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Health & Social Care in the Community Nov 2022Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises... (Review)
Review
Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well-resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community-based child and family health (CFH) service models for rural and other under-resourced settings. A modified Delphi study was undertaken with a 12-person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access.
Topics: Child; Humans; Delphi Technique; Australia; Child Health Services; Community Health Services; Rural Population
PubMed: 36195997
DOI: 10.1111/hsc.14052 -
Chest Mar 2023The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable...
BACKGROUND
The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments.
RESEARCH QUESTION
What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals?
STUDY DESIGN AND METHODS
Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of consensus. Additionally, rank-order voting on the recommended diagnostic approach and terminology was performed.
RESULTS
Twenty-five of 28 statements reached consensus, including the definition of CB as a histologic pattern of lung injury that occurs in some previously deployed individuals while recognizing the importance of considering alternative diagnoses. Consensus statements also identified a diagnostic approach for the previously deployed individual with respiratory symptoms, distinguishing assessments best performed at a local or specialty referral center. Also, deployment-related respiratory disease (DRRD) was proposed as a broad term to subsume a wide range of potential syndromes and conditions identified through noninvasive evaluation or when surgical lung biopsy reveals evidence of multicompartmental lung injury that may include CB.
INTERPRETATION
Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
Topics: Humans; Lung Injury; Delphi Technique; Respiratory Tract Diseases; Bronchiolitis Obliterans; Respiration Disorders
PubMed: 36343686
DOI: 10.1016/j.chest.2022.10.031 -
Journal of Foot and Ankle Research Mar 2022The coronavirus pandemic resulted in unique challenges for podiatrists in Australia. Podiatrists were tasked with having to make triage decisions about face-to-face care... (Review)
Review
Development and use of the PodEssential and Paeds-PodEssential triage tools to define "essential" podiatry services. A Delphi survey, scoping review, and face validity testing study.
BACKGROUND
The coronavirus pandemic resulted in unique challenges for podiatrists in Australia. Podiatrists were tasked with having to make triage decisions about face-to-face care without clear guidelines. This research aimed to develop podiatry triage tools to understand individual risk for adults and children, and explore the face validity of both tools.
METHODS
An online three-round modified Delphi technique was used to elicit podiatrists' opinions on conditions, assessments and social factors that elevate risk. Additional elements of known foot and/or leg risk were informed by a synchronous scoping review. Australian podiatrists who held a clinical role treating patients or directly managing podiatrists treating patients within the past six months were recruited. Where 70% of participants reported the same or similar theme in Round 1, statements were accepted with consensus. Where 50-69% of participants reported a similar theme, these were returned to participants to rate agreement using a four-point Likert agreement scale. Statements identified in the scoping review were added at Round 2, if not already identified by participants. The final round presented participants with triage tools, and a series of mock patient scenarios.. Participants were asked to indicate if they would or would not provide face to face podiatry service based on these scenarios.
RESULTS
There were 40 participants who responded to Round 1 (Adult presentations), of these, 23 participants also provided paediatric presentation responses. Participants developed and agreed upon 20 statements about risk in podiatry service delivery for both adults and children across Rounds 1 and 2. The PodEssential and Paed-PodEssential were developed based on these statements indicating stand-alone condition risk (tier 1), elements that should elevate risk (in the absence of a stand-alone condition) (tier 2), and assessments results identifiying a limb at risk (tier 3) in adults and children respectively. Participants utilising these tools in Round 3 more frequently indicated face-to-face service when mock patient scenarios included a greater number elements, suggesting the tool can be useful in making triage decisions.
CONCLUSION
The PodEssential and Paeds-PodEssential tools direct conditions requiring urgent attention as well as providing considered elements to a person's health status to assist in making triage decisions.
Topics: Adult; Australia; Child; Consensus; Delphi Technique; Humans; Podiatry; Reproducibility of Results; Triage
PubMed: 35260188
DOI: 10.1186/s13047-022-00525-8 -
Evidence-based Nursing Jul 2020
Topics: Consensus; Delphi Technique; Humans; Research Design
PubMed: 32430290
DOI: 10.1136/ebnurs-2020-103303 -
International Journal of Environmental... Oct 2022The salutogenesis theory of Aaron Antonovsky and the Health Assets Model of Morgan and Ziglio have given rise to a notable interest in defining the resources available...
The salutogenesis theory of Aaron Antonovsky and the Health Assets Model of Morgan and Ziglio have given rise to a notable interest in defining the resources available to individuals and the community to maintain or improve their health and well-being. The present study began by identifying the universal dimensions of Community Assets for Health, and then analyzed and validated an assessment scale following the Delphi method. A high degree of consensus was achieved among 13 experts from different disciplines. The results of the content analysis and statistical analysis led to a reconfiguring of an instrument that is so far unique in its approach. It is composed of 103 items across 14 dimensions (utility, intention, previous use, affordability, proximity, walkability, connectivity, intelligibility, identity, design, safety, diversity, public dimension, and sustainability).
Topics: Humans; Consensus; Delphi Technique
PubMed: 36360857
DOI: 10.3390/ijerph192113979 -
Human Resources For Health Jun 2023The eye care workforce, particularly in lower resource settings, face challenges of limited integration into the health system, limited workforce capacity, mismatch of...
BACKGROUND
The eye care workforce, particularly in lower resource settings, face challenges of limited integration into the health system, limited workforce capacity, mismatch of workforce to population need and poor quality of care. In recognition of these challenges, coupled with a gap in existing tools, provides a strong rationale for the development of the Eye care competency framework (ECCF).
METHODS
A mixed methods approach was utilised to develop and validate the ECCF. Content was developed by extracting relevant components of existing frameworks used both within and outside of eye care. A diverse technical working group provided feedback and guidance on the structure, design, and content to create a preliminary draft. Competencies and activities were validated using a modified-Delphi study, and the framework was then piloted at four sites to understand how the tool can be implemented in different settings.
RESULTS
The final version of the ECCF included eight outcomes, nine guiding principles, and content of each of the key elements, including the six domains, 22 competencies, 21 activities, 193 behaviours and 234 tasks, and the knowledge and skills that underpin them. 95/112 participants from the six WHO regions completed the modified-Delphi study, yielding an average of 96% agreement across the competencies and activities in the ECCF. The pilot showcased the versatility and flexibility of the ECCF, where each of the four sites had a different experience in implementing the ECCF. All sites found that the ECCF enabled them to identify gaps within their current workforce documentation.
CONCLUSIONS
The ECCF was developed using a collaborative approach, reflecting the opinions of participants and stakeholders from all around the world. The comprehensive competencies and activities developed in the ECCF encompass the diverse roles of eye care workers, and thus encourage multi-disciplinary care and better integration into the health system. It is recommended that eye care workforce planners and developers use the ECCF, and adapt it to their context, to support workforce development and focus on the quality and scope of eye care service provision.
Topics: Humans; Health Personnel; Workforce; Delphi Technique; World Health Organization
PubMed: 37337207
DOI: 10.1186/s12960-023-00834-4 -
Disaster Medicine and Public Health... Apr 2022The main objective of this research was to generate a consensus on the conceptual definition of household emergency preparedness from experts representing multiple...
OBJECTIVE
The main objective of this research was to generate a consensus on the conceptual definition of household emergency preparedness from experts representing multiple disciplines and countries, in order to facilitate the development of an all-hazards, comprehensive, valid, and reliable instrument.
METHODS
Questions were generated via 3 methods: literature search, using existing instruments, and expert panels using the Delphi technique.
RESULTS
Panelists (n = 154) representing 36 countries came to a consensus that household emergency preparedness is defined as the completion of several preparedness actions and assembling a kit that can be transported in an evacuation. The new 51-question instrument demonstrates face, content, and criterion validity and internal consistency reliability (α = 0.96). The instrument assesses whether specific preparedness actions have been taken, and the presence or absence of essential supplies that could enable households to safely endure conditions that disasters would likely present (loss of power, water limitations, and/or lack of access to additional supplies for a few days).
CONCLUSION
A valid and reliable instrument provides researchers with a replicable approach to assessment of preparedness levels, which is necessary to plan mitigation strategies, enhance health promotion, prevent injuries, and increase resilience for individuals and communities. The instrument can provide evidence to support interventions addressing health needs of community members following a disaster.
Topics: Civil Defense; Delphi Technique; Disaster Planning; Family Characteristics; Humans; Reproducibility of Results
PubMed: 33213596
DOI: 10.1017/dmp.2020.292 -
Complementary Therapies in Clinical... Aug 2023Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat...
BACKGROUND
Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat challenging however, due to interprofessional and interjurisdictional variations in reported barriers. An efficient, systematic, comprehensive and innovative approach to isolating the barriers to evidence implementation is therefore needed.
MATERIALS AND METHODS
Using a mixed methods design, the study aimed to develop, refine and validate a tool to assess the evidence implementation environment for complementary medicine (CM) professions. The tool was developed using a five-stage process, and refined and validated using a two-round e-Delphi technique.
RESULTS
Informed by reviews examining the barriers and enablers to evidence implementation in CM, and shaped by the Behaviour Change Wheel Framework, a preliminary 33-item tool was created (i.e. the Global Assessment of the Evidence Implementation Environment [GENIE] tool). A two-round Delphi technique was used to refine the criteria, with a panel of 23 experts agreeing to the removal of two criteria, and the addition of two items. In the end, the Delphi panel reached consensus on 33 criteria, which were sorted into nine stakeholder groups.
CONCLUSION
This study has for the first time, created an innovative tool to assess the capacity and capability of CM professions to engage in evidence-based practice at an optimal level. By assessing the evidence implementation environment of CM professions, the GENIE tool is able to determine where resources, infrastructure and personnel should be directed in order to optimise the uptake of evidence-based practices within CM professions.
Topics: Humans; Delphi Technique; Evidence-Based Practice; Consensus; Complementary Therapies
PubMed: 37137208
DOI: 10.1016/j.ctcp.2023.101764 -
PloS One 2021In this paper, we use a Delphi approach to investigate whether, and to what extent, blockchain-based applications might affect firms' organizations, innovations, and...
In this paper, we use a Delphi approach to investigate whether, and to what extent, blockchain-based applications might affect firms' organizations, innovations, and strategies by 2030, and, consequently, which societal areas may be mainly affected. We provide a deep understanding of how the adoption of this technology could lead to changes in Europe over multiple dimensions, ranging from business to culture and society, policy and regulation, economy, and technology. From the projections that reached a significant consensus and were given a high probability of occurrence by the experts, we derive four scenarios built around two main dimensions: the digitization of assets and the change in business models.
Topics: Blockchain; Delphi Technique; Geography; Humans; Surveys and Questionnaires; Technology
PubMed: 34788307
DOI: 10.1371/journal.pone.0258995 -
BMC Public Health Mar 2022Occupational safety and health (OSH) surveillance systems track work-related fatalities, injuries and illnesses as well as the presence of workplace hazards and... (Review)
Review
BACKGROUND
Occupational safety and health (OSH) surveillance systems track work-related fatalities, injuries and illnesses as well as the presence of workplace hazards and exposures to inform prevention efforts. Periodic evaluation is critical to the improvement of these systems to meet the demand for more timely, complete, accurate and efficient data processing and analysis. Despite the existence of general guidance for public health surveillance evaluation, no tailored guidance exists for evaluating OSH surveillance systems to date. This study utilized the Delphi technique to collect consensus among experts in the United States on surveillance elements (components, attributes and measures) to inform the development of a tailored evaluation framework.
METHODS
A Delphi study approach with three survey rounds invited an expert panel to rate and comment on potential OSH surveillance evaluation framework elements, resulting in an optimal list of elements through the panel's consensus. Additionally, experts completed a review of OSH surveillance systems they worked with and answered questions regarding the development of an evaluation framework. Descriptive statistics of the ratings were compiled for the Delphi process. Major themes from experts' comments were further identified using content analysis to inform contextual information underlying their choices.
RESULTS
Fifty-four potential experts across the United States were contacted to participate in the Delphi study. Ten experts began the first survey round with eight then seven experts continuing in the subsequent rounds, respectively. A total of 64 surveillance components, 31 attributes, and 116 example measures were selected into the final list through panel consensus, with 134 (63.5%) reaching high consensus. Major themes regarding current OSH surveillance focused on resources and feasibility, data collection, flexibility, and the inter-relatedness among elements.
CONCLUSIONS
A Delphi process identified tailored OSH surveillance elements and major themes regarding OSH surveillance. The identified elements can serve as a preliminary guide for evaluating OSH surveillance systems. A more detailed evaluation framework is under development to incorporate these elements into a standard yet flexible approach to OSH surveillance evaluation.
Topics: Consensus; Delphi Technique; Humans; Occupational Health; Public Health Surveillance; Surveys and Questionnaires
PubMed: 35287647
DOI: 10.1186/s12889-022-12895-6