Nominal Group Technique Sessions Research Articles

Environmental Changes to Increase Physical Activity: Perceptions of Older Urban Ethnic-Minority Women

Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants' perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50-75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concerns for personal safety cut across categories. Participants indicated the need for more facilities in which to be active.

WHAT SHOULD WE INCLUDE IN A CULTURAL COMPETENCE CURRICULUM? A FORMATIVE EVALUATION.

Background and Objective Designing a cultural competence curriculum is inherently complex. Many elements are needed, and multiple frameworks exist. We used a novel approach to identify and prioritize elements to include in a cultural competence curriculum to address disparities in cardiovascular disease. Methods First, we used the nominal group technique (NGT) to generate and prioritize a list of ideas to include in the curriculum. NGT is a structured small group process that fosters creativity and equal participation of participants. We conducted four NGT sessions and elicited responses to “What sorts of things could be included in a curriculum that focuses on cultural competence training for physicians?” Participants of the NGT sessions were nine medical students, seven medicine residents, seven practicing physicians, and seven disparities researchers. To organize the ideas generated, we then asked 45 educators and researchers to group and rank the ideas based on their own perceptions of importance. Lastly, to produce homogeneous groupings of elements based on the ideas grouped and ranked, we used multidimensional scaling (MDS) and hierarchical cluster analysis. Results The NGT sessions generated 61 ideas, 29 of which were selected by at least 2 participants. We observed five clusters of related issues within the multidimensional space: (1) patients9 cultural background (provide information on cultures,* habits, customs, values); (2) impact on health care and health behavior (include factors influencing health services, folk remedies, diet); (3) differences in therapies and health disparities (provide pharmacologic therapies, reasons for cardiovascular disparities); (4) awareness of approaches to multicultural care (increased awareness of own biases,* “stereotype avoidance”); and (5) resources to manage cultural diversity (provide resources for patients and their families to comprehend instructions,* provide questions to permit taking a cultural history,* language translation guide and available services, community resources). The asterisks indicate the top-rated ideas by the NGT groups. The MDS showed good fit of the dimensions (stress = 0.074; R2 = .97). Conclusions Our cognitive mapping approach allowed us to use input obtained from various stakeholders and generate critical domains to guide the development of the new curriculum.

Changing Social and Built Environments to Promote Physical Activity: Recommendations from Low Income, Urban Women

Middle age and older (mean = 58.7 y), racial/ethnic minority women report low levels of physical activity. Recommendations to change the social and built environments to promote physical activity in this group are underdeveloped. Two research questions guided this study: What environmental changes are recommended by racial/ethnic minority women? What policies are related to the environmental changes? The findings from nine Nominal Group Technique sessions with 45 subjects were analyzed. More police protection, cleaner streets, removal of drugs from streets, more street lights, walking groups, and free gyms were prioritized by subjects as the most important recommendations. The relevant policies included municipal, police department, sanitation department, public works, and transportation department. Racial/ethnic minority women living in low income, urban areas recommend improvements that affect overall quality of life. Meeting basic needs may be a prerequisite for use of physical activity resources.

Using Community-based Participatory Research to Assess Health Needs among Migrant and Seasonal Farmworkers

Principles of community-based participatory research (CBPR) were applied among migrant and seasonal farmworkers (MSFWs) in a seven-county region of east Texas. The study purpose was to establish community-based partnerships for CBPR and conduct a preliminary qualitative assessment of perceived health needs and capacities. Key informant interviews and a snowballing technique were used to identify gatekeepers and recruit participants from three stakeholder groups: health care providers, social service providers, and MSFWs. A modified nominal group technique (NGT) was applied in a series of five qualitative group interviews: one group of health care providers (n=9), one group of social service providers (n=11), and three groups of MSFWs (one all male, n=4; one all female, n=8; one gender-balanced, n=8). To enhance response validity, the protocols used in each NGT session were adapted to the communication and problem-solving styles of each stakeholder group. The participants collectively identified behavioral, psychological, environmental, social/economic, and health service access/treatment factors believed to contribute to the health status of the MSFW community. A preliminary comparison of responses across stakeholder groups, known as heterogeneity sampling, revealed differing perspectives related to contributing factors and potential solutions. A discussion of the CBPR process and results, and specific intervention recommendations are provided.

Project‐Level Reuse Factors: Drivers for Variation within Software Development Environments*

ABSTRACTSystematic reuse can dramatically improve software development productivity and quality even though a software reuse methodology may require substantial investments. Some projects may fail to achieve the targeted amounts of reuse within organizations that are overall successful in employing reuse. To explain such variation, this research explores the effects of project‐level factors in the success of software reuse. A model that relates project factors to project reuse success is developed using an information‐rich case study approach. The results are based on the insights obtained in a nominal group technique session, triangulated with structured interviews and comparative case studies. Success factors identified by the study relate to client influence, project culture, project attributes, and developer reuse experience. An organization that can successfully identify the factors affecting potential software reuse will be able to better target investments for the improvement of its reuse methodology and thus positively affect its software development productivity and quality.

Enhancing their likelihood for a positive future: focus groups reveal the voice of inner-city youth.

To learn directly from adolescents living in a challenging environment what they believe would most influence their likelihood of achieving a positive future. A teen-centered methodology used focus groups, nominal group technique sessions, and a survey to allow adolescents to develop, prioritize, and explain their own solutions. AmeriCorps workers guided in-school 8th-, 9th-, and 12th-graders in north Philadelphia through a 4-stage hierarchical process. This article reports the qualitative explanations offered by adolescents in Stage 4 explanatory focus groups. In these 10 groups, 91 youth added meaning and context to the ideas their fellow students generated and prioritized. Transcriptions were reviewed for consistent themes. Direct quotations representative of those themes are offered here. Students in all grades gave highest priority to solutions that would promote educational or job opportunities. Solutions that would ameliorate disruptive surroundings or reduce risk behaviors were generally rated lower. Focus group participants agreed that education, improved employment opportunities, connection with adults, and meaningful uses of their time were the keys to positive change. They also expressed how a risky environment impacted on their chances for success and offered strategies for reducing their risks. They discussed how positive forces might counter the draw of the streets. Although most adolescents remained optimistic, some viewed problems in their neighborhood as intractable. An individual's ability to draw from protective resources while avoiding the challenges inherent to a risky environment may determine his/her ability to succeed. Youth have clear ideas about how they can best be supported to succeed. Adults should consider and incorporate their wisdom as they plan strategies to develop productive young adults.

Enhancing their likelihood for a positive future: the perspective of inner-city youth.

Inner-city youth must overcome many environmental challenges as they strive for success. Their outcome is influenced by the interplay of protective forces and risk factors. To learn directly from youth what solutions they believe would most influence their likelihood of achieving a positive future. In-school 8th-, 9th-, and 12th-graders in north Philadelphia generated, prioritized, and explained their own solutions through a 4-stage hierarchical process facilitated by AmeriCorps workers. In Stage 1, 60 randomly selected students participated in 8 focus groups to develop the study question. In Stage 2, youth in Nominal Group Technique sessions generated and prioritized solutions. In Stage 3, a survey for each grade that included their top prioritized ideas was distributed, and youth rated each idea on a Likert scale (5= Definitely would make me more likely to have a positive future to 1 = Would definitely not.). One thousand twenty-two ninth-graders (69% of in-school youth at 5 high schools) returned usable surveys. Ninety-three percent of responders were 14 to 16 years old, 44% were male, 54% were black, and 32% were Latino. Four hundred seventeen 8th-graders and 322 12th-graders returned usable surveys. In Stage 4, youth in 10 focus groups added meaning and context to the ideas. The highest rated items in all grades were solutions that promoted education or increased job opportunities. Ninth-graders ranked helping youth get into college first by the Marginal Homogeneity Test. The creation of more jobs was ranked second. Third rank was shared by more job training, keeping youth from dropping out of school, and better books for schools. The next tier of items focused mostly on opportunities for youth to spend their free time productively and to have interactions with adults. Many items calling for the reduction of risk behaviors or disruptive surroundings were rated lower. The Kruskal-Wallis test found little variation in rating of the ideas by gender, race, or socioeconomic status. Youth believe that supportive solutions would do more to enhance their likelihood of reaching a positive future than would attempts to reduce "negative" behaviors or disruptive surroundings. This suggests that research and policies should consider how best to augment the protective influences of education, employment, meaningful use of time, and connection to adults.

Factors affecting the decision to seek health care: the voice of adolescents.

To learn from teenagers why they do, or do not, seek preventive health care. A teen-centered methodology utilized focus groups, nominal group technique sessions, and surveys to allow adolescents to generate, prioritize, and explain their own responses. This article reports the qualitative explanations offered by youths in focus groups. In 21 groups, teenagers commented on the 15 factors that ninth graders in the School District of Philadelphia had determined most influenced their decision to seek care. Transcriptions were reviewed for consistent themes. Direct quotations are presented here to be representative of those themes. Two key points emerged. First, adolescents are more concerned about provider characteristics than site or system characteristics. Second, they worry deeply about disease transmission in the health care setting. Teenagers suggest some simple steps that may produce significant inroads toward developing an effective working relationship with them. A few examples include: to alleviate anxiety of disease transmission, providers should wash hands and remove instruments from sterile packaging in front of patients; to reassure teenagers of competence, providers should keep diplomas and certificates displayed; and to alleviate perceptions of racism, sites should post signs that clearly explain why patients are sometimes seen out of order. Adolescents know what draws them to services and what offends them. This study documents, in the words of youths, the factors contributing to their decisions to seek care. The results allow health professionals who care for adolescents to consider what they do well and where change may be needed.

Promoting safe use of multiple medications by elderly persons

Polypharmacy is highly prevalent in residential aged care facilities (RACFs). Although polypharmacy is sometimes unavoidable, polypharmacy has been associated with increased morbidity and mortality.To identify and prioritize a range of potential interventions to manage polypharmacy in RACFs from the perspectives of health care professionals, health policy and consumer representatives.Two nominal group technique (NGT) sessions were convened in August 2015. A purposive sample (n = 19) of clinicians, researchers, managers and representatives of consumer, professional and health policy organizations were asked to nominate interventions to address the prevalence and appropriateness of medication use. Participants were then asked to prioritize five interventions suitable for possible implementation at the system level.Six of 16 potential interventions were prioritized highest for possible implementation in clinical practice, with two interventions prioritized as second highest. The top interventions in rank order were ‘implementation of a pharmacist-led medication reconciliation service for new residents,’ ‘conduct facility-level audits and feedback to staff and health care professionals,’ ‘develop deprescribing scripts to assist clinician-resident discussion,’ ‘develop or revise prescribing guidelines specific to older people with multimorbidity in RACFs,’ ‘implement electronic medication charts and records’ and ‘better support Medication Advisory Committees (MACs) to address medication appropriateness.’This study prioritized a range of potential interventions that may be used to assist clinicians and policy makers develop a comprehensive strategy to manage polypharmacy in RACFs.

Issues in information systems planning

Numerous difficulties face information systems managers as they develop IS plans. Three nominal group technique sessions used IS practitioners from different levels of management to identify specific difficulties. The findings indicate a wide variety of problems faced by these managers. Top IS managers were concerned most with learning the objectives of top general management. Middle IS managers were concerned most with adopting a methodology for planning. Operating IS managers were concerned most with understanding the perceived needs of the user. These results suggest the need for more sophisticated management techniques (or the better use of existing techniques) and the need for research to address the development, utilization and evaluation of such techniques.

Nominal group technique. A method of decision-making by committee.

Committee-work which involves decision-making from a range of alternatives is frequently time-consuming, inefficient, and frustrating. Nominal Group Technique is a structured method of group decision-making which allows a rich generation of original ideas, balanced participation of all members of the group, and a rank-ordered set of decisions based on a mathematical voting method. A brief description of a Nominal Group Technique session is given and its application to decision-making by committees of anaesthetists is illustrated by an example.