Online Delphi Method Research Articles

Development of a framework of the skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis: A Delphi consensus study.

Complex psychosis is associated with high social and economic costs. The key skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis have not previously been defined. A framework detailing these skills and attributes is needed to support the identification of training needs for those working with this population. A modified online Delphi method was used to reach consensus on the skills and attributes essential for mental health professionals to deliver optimal clinical care to people experiencing complex psychosis. Participants were international healthcare professionals and academic researchers who self-identified as experts in complex psychosis. Participants were asked to rate their level of agreement with each item on a five-point Likert-type scale and to provide comments. Qualitative feedback was used to modify existing, or create new, items for subsequent rounds. 64 responses were received across three Delphi rounds. 167 items reached consensus and were endorsed (132 in Round 1, 31 in Round 2 and 4 in Round 3). Median score range for endorsed items was 4.5/5, with 88.6% scoring 5/5. All 167 endorsed items were included in the framework, categorised into 14 overarching domains. Multiple skills and attributes were identified as being core components required in the delivery of optimal care by mental health professionals to people experiencing complex psychosis. The resulting framework provides a benchmark for training and skill development of mental health clinicians at both individual and team levels to optimise effective working with this high-needs population.

The Reporting of a Disproportionality Analysis for Drug Safety Signal Detection Using Individual Case Safety Reports in PharmacoVigilance (READUS-PV): Development and Statement.

Disproportionality analyses using reports of suspected adverse drug reactions are the most commonly used quantitative methods for detecting safety signals in pharmacovigilance. However, their methods and results are generally poorly reported in published articles and existing guidelines do not capture the specific features of disproportionality analyses. We here describe the development of a guideline (REporting of A Disproportionality analysis for drUg Safety signal detection using individual case safety reports in PharmacoVigilance [READUS-PV]) for reporting the results of disproportionality analyses in articles and abstracts. We established a group of 34 international experts from universities, the pharmaceutical industry, and regulatory agencies, with expertise in pharmacovigilance, disproportionality analyses, and assessment of safety signals. We followed a three-step process to develop the checklist: (1) an open-text survey to generate a first list of items; (2) an online Delphi method to select and rephrase the most important items; (3) a final online consensus meeting. Among the panel members, 33 experts responded to round 1 and 30 to round 2 of the Delphi and 25 participated to the consensus meeting. Overall, 60 recommendations for the main body of the manuscript and 13 recommendations for the abstracts were retained by participants after the Delphi method. After merging of some items together and the online consensus meeting, the READUS-PV guidelines comprise a checklist of 32 recommendations, in 14 items, for the reporting of disproportionality analyses in the main body text and four items, comprising 12 recommendations, for abstracts. The READUS-PV guidelines will support authors, editors, peer-reviewers, and users of disproportionality analyses using individual case safety report databases. Adopting these guidelines will lead to more transparent, comprehensive, and accurate reporting and interpretation of disproportionality analyses, facilitating the integration with other sources of evidence.

HOW HAS KIDS PHYSICAL ACTIVITY PREVIOUSLY BEEN MEASURED IN AUSTRALIA? AND WHAT QUESTIONS COULD WE USE IN THE FUTURE?

INTRODUCTION & AIMS The complex nature of children’s and adolescents’ participation in physical activity (PA) makes it difficult to measure. Questions have been used in Australia for many decades to subjectively monitor PA and sedentarism, however there is no consensus on which are the best. Since better data is needed to more accurately determine PA participation, the aim of this research was to identify existing questions and utilise expert opinion to develop a set of recommended questions. METHODS An audit of existing research measuring Australian children’s and adolescents’ participation in PA and sedentary behaviours was conducted. Existing questions were collated, classified and described in terms of the behaviours they measured and how they have previously been used. A two-round online Delphi method was chosen to identify experts’ opinions on existing questions measuring PA and sedentary behaviours. RESULTS From 1951 to 2019, 362 index questions were identified as previously used to measure PA and sedentary behaviours. The questions were diverse, with varying characteristics such as the behaviours measured, question structure, recall timeframe, and temporal alterations to the questions. Some continuity in data collection was identified, with one question measuring overall PA participation repeated 35 times across different studies. Within the Delphi questionnaire, 29 experts provided feedback on 31 questions which met the pre-determined criteria. The highest-ranked questions measuring participation in overall PA and sedentary behaviours were selected as two key questions for measuring compliance to PA guidelines. CONCLUSION Numerous questions exist able to measure compliance to guidelines or more specific measurement needs. If researchers and practitioners utilise recommended questions, it will help to accumulate comparative data and provide further insight on how to meaningfully improve PA of an individual child or a whole population.

Selection of Quality Indicators to Evaluate Quality of Care for Patients with Esophageal Atresia Using a Delphi Method.

Survival of neonates with esophageal atresia (EA) is relatively high and stable, resulting in increased attention to optimizing care and longer-term morbidity. This study aimed to reach consensus on a quality indicator set for benchmarking EA care between hospitals, regions, or countries in a European clinical audit. Using an online Delphi method, a panel of EA health care professionals and patient representatives rated potential outcome, structure, and process indicators for EA care identified through systematic literature and guideline review on a nine-point Likert scale in three questionnaires. Items were included based on predefined criteria. In rounds 2 and 3, participants were asked to select the five to ten most essential of the included indicators. An international panel of 14 patient representatives and 71 multidisciplinary health care professionals representing 41 European hospitals completed all questionnaires (response rate: 81%), eventually including 22 baseline characteristics and 32 indicators. After ranking, 10 indicators were prioritized by both stakeholder groups. In addition, each stakeholder group highly prioritized one additional indicator. Following an additional online vote by the other group, these were both added to the final set. This study established a core indicator set of twenty-two baseline characteristics, eight outcome indicators, one structure indicator, and three process indicators for evaluating (quality of) EA care in Europe. These indicators, covering various aspects of EA care, will be implemented in the European Pediatric Surgical Audit to enable recognition of practice variation and focus EA care improvement initiatives.

Barriers and solutions for the management of severe hypoglycaemia in people with diabetes in Spain: A Delphi survey

Background and objectiveSevere hypoglycaemia (SH) imposes a significant burden for people with diabetes (PwD), their caregivers (CGs), and the healthcare system. The study aimed to identify barriers and solutions in the management of SH in PwD in Spain, gathering consensus from physicians and nurses. Material and methodsExpert opinion from physicians and nurses who manage PwD was collected via a 2-round online Delphi method. Consensus was predefined as ≥ 70% of the panellists agreeing or disagreeing with the statement. ResultsPhysicians (n = 25) and nurses (n = 17) reached ≥ 90% consensus on the following barriers for the management of SH: absence of symptoms, cost to the health system, lack of implementation of glucose monitoring devices, lack of patient training to identify and manage SH, and the fear of SH in children and CGs. Main solutions, identified with ≥ 70% consensus, included training, education, and psychological support using diabetes nurse educators and the use of new glucose monitoring technologies and applications. ConclusionsThis study provides valuable insights on the barriers and solutions in the management of SH in Spain. Structured self-management training, the support of diabetes educators, and the use of insulin delivery devices and glucose monitoring technologies is required for the management of SH.

Determining essential elements and functionalities for a patient record system in community pharmacy

BackgroundAs community-based pharmacy continues to evolve from a focus on product distribution to a practice focused on patient care, a key requirement is for pharmacists to document their patient care activities. Some community-based pharmacies are working to routinely use the Pharmacist eCare Plan standard in documenting their new care activities. ObjectivesWith the need for a robust patient record in community-based pharmacies, the purpose of this study was to identify key elements and functionalities for a community-based pharmacy patient record. MethodsAn expert panel of 26 individuals participated in 3 rounds of surveys using an online Delphi method to develop consensus about the key data elements and functionalities for a pharmacy patient record system. ResultsA total of 46 items reached consensus: 16 as essential elements for a longitudinal pharmacy patient record, 7 as essential elements for a patient encounter, and 23 functionalities for a pharmacy patient record system. A rubric was developed to assess community-based pharmacy patient record systems. ConclusionThe functionalities can support pharmacists in fully adopting a standard care process and providing and documenting patient care, while coordinating and improving communication with patients, providers, and payers. Pharmacists are encouraged to use the rubric in evaluating software for their practices.

A global neuronopathic gaucher disease registry (GARDIAN): a patient-led initiative

BackgroundGaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder. GD types 2 and 3 are known as neuronopathic Gaucher disease (nGD) because they have brain involvement that progresses over time. Implementing a systematic approach to the collection of real-world clinical and patient-relevant outcomes data in nGD presents an opportunity to fill critical knowledge gaps and ultimately help healthcare providers in the management of this patient population. This paper summarizes the development of a patient-initiated Gaucher Registry for Development Innovation and Analysis of Neuronopathic Disease (GARDIAN).MethodsThe International Gaucher Alliance led the GARDIAN planning, including governance, scope, stakeholder involvement, platform, and reporting. Registry element input was determined in a series of meetings with clinical experts, patients, and caregivers, who identified key clinical variables and the draft content of nGD patient-reported outcomes (PRO) and observer-reported outcomes (ObsRO) focusing on symptoms, patient physical and emotional functioning. These were then tested in cognitive interviews with patients with nGD (> 12 years of age) and caregivers.ResultsCore registry data elements (n = 138) were identified by seven global clinical experts from Egypt, Germany, Israel, Japan, United Kingdom (UK), and United State (US) and reviewed via online Delphi method by 14 additional clinicians with experience of nGD from six countries and three pharmaceutical representatives. The elements were consistent with those identified via interviews with 10 patients/caregivers with nGD from Japan, Sweden, UK, and US. Key domains identified were demographics, diagnostic information, health status, clinical symptomatology, laboratory testing, treatment, healthcare resource utilization, aids/home improvements, and patient/caregiver burden and quality of life, specifically physical functioning, self-care, daily and social activities, emotional impacts, support services, and caregiver-specific impacts. Nine caregivers and six patients from the US, UK, China, Mexico, Egypt, and Japan participated in the cognitive interviews that informed revisions to ensure that all items are understandable and interpreted as intended.ConclusionsThe comprehensive set of clinical and patient relevant outcomes data, developed collaboratively among all stakeholders, to be reported using GARDIAN will bridge the many gaps in the understanding of nGD and align with regulatory frameworks on real-world data needs.

Investigate the factors affecting safety culture in the Malaysian mining industry

Nowadays, safety culture is critical in preventing near-misses, accidents, and disasters. It has three dimensions: psychological, situational, and behavioural. To the best of the author's knowledge, lack of research has been done on psychological and behaviour safety culture in the Malaysian mining industry. The objective of the study is to investigate the factors affecting psychological and behaviour safety culture in the Malaysian mining industry. A two-round online Delphi method was performed among mining experts. The Delphi Experts (n = 21) with extensive experience in mining operations volunteered in this study. The Delphi I (open ended interview) and Delphi II (questionnaire survey) were completed by 100% (n = 21/21) and 87.5% (n = 18/21) of the experts, respectively. Thematic analysis was used to analyse the Delphi I and generate five and nine themes for psychological, situational and behaviour factors. For psychological safety culture, the Delphi II resulted median, IQD and percentage distribution analysis with 83.3%, 83.3% with the IQD cut-off (IQD ≤1) and 64.81% respectively.For situational, safety culture, the consensus was achieved with median, IQD and total percentage distribution analysis with 94.4%, 61.1% and 73.15%, respectively For behavioural safety culture, the consensus was achieved with median, IQD and total percentage distribution analysis with 94.4%, 66.7% and 73.6%, respectively. To conclude, the Delphi analysis revealed that experts agreed and consensuses were achieved on five, ten and nine factors that have major impacts on psychological, situational and behavioural safety culture in the Malaysian mining industry.

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study.

Nonhuman primates (NHPs) are suitable for being model animals in the study of consciousness and loss of consciousness (LoC) with a similar brain structure and function to humans. However, there is no effective consciousness assessment scale for them. This study aimed to develop a behavioral assessment scale of consciousness for NHPs. We constructed an initial indicator framework based on the clinical consciousness disorder assessment scales and the physiological characteristics, consciousness, and arousal behavior of NHPs. A two-round online Delphi method was conducted by a multidisciplinary expert panel to construct a behavioral assessment scale of consciousness for NHPs. The indicators and descriptions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. The accepted competencies of indicators were established with mean scores in two scoring criteria (importance and feasibility) ≥4.0, agreement rate with a rating of importance or essential ≥70.0%, and a coefficient of variation ≤0.25, as well as discussions of the research group. Consensus was achieved after the second round of consultations, which was completed by 28 experts who specialized in rehabilitation, neuroscience, psychology, neurosurgery, and neurology. A new behavioral assessment scale of consciousness for NHPs, including 37 items organized hierarchically within seven dimensions including visual function, auditory function, motor function, orofacial movements, arousal, brainstem reflexes, and respiration, was developed in this study. This study has successfully developed a behavioral assessment scale for measuring the conscious state of NHPs or NHP models with LoC. This tool is expected to facilitate future research into the underlying mechanisms of consciousness by providing a detailed and comprehensive means of measurement.

Feasibility of Parkour-style training in team sport practice: A Delphi study

ABSTRACT Research has suggested Parkour-style training could act as a donor sport for athlete development in team sports. This study aimed to interrogate expert consensus on the feasibility of integrating Parkour-style training into team sport practice, by employing a three-round, online Delphi method. Talent development and strength and conditioning coaches working in team sport settings were invited to participate. Twenty-four coaches completed Round One, 21 completed Round Two and 20 completed Round Three. In Round One, coaches answered 15 open-ended questions across four categories: (1) General Perceptions of Parkour-style training; (2) Potential Applications of Parkour-style training; (3) Designing and Implementing Parkour-style training Environments; and (4), Creating an Inclusive Learning Environment. Responses from Round One were analysed using reflexive thematic analysis with deductive and inductive coding resulting in 78 statements across three dimensions (Application of Parkour Style Training in Team Sports; Designing and Implementing Parkour-style training Environments; Overcoming Potential Barriers when Integrating Parkour-style training). In Rounds Two and Three, coaches rated these statements using a four-point Likert scale and measures of collective agreement or disagreement were calculated. This study established consensus around a set of design principles for integrating Parkour-style training into team sport practice routines.

Expert consultation using the on-line Delphi method for the revision of syndromic groups compiled from emergency data (SOS Médecins and OSCOUR®) in France

BackgroundConsultation data from emergency general practitioners known as SOS Médecins and emergency departments (ED) from OSCOUR® network to the French syndromic surveillance system SurSaUD® (Surveillance sanitaire des urgences et décès). These data are aggregated and monitored on a daily basis through groupings of one or more medical symptoms or diagnoses (“syndromic groups” (SG)).The objective of this study was to evaluate, revise and enrich the composition of SGs through a consensus of experts who contributed or have experience in syndromic surveillance.MethodsThree rounds of a Delphi survey were organised, involving 15 volunteers from SOS Médecins and 64 ED physicians in the OSCOUR® network as well as 8 international epidemiologists. Thirty-four SOS Médecins and 40 OSCOUR® SGs covering major medical specialities were put to the experts, along with their diagnostic codes and their surveillance objectives. In each round, the experts could retain or reject the codes according to the surveillance objective. The panel could also put forward new diagnostic codes in the 1st round, included in subsequent rounds. Consensus was reached for a code if 80% of participants had chosen to keep it, or less than 20% to reject it.ResultsA total of 12 SOS Médecins doctors (80%), 30 ED doctors (47%) and 4 international experts (50%) participated in the three rounds. All of the SGs presented to the panel included 102 initial diagnostic codes and 73 additional codes for SOS Médecins, 272 initial diagnostic codes and 204 additional codes for OSCOUR®. At the end of the 3 rounds, 14 SOS Médecins (40%) and 11 OSCOUR® (28%) SGs achieved a consensus to maintain all of their diagnostic codes. Among these, indicators of winter seasonal surveillance (bronchiolitis and gastroenteritis) were included.ConclusionThis study involved a panel of national experts with international representation and a good level of involvement throughout the survey. In the absence of a standard definition, the Delphi method has been shown to be useful in defining and validating syndromic surveillance indicators.

Priority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method

BackgroundTake-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders.MethodsWe used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline.ResultsNine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses.ConclusionsThe Delphi method is an equitable consensus building process that generated priorities to guide guideline development.

Use of mucoactive agents in cystic fibrosis: A consensus survey of Italian specialists.

BackgroundThe goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients.MethodA consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF.ResultsFull or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice.ConclusionsThe consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient.

Core procedural skills competencies and the maintenance of procedural skills for medical students: a Delphi study

BackgroundIt is well recognised that medical students need to acquire certain procedural skills during their medical training, however, agreement on the level and acquisition of competency to be achieved in these skills is under debate. Further, the maintenance of competency of procedural skills across medical curricula is often not considered. The purpose of this study was to identify core procedural skills competencies for Australian medical students and to establish the importance of the maintenance of such skills.MethodsA three-round, online Delphi method was used to identify consensus on competencies of procedural skills for graduating medical students in Australia. In Round 1, an initial structured questionnaire was developed using content identified from the literature. Respondents were thirty-six experts representing medical education and multidisciplinary clinicians involved with medical students undertaking procedural skills, invited to rate their agreement on the inclusion of teaching 74 procedural skills and 11 suggested additional procedures. In Round 2, experts re-appraised the importance of 85 skills and rated the importance of maintenance of competency (i.e., Not at all important to Extremely important). In Round 3, experts rated the level of maintenance of competence (i.e., Observer, Novice, Competent, Proficient) in 46 procedures achieving consensus.ResultsConsensus, defined as > 80% agreement, was established with 46 procedural skills across ten categories: cardiovascular, diagnostic/measurement, gastrointestinal, injections/intravenous, ophthalmic/ENT, respiratory, surgical, trauma, women’s health and urogenital procedures. The procedural skills that established consensus with the highest level of agreement included cardiopulmonary resuscitation, airway management, asepsis and surgical scrub, gown and gloving. The importance for medical students to demonstrate maintenance of competency in all procedural skills was assessed on the 6-point Likert scale with a mean of 5.03.ConclusionsThe findings from the Delphi study provide critical information about procedural skills for the Clinical Practice domain of Australian medical curricula. The inclusion of experts from medical faculty and clinicians enabled opportunities to capture a range of experience independent of medical speciality. These findings demonstrate the importance of maintenance of competency of procedural skills and provides the groundwork for further investigations into monitoring medical students’ skills prior to graduation.

Tales from two cities: COVID-19 and the localisation of tourism in London and Paris

Purpose Drawing on empirical research conducted in London and Paris between July 2020 and June 2021, this paper explores whether these two global metropolises may be able to take the COVID-19 crisis as an opportunity to develop more sustainable forms of urban tourism. More specifically, this study aims to analyse whether new forms of localised tourism have developed as a result of the pandemic, how these have been nurtured and encouraged by the tourism industry in these two cities and the implications of these trends for the sustainable development of tourism in these two cities. Design/methodology/approach A combination of research methods was used: an online Delphi method, followed by in-depth one-to-one interviews with selected stakeholders and complemented by the analysis of media articles, policy documents and secondary data. Findings The qualitative data analysis highlights some key findings: tourism sustainability gained new importance after the pandemic; however, the crisis did not bring the sustainable revolution some stakeholders wished or expected. Nonetheless, in both cities, tourism marketing adopted a new “hyper-local” approach with the objective of encouraging proximity tourism and involving local residents more; thus, pointing to the need to review traditional definitions of the (urban) tourist. Originality/value Although the blurring between tourism and every day in cities has been widely discussed in tourism theory, this paper provides empirical evidence from two world tourism cities, showing some of the wider, practical implications of these theoretical debates for industry and policymaking in the context of the COVID-19 pandemic.

COVID-19 Lockdown: Challenges Faced by Indian Students.

Fear of spread of the COVID-19, disciplinary lockdown, and delay in getting back to the normal routine of education centers is affecting the academic performance of the students, as they are facing difficulties to cope up with the new mode of learning. The purpose of this study was to look out for the challenges faced in learning during the lockdown and if they were raising the mental stress in students. A self-structured questionnaire including 10 questions formed through Google forms and validated using online Delphi method was forwarded to the students from different colleges and universities of Haryana and Punjab regions of North India. Out of a total of 844 student participants, 631 (74.8%) students were facing difficulty in studies. Whereas 744 (88.2%) students felt that they may encounter the loss of studies during the lockdown. The study found that most of the students are facing difficulties in the study during the lockdown which is increasing the mental stress.

Consensus of physician behaviours to target for early diagnosis of cerebral palsy: A Delphi study.

Historically, the diagnosis of cerebral palsy has been made after 12 months of age, delaying access to crucial early intervention that optimises functional outcomes. This study aimed to identify and specify priority physician diagnostic behaviours to target in implementation interventions to increase the rate of diagnosis of cerebral palsy under 6 months of age in Australia. We conducted a two-round online Delphi study with a multi-professional expert panel of cerebral palsy researchers and clinicians. A reference group identified a six-item list of potential diagnostic behaviours, which were modifiable at the individual level, that could lead to an early cerebral palsy diagnosis. In the first survey, participants rated the importance of each item on a 10-point Likert scale and supplied their reasoning for this, and were able to suggest new behaviours. In the second survey, participants ranked items in order of priority. All six items reached consensus for inclusion (100%). No new items were added to the list. Ranking identified the top three priorities for online physician implementation interventions: (i) refer for or conduct the General Movements Assessment; (ii) refer for or conduct the Hammersmith Infant Neurological Examination; and (iii) communication of the diagnosis. An online Delphi method can effectively inform tailored implementation intervention development. A consensus was achieved on the priority physician diagnostic behaviours to target in interventions to lower the age of cerebral palsy diagnosis in Australia.

Development of a communication and health literacy curriculum: Optimizing the informal cancer caregiver role.

The aim of this study was to develop learning objectives and identify content for a core communication and health literacy curriculum designed to optimize the role of informal cancer caregivers (family or friends). A three-step process was conducted: (a) two-round online Delphi method process with experts (n = 9) in cancer caregiving to gain consensus on curriculum learning objectives; (b) online survey of oncology providers (n = 32) to generate potential content and rate importance of domains; and (c) focus group of cancer caregivers (n = 6) to explore caregiving experiences and curriculum content topics. Overall, 17 learning objectives and 53 topics were identified for a cancer caregiver communication and health literacy curriculum. Feedback from cancer caregivers did not produce any new topics yet confirmed topics generated by experts and providers. The curriculum identified as essential has been organized under the following headings: finding cancer information; assessing and integrating information; working with health care providers; getting help; talking with the care recipient; recognizing the care recipient's needs; and planning for caregiver self-care. This theoretically grounded study systematically identified seven curriculum topic areas and content unique to caregivers and included input from key stakeholders. The next step is to develop the program for dissemination and to test its impact on caregiver and patient outcomes.

Developing interventions to address sexuality after stroke: Findings from a four-panel modified Delphi study.

Although stroke has a profound impact on sexuality there are limited evidence-based interventions to support rehabilitation professionals in this area. The aim of the current research was to prioritize content areas and approaches to sexual rehabilitation from the perspective of stroke survivors, their partners, stroke rehabilitation clinicians and researchers. A 2-step online Delphi method was used to prioritize the content of, and approaches to, sexual rehabilitation with stroke survivors, their partners, stroke rehabilitation clinicians and researchers. Stroke survivors (n = 30), their partners (n = 18), clinicians and researchers in stroke rehabilitation (n = 45) completed at least 1 of 2 investigator-developed surveys. Participants prioritized 18 core content areas for inclusion in sexual rehabilitation following stroke with a high degree of consensus. Another 27 content areas were considered moderately important. There was strong consensus that sexual rehabilitation should be offered in the subacute and chronic phases of stroke recovery. Participants would prefer health professionals to deliver the intervention face-to-face. This study presents opinions from stroke survivors, partners of stroke survivors, clinicians and researchers. The information about content, timing and mode of delivery will be used to develop and evaluate a comprehensive sexuality rehabilitation programme.

Adaptation of interaction in web environments with educational content

This study, which aims to determine the design principles of interaction adaptation in adaptive online learning environments, was based on a mixed and comparative type of relational screening model. Modified online Delphi method was employed in order to develop the principles and determine the relative importance. Ninety experts participated in the study. Arithmetic mean, first quartile deviation, standard deviation and intraclass coefficient of correlation were utilised to determine the levels of agreement of the experts on the principles. Two hundred and seventy studies which included parameters utilised during the design of interaction were analysed by using content analysis and the robustness of the findings was categorically evaluated, and it was found that experts had almost full agreement on all the 10 principles. Furthermore, the agreement on principles between the observers (intraclass correlation coefficient = 0.903) was found perfect. The obtained principles that indicate the common inclinations both in the literature and of the domain experts should be employed.