency exercise performance, and facilitate measuring improvement over time. Candidate criteria were based on the usual parts of an emergency plan and three other frameworks used elsewhere in public health or emergency response. RESULTS: The response rate from the expert panel for Delphi Round I was 74%, and for Delphi Round II was 55%. This final menu included 46 public health-agency level criteria grouped into nine categories for use in evaluating an emergency drill or exercise at the local public health level. CONCLUSION: Use of the public health-specific criteria developed through this process will allow for specific assessment and planning for measurable improvement in a health agency over time.

Delphi Technique↗

PubMed2006

The development of a consensus among primary care dentists of referral criteria for school dental screening.

OBJECTIVE: To obtain consensus amongst a sample of primary care dentists in the North West of England on a set of clinical criteria that should trigger referral following school dental screening. DESIGN: Delphi process. SETTING: Primary dental care, England 2002. METHOD: Primary care dentists in the North West of England were randomly selected to complete a two round 'Delphi exercise' that included 10 potential referral criteria. The dentists were invited to express their level of support for the inclusion of each referral criterion. MAIN OUTCOME MEASURES: Level of agreement for each referral criterion. Acceptance of any criterion was that the interquartile range should be no more than 3 scale points with the lower value being no less than 7. RESULTS: Eighty-eight dentists, (72.7%), completed the Delphi exercise. Six referral criteria met with the groups' approval: Child with caries in permanent dentition. Child with darkened/discoloured permanent incisors. Child aged 9-10 years with overjet greater than 10 mm. Child over six years with either gross plaque, calculus or swollen gums. Child with evidence of sepsis. Child registered with a GDP with caries in permanent dentition. CONCLUSION: It is possible for a representative sample of primary care dentists in the North West to agree referral criteria following school dental screening.

Child↗

PubMed2003

Balancing professional and personal satisfaction of nurse managers: current and future perspectives in a changing health care system.

OBJECTIVE: The objectives of this research were to explore and describe emerging new roles of First-Line Nurse Managers (F-LNMs i.e. individuals who oversee the daily operations of nursing units, regardless of their titles) in one Canadian province, identify their requisite knowledge, skills, competencies, and determine the training and development needs of these managers. BACKGROUND: F-LNMs, recognized as key players in health care systems, face major challenges (e.g. continuing organizational change, lack of resources) daily. These challenges affect their ability to achieve quality work experiences for their staff members and quality of nursing care for their patients and for themselves. METHODS: The research design entails a triangulation of investigators (nursing and management), methods (interviews and a Delphi Study), samples (interviews with 26 F-LNMs and a Delphi Study with 62 panelists), and data (qualitative and quantitative). Institutions were randomly selected and then F-LNMs were randomly selected to participate in personal interviews and the remaining F-LNMs, along with nominated senior administrators, were invited to participate in the Delphi Study. RESULTS: Key findings relate to role changes (e.g. job enlargement and emphasis on efficiency), challenges (e.g. staffing and retention, frustrations), and recommendations for administrators (e.g. provide resources, training and development) and educators (e.g. link education to organizational needs). Ultimately, organizational changes and challenges affect how F-LNMs perceive their future professional (e.g. providing quality of patient care) and personal (e.g. high quality of life) satisfaction levels. CONCLUSIONS: This research suggests that the role of F-LNMs continues to evolve, consistent with the changing health care system. F-LNMs face challenges that compromise performance of their functions as they believe their work should be completed. To enhance satisfaction in their roles, F-LNMs express a desire for balance in their professional and personal lives.

Adaptation, Psychological↗

PubMed2006

Development of clinical guidelines for the prescription of orthoses in patients with neurological disorders in The Netherlands.

The objective of this study was to develop guidelines for the prescription of ankle-foot, knee, wrist-hand and elbow orthoses for patients with neurological disorders. The study is part of a more comprehensive study focusing on the development of clinical guidelines for the prescription of these orthoses in a wider patient population. Evidence from literature (reviews, randomized controlled trials with good quality), information from literature with a lower degree of evidence and information from structured interviews with experts in the field of orthotics, form the basis of statements presented in a Delphi procedure. The Delphi technique was used to gain consensus on statements published on the Internet. A group of experts in the field of orthotics and neurological disorders was asked to give their opinion on 41 statements. Statements with a general agreement of at least 75% were accepted. Statements with less general agreement were rewritten and the experts could react in a second and possibly in a third round. Afterwards, an opinion-based workshop was organized in which participants could react on preliminary guidelines and on Delphi-statements with between 65% and 75% agreement. Consensus on 32 statements was gained during the three rounds and the opinion-based workshop. These statements form the basis of the consensus based clinical guidelines for the prescription of orthoses in patients with neurological disorders.

Consensus↗

PubMedDate not supplied

Identification of relevant ICF categories by health professionals in the acute hospital.

PURPOSE: To identify the most relevant problems of patients in the acute hospital in the view of health professionals using focus groups followed by a Delphi process. METHODS: Focus group and Delphi methodology were applied. The focus groups were conducted at three university hospitals. Three groups focusing on the problems in patients with neurological/neurosurgical, cardiopulmonary and musculoskeletal conditions were conducted at each hospital. The participants had to decide about which categories of the International Classification of Functioning, Disability and Health are relevant to patients in the acute hospital. The results from the focus groups were then followed by a Delphi process. RESULTS: Forty health professionals participated in the nine focus groups, 14 in the three neurological/neurosurgical groups, 13 in the three musculoskeletal groups, 13 in the three cardiopulmonary groups. One hundred and sixty-four of the second-level ICF categories (61.7% of all second-level categories) were considered as relevant by the health professionals of the neurological group, 100 categories (37.6%) by the musculoskeletal group and 91 (34.2%) by the cardiopulmonary group. CONCLUSIONS: The involvement of experts from different health professions is a valuable tool to identify typical patient characteristics, expressed as distinct ICF categories, which can be used across different acute conditions.

Activities of Daily Living↗

PubMed2005

Developing a competence framework and evaluation tool for primary care nursing in South Africa.

CONTEXT: Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. OBJECTIVES: To identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. METHODS: The descriptive and exploratory techniques used included two meetings of a reference group of South African primary care professionals, followed by a consensus-building exercise. Using the Delphi technique expert opinion was solicited from South Africa, Canada and the USA. FINDINGS: The reference group meetings yielded a list of nine core competencies. Infrastructure issues, such as the supermarket (one-stop shopping) approach to service delivery, communication and transport systems, and the quality of supervision still cause concern. These issues underscore that competence cannot be measured in a vacuum. Input from Delphi participants affirmed the nine core competencies and the need to assess the impact of core competency training. One possible way to measure the nine core competencies would be to use proxy indicators. DISCUSSION/CONCLUSIONS: Identifying core competencies is a complex process. There is a need to process a wide range of views and ideas. Also, balancing academic concerns with service delivery needs and constraints is an ongoing challenge. A potential limitation of the Delphi technique is participant selection bias and fatigue. Accessing a diverse international panel and making numerous follow up attempts via phone, mail and email were used to attempt to ameliorate these inherent limitations. Although the process is cumbersome, providing "experts" with a venue to wrestle with these ideas can be fruitful. Future studies would help to assess the reliability of the findings.

Clinical Competence↗

PubMed2006

The health promoting sports club in Finland--a challenge for the settings-based approach.

The purpose of this article is, first, to compile a frame of reference for the health promoting sports club and, second, to develop standards for the concept. This concept is based on the settings-based health promotion approach. Sports clubs are a new setting for health promotion, which until now has been little examined from a settings point of view. Nevertheless, this concept has much potential. For example, sports clubs attract a large number of children and adolescents and their educational nature can be considered to be informal. The present standards were developed using the Delphi method. The researcher, in cooperation with a panel of experts (experts in health promotion, n = 11, and experts in sports clubs, n = 16), sought to create a consensus statement on the standards. At the preliminary stage of the study 64 original standards were created on the basis of existing literature and the principles of the Ottawa Charter. During the three rounds of the Delphi process 15 standards were evaluated as the most important. After the Delphi process, the researcher modified the standards by eliminating overlap, interpolating seven standards to involve all strategic areas of the Ottawa Charter and creating a preliminary typology of the standards. At the subsequent stages of the study, indicators for these standards will be drafted and tested in practice. Therefore, this study would provide tools for determining and evaluating how health promoting a particular sports club is.

Adolescent↗

PubMed2002

Preventing drug-related morbidity--determining valid indicators.

OBJECTIVE: To describe the process that is being undertaken to validate a series of indicators for preventable drug-related morbidity - originally developed in the US - for application in the UK health care system. DESIGN: A two-round Delphi questionnaire survey after a preliminary validation of the indicators within the University of Manchester School of Pharmacy. SETTING: A primary care study set in the UK. STUDY PARTICIPANTS: A purposively selected sample of general practitioners with a specific responsibility for prescribing-related issues (n = 6) and pharmacists actively involved in medication review in primary care (n = 10). MAIN OUTCOME MEASURES: The establishment of consensus among the participants that an indicator reflected preventable drug-related morbidity in primary care. RESULTS: After preliminary validation, 37 of the original 57 US indicators were retained. The Delphi panel generated 16 additional new indicators in the first round. At the end of the second round, the pre-defined level of consensus was reached for 29 indicators (19 of the US generated indicators; 10 generated by the panel in the first round). CONCLUSIONS: The Delphi results highlighted differences in both the clinical perspective and, possibly, philosophical viewpoints of health professionals practising in the UK and US health care systems. Further work, located in both primary and secondary care, is now in progress to operationalize the indicators. This process will form a key part of the refining, and hence further validation, of the indicators. The future development of prospective medical-record-based indicators should facilitate a reduction in the human, clinical, and economic burden of drug-related morbidity.

Attitude of Health Personnel↗

PubMed1991

Modeling physical therapy clinical research centers.

Because the establishment of physical therapy clinical research centers (PTCRCs) has been of interest to the profession, this project was undertaken to (1) assess the available resources, (2) complete a systems analysis, and (3) apply the results of a Delphi survey to the resulting clinical research center models. The methodology included several techniques. First, a questionnaire that addressed the status and elements of organization of PTCRCs was distributed to 118 academic institutions and 22 other facilities. A systems analysis of clinical research centers supported by various institutes at the National Institutes of Health was then completed. A Delphi procedure was also used to query a panel of physical therapy researchers regarding the components of a PTCRC. Site visits were conducted at three facilities to assess the possibility of those facilities becoming PTCRCs. From the data derived via these methods, models for PTCRCs were developed. Results showed that as many as 40 facilities reported the capability of becoming a PTCRC, but the data also showed that only four sites had extensively contributed by means of publication in peer-reviewed journals. The Delphi survey produced a number of items regarding characteristics and foci on which consensus was reached. Considering all the data, several models for PTCRCs were developed. Allowance for diversity in the structure and focus of PTCRCs appears to be a critical factor if the development of PTCRCs is to be encouraged.

Academies and Institutes↗

PubMed2001

Priorities for adult cancer nursing research: a West Australian replication.

Two Delphi surveys have been conducted during the past 20 years to identify cancer nursing research priorities; one in the United States and one in Canada. Sir Charles Gairdner Hospital, the State Cancer Referral Centre in Western Australia, undertook a replication of this Delphi survey to identify nursing research priorities for adult cancer nursing. The aim of this replication was to identify possible changes in priorities and account for cultural difference in the healthcare systems. A total of 45 responses were received from the first Delphi round and 30 from the second. The top ten priorities identified by this sample were different from those identified in prior studies. The top ranked research topic was "What strategies would be most helpful in allowing nurses time to provide emotional support to cancer patients and carers?" These results may stimulate discussion and re-assessment of research priorities in other adult cancer care settings.

Adult↗

PubMedDate not supplied

Research priorities for burn nursing: patient, nurse, and burn prevention education.

Fifteen of the 101 research questions that were assigned priorities in the Burn Nursing Delphi study by Marvin et al. (Marvin JA, Carrougher GJ, Bayley EW, Weber B, Knighton J, Rutan RL. Burn nursing Delphi study: setting research priorities. J BURN CARE REHABIL 1991;12:190-7) addressed education from the perspectives of patients, their families, and burn nurses; the study also addressed the issue of burn prevention education. Questions concerning patient education were assigned the highest priority in this education subgroup with respect to the potential for research that would have an impact on patient welfare. The question that rated highest as a priority for its potential impact on the profession of burn nursing addressed the core competencies needed for safe and effective burn nursing practice. Prevention education was generally found to be a low priority in the Delphi study. Many of the questions in the education subgroup can best be answered by comparative or experimental studies designed to explain and predict the effects of various teaching strategies on behavioral outcomes. Research on patient, nurse, and burn prevention education provides a fertile ground for nurse researchers and an opportunity to contribute knowledge of vital importance to clinicians, educators, managers, and the public.

Burn Units↗

PubMed2004

Important computer competencies for the nursing profession.

Nursing requires computer competencies. This study aimed at identifying those competencies required for the nursing profession in Taiwan. The Delphi technique was deployed in this study. In the Delphi questionnaires, computer competencies were sorted into seven domains: concepts of hardware, software, and networks; principles of computer applications; skills of computer usage; program design; limitations of the computer; personal and social issues; attitudes toward the computer. In three Delphi questionnaires, nursing informatics experts gave us their opinions on the importance of each computer competency for the nursing profession. The experts also designated when the competency should be cultivated. This study provides a comprehensive list for nursing professionals to check on their computer competence. The results of this study should also serve as good references for teachers and schools in designing related curriculums.

Adult↗

PubMed2005

Development of a questionnaire to collect public health data for school entrants in London: Child Health Assessment at School Entry (CHASE) project.

BACKGROUND: To develop a multiprofessional consensus about the relative contributions of the components of children's health and well-being and to develop a questionnaire that can be used to assess these in London's children. METHODS: Semi-structured interviews with health, education and social services professionals were used to identify areas to include in the questionnaire. These ideas were used as the basis for a wider Delphi consultation, with 79 experts in the area of child health. Round 1 of the Delphi asked panelists to rate 54 items as to whether they should be included in the questionnaire or not. Responses were divided into four categories: item to be included measurement method agreed, item to be included measurement method not agreed, no consensus, or excluded. In round 2, consensus was sought for the categories where there was none following round 1. RESULTS: Themes identified by the interviews were: economic factors, ethnicity, environment, nutrition, hygiene and physical activity, growth, suffers from chronic/serious illness, development, disability and learning, accidents and hospital attendances, self-regulation, psychological well-being, significant life events. After Delphi round 1, items included, where quality measurement method was agreed, were: deprivation index (from postcode), child's ethnicity, temporary accommodation, care status, registered with general practitioner, dental visits, height, weight, special educational needs status, baseline educational assessment result, immunization status, visual and hearing function. Following round 2, items relating to chronic illness, mental health, physical functioning, general health, self-esteem, family cohesion and accident status were agreed for inclusion with a measurement method also agreed. The questionnaire was acceptable to parents. CONCLUSION: The validity, reliability and feasibility of this questionnaire must now be examined. This data set, if collected across London, would substantially increase the public health data available and allow trends in health to be monitored.

Child↗

PubMed2007

Definitions for haemophilia prophylaxis and its outcomes: the Canadian consensus study.

The creation of acceptable standard definitions for terms used in the care and assessment of haemophilia patients has become increasingly important, as a growing number of international clinical studies have been initiated. The Delphi approach has been used in health research to reach consensus in large groups and can be used to develop definitions by using several iterations of surveys eliciting opinions from specialists in the field. Three consecutive surveys were designed based on the Delphi approach and distributed to specialist physicians, nurses and physiotherapists in order to develop definitions for seven haemophilia terms: 'primary prophylaxis', 'secondary prophylaxis', 'target joint', 'joint bleed', 'significant soft-tissue bleed', 'superficial soft-tissue bleed' and 'mucosal bleed'. Suggestions were solicited, compiled into a subsequent survey and fed back to the group to rank-order the importance of each suggested component of the definition. Final definitions were created using the top-ranked suggestions and sent back to the experts for approval. Five of the seven terms were highly endorsed with greater than 90% agreement. Some differences in agreement were found when analysed by profession. Haemophilia terms were successfully defined using the Delphi approach. Further refinement from members of the international haemophilia community will ensure that comprehensive standard definitions can be used in multicentre studies in the future.

Canada↗