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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 -
BMC Medical Research Methodology Jul 2022Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians...
BACKGROUND
Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption.
METHODS
A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise.
RESULTS
Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP.
CONCLUSIONS
The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.
Topics: Consensus; Cost-Benefit Analysis; Delphi Technique; Humans
PubMed: 35818027
DOI: 10.1186/s12874-022-01667-w -
International Journal of Health Policy... Aug 2022Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step...
BACKGROUND
Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators.
METHODS
The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors.
RESULTS
Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75.
CONCLUSION
A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.
Topics: Child; Adult; Humans; Health Equity; Consensus; Pediatric Obesity; Delivery of Health Care; Health Promotion; Delphi Technique
PubMed: 34273926
DOI: 10.34172/ijhpm.2021.54 -
BMC Emergency Medicine Jun 2023Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and...
BACKGROUND
Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.
METHODS
This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.
RESULTS
In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.
CONCLUSION
According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users' requirements.
Topics: Humans; Delphi Technique; Surveys and Questionnaires; Emergency Service, Hospital; Consensus; Information Systems
PubMed: 37259025
DOI: 10.1186/s12873-023-00831-9 -
The Bone & Joint Journal Jun 2022The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark...
AIMS
The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV.
METHODS
The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children's Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results.
RESULTS
The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached 'consensus in', no statements reached 'consensus out', and 18 reached 'no consensus'. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached 'consensus in', no statements reached 'consensus out', and three reached 'no consensus' and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages.
CONCLUSION
We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: 2022;104-B(6):758-764.
Topics: Child; Clubfoot; Consensus; Delphi Technique; Humans; Walking
PubMed: 35638218
DOI: 10.1302/0301-620X.104B6.BJJ-2021-1687.R1 -
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 -
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 -
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