Three-round Delphi Study Research Articles

What motivates employees to participate in continuous improvement activities?

Continuous improvement (CI) is still one of the strongest ways for companies to achieve process excellence in order to survive in nowadays’ competitive environments. Yet, it is still very difficult to implement and sustain CI systems, mainly because of the difficulty in engaging people in these activities. Based on an exhaustive literature review, followed by a three-round Delphi study with Spanish experts, this paper helps to assess what the main elements are with respect to the CI system that could motivate employees’ intention to participate in CI activities. Main results show 44 elements grouped into 10 factors that could affect employees’ intention to participate. These factors were structured into a more comprehensive model following an interpretive structural modelling approach.

What are we aiming for?—A Delphi study on the development of civic scientific literacy in Sweden

ABSTRACTBased on the EU FP 7 project, PROFILES, this article presents our findings from a three-round Delphi study conducted in Sweden that aimed at establishing a consensus on how science education should be developed for citizens to enhance civic scientific literacy. A total of 100 stakeholders (9th graders, school teachers, scientists, and science education researchers) were involved in our Delphi study in 2012–2013. The results revealed that there were some highly ranked consensus ideas: environmental issues, inquiry skills, motivation/interest, and holistic comprehension. The conclusions of our research imply the importance of involving different stakeholders in the educational reconstruction process; we suggest that schoolteachers in particular should play a vital role.

A competence development framework for learning and teaching system dynamics

Current teaching and learning of system dynamics are based on materials derived from the expertise of masters. However, there is little explicit reference to neither the stages which beginners go through to become proficient nor what is learned at each of these stages. We argue that this hinders cumulative research and development in teaching and learning strategies. We engaged 15 acknowledged masters in the field to take part in a three-round Delphi study to develop an operational representation of the competence development stages and what is learned at each stage. The resulting system dynamics competence framework consists of a qualified, expert-evaluated, empirically based set of seven skills and 265 learning outcomes. The skills provide a common orientation, in the language of current educational research, to facilitate research, course design and certification efforts to ensure quality standards. To conclude, this paper provides avenues for future work. Copyright © 2016 The Authors System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society

Expert and patient consensus on a dynamic model for shared decision-making in frail older patients

ObjectiveShared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities. MethodsWe used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1–3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model. ResultsConsensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). ConclusionsSDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker. Practice implicationsThe developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients.

The Honorable Merchant in International Marketing: An Ancient Concept Newly Needed

In the spring of 2014, the American Marketing Association's Special Interest Group hosted a conference in Cancun, Mexico, on “The Honorable Merchant in International Marketing.” Conference participants from around the globe discussed in detail what it means to be honorable and how behavior affects business and academia today. A three-round Delphi study was conducted throughout the conference, providing the participants’ perspectives on the topic of honorable practices in academia and business and its relation to international marketing. Inferences are drawn about the usefulness of honorable behavior in developing trust relations and conducting international business relations more easily. © 2015 Wiley Periodicals, Inc.

Core Outcomes in Ventilation Trials (COVenT): protocol for a core outcome set using a Delphi survey with a nested randomised trial and observational cohort study.

BackgroundAmong clinical trials of interventions that aim to modify time spent on mechanical ventilation for critically ill patients there is considerable inconsistency in chosen outcomes and how they are measured. The Core Outcomes in Ventilation Trials (COVenT) study aims to develop a set of core outcomes for use in future ventilation trials in mechanically ventilated adults and children.Methods/designWe will use a mixed methods approach that incorporates a randomised trial nested within a Delphi study and a consensus meeting. Additionally, we will conduct an observational cohort study to evaluate uptake of the core outcome set in published studies at 5 and 10 years following core outcome set publication. The three-round online Delphi study will use a list of outcomes that have been reported previously in a review of ventilation trials. The Delphi panel will include a range of stakeholder groups including patient support groups. The panel will be randomised to one of three feedback methods to assess the impact of the feedback mechanism on subsequent ranking of outcomes. A final consensus meeting will be held with stakeholder representatives to review outcomes.DiscussionThe COVenT study aims to develop a core outcome set for ventilation trials in critical care, explore the best Delphi feedback mechanism for achieving consensus and determine if participation increases use of the core outcome set in the long term.

Research Priorities in Correctional Nursing Practice: Results of a Three-Round Delphi Study.

Correctional nursing has been recognized as a specialty since 1985, but research to describe and support nursing practice in the criminal justice system has been sparse. The development of a research agenda can stimulate the research necessary to provide an evidence base for specialty practice development. A three-round Delphi study was undertaken to elicit a prioritized list of research topics to guide future research efforts for meaningful results. Six predominant themes emerged from an analysis of top research questions generated by a panel of 18 correctional nursing experts. Research priorities include critical thinking and clinical judgment, competency and educational level, assessment, nursing protocols, effect on patient outcomes, and the environment of care.

The Honorable Merchant and Customer Trust: Key Dimensions for International Business Success

What does it mean to be honorable in an international business context, and why is it important? The history of business honorability is discussed in addition to its applicability to today's expectations. A solution of trust bridges is suggested to find commonalities between two parties in order to strengthen their network and relationship with one another. These postulates were investigated during the American Marketing Association's Special Interest Group conference on “The Honorable Merchant in International Marketing” hosted in Cancun, Mexico, in the spring of 2014. At the conference, a three-round Delphi study was conducted to analyze the various global perspectives participants had on honorable practices in academia and business and their relation to international marketing. © 2015 Wiley Periodicals, Inc.

Attribution of mental illness to work: a Delphi study.

Clinicians may be asked whether mental ill-health has been caused by work but there is no guidance on how this judgement should be made. To seek a consensus on the factors that should be considered and how they should be sought when attributing mental ill-health to work. A three-round Delphi study involving expert academics, occupational physicians, psychiatrists and psychologists. We deemed consensus had been reached when 66% or more of the experts were in agreement. Of 54 invited experts, 35 (65%) took part in the first round, 30 of these 35 (86%) in the second and 29 of these 30 (97%) in the final round. Consensus was reached for 11 workplace stressors: high job strain; effort-reward imbalance; major trauma; interpersonal conflict; inadequate support; role ambiguity; person-job mismatch; organizational injustice; organizational culture; work scheduling and threats to job security. Seven personal factors were identified as being important: previous mental illness; personality traits of neuroticism; adverse life events or social circumstances; resilience; a family history of mental illness and secondary gain. The worker, manager and co-workers were thought to be the most useful sources of workplace information. Consensus was reached for a definition of occupational mental illness but not for a threshold of work-relatedness. The attribution of mental ill-health to work is complex and involves the consideration of both workplace stressors and personal factors of vulnerability. Clinical consultation with an occupational physician who is familiar with the workplace is central to the process.

Web-based interventions to decrease alcohol use in adolescents: a Delphi study about increasing effectiveness and reducing drop-out.

BackgroundWeb-based computer-tailored (CT) interventions have a high potential to reach a large number of people and effectively change health risk behaviors and their determinants. However, effect studies show small and variable effect sizes, and these interventions also suffer from high drop-out. In this study we explored how Web-based CT interventions can be used effectively to reduce binge drinking in 16- to 18-year-old adolescents.MethodA three-round Delphi study was conducted. We invited experts to identify strategies to be used in Web-based CT interventions that can effectively decrease binge drinking in adolescents and to rate these strategies by importance. We asked to discriminate between interventions targeted for adolescents and those targeted for parents. Furthermore, we asked experts to suggest strategies for reducing drop-out and to indicate their importance.ResultsImportant strategies mentioned by the experts were: encouraging parents to set appropriate rules, encouraging consistent communication, and training refusal skills among adolescents. Concerning the reduction of drop-out from Web-based CT interventions experts came up with suggestions involving the content of the intervention (e.g., relevant material, use of language, tailored messages) but also involving the use of reminders and incentives.ConclusionsThe results of this explorative study provide useful strategies to increase effectiveness and decrease drop-out in future interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1639-z) contains supplementary material, which is available to authorized users.

Effectiveness of economic incentives on clients' participation in health and safety programmes

The use of economic incentives to improve health and safety (H&S) performance in the construction industry in general has been investigated by various scholars. However, few studies have looked at the impact of economic incentives on construction clients, especially in the developing world. This paper reports findings on the feasibility of incentives to influence construction clients to perform on H&S. The investigation was conducted using a Delphi technique to determine the impact significance of economic incentives or disincentives on construction clients' H&S performance. A panel of experts in construction H&S was assembled from most regions of the world. A three-round iterative Delphi study aimed at establishing consensus from the expert panel was then conducted. The study found that economic factors have critical impact significance on clients' H&S performance, and that clients were 'very likely' to implement various H&S elements as a result of the economic incentives and or disincentives. There is little research on the use of incentives to influence construction clients' H&S performance and the effectiveness of such incentives. This gap in literature, and the need for improvement in construction H&S performance, motivated the current study. Therefore it was necessary to investigate specifically the extent to which economic incentives could be used to influence construction clients to become involved in H&S programmes. Economic incentives are considered to be a proactive way of improving H&S performance among other key parties, such as employees in the construction industry. The paper reports on the findings from an analysis of the impact significance of economic incentives on clients. It underscores the point that economic incentives or disincentives for construction clients are necessary to encourage them to actively participate in H&S programmes, hence resulting in performance improvement.

Environmental and occupational health research and training needs in Colombia: A Delphi study.

Environmental factors contribute with 16% of the burden of disease in Colombia. A main obstacle in implementing national and regional environmental and occupational health policies is the limited knowledge on the local ability to study and control the impact of harmful exposures on health. To identify needs for research and training in environmental and occupational health in Colombia. We conducted a three-round hybrid Delphi study. A group of environmental and occupational health Colombian experts (n=16) from government agencies, universities, and research centers was recruited to participate in the study. Expert´s opinions on research and training needs were gathered through online questionnaires, followed by an in-person meeting. The percentage of agreement and the coefficient of variation were used to measure consensus. Air pollution and chemical products were considered the most important environmental and occupational exposures, due to their significant impact on chronic non-communicable diseases, such as respiratory diseases, cardiovascular diseases, and cancer. Research on the effects of outdoor air pollution on cardiovascular and respiratory diseases was considered of the greatest importance. Priority training areas included environmental and occupational health risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology. These findings provide a valuable input for the definition and implementation of national environmental and occupational health policies and for the development of a regional hub aimed at strengthening the capacity for research and training in Colombia.

Necesidades de investigación y formación en salud ambiental y ocupacional en Colombia: Un estudio Delphi

Introduction: Environmental factors contribute with 16% of the burden of disease in Colombia. A main obstacle in implementing national and regional environmental and occupational health policies is the limited knowledge on the local ability to study and control the impact of harmful exposures on health. Objective: To identify needs for research and training in environmental and occupational health in Colombia. Materials and methods: We conducted a three-round hybrid Delphi study. A group of environmental and occupational health Colombian experts (n=16) from government agencies, universities, and research centers was recruited to participate in the study. Expert’s opinions on research and training needs were gathered through online questionnaires, followed by an in-person meeting. The percentage of agreement and the coefficient of variation were used to measure consensus. Results: Air pollution and chemical products were considered the most important environmental and occupational exposures, due to their significant impact on chronic non-communicable diseases, such as respiratory diseases, cardiovascular diseases, and cancer. Research on the effects of outdoor air pollution on cardiovascular and respiratory diseases was considered of the greatest importance. Priority training areas included environmental and occupational health risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology. Conclusions: These findings provide a valuable input for the definition and implementation of national environmental and occupational health policies and for the development of a regional hub aimed at strengthening the capacity for research and training in Colombia

Core outcome sets for use in effectiveness trials involving people with bipolar and schizophrenia in a community-based setting (PARTNERS2): study protocol for the development of two core outcome sets.

BackgroundIn the general population the prevalence of bipolar and schizophrenia is 0.24% and 1.4% respectively. People with schizophrenia and bipolar disorder have a significantly reduced life expectancy, increased rates of unemployment and a fear of stigma leading to reduced self-confidence. A core outcome set is a standardised collection of items that should be reported in all controlled trials within a research area. There are currently no core outcome sets available for use in effectiveness trials involving bipolar or schizophrenia service users managed in a community setting.MethodsA three-step approach is to be used to concurrently develop two core outcome sets, one for bipolar and one for schizophrenia. First, a comprehensive list of outcomes will be compiled through qualitative research and systematic searching of trial databases. Focus groups and one-to-one interviews will be completed with service users, carers and healthcare professionals. Second, a Delphi study will be used to reduce the lists to a core set. The three-round Delphi study will ask service users to score the outcome list for relevance. In round two stakeholders will only see the results of their group, while in round three stakeholders will see the results of all stakeholder group by stakeholder group. Third, a consensus meeting with stakeholders will be used to confirm outcomes to be included in the core set. Following the development of the core set a systematic literature review of existing measures will allow recommendations for how the core outcomes should be measured and a stated preference survey will explore the strength of people’s preferences and estimate weights for the outcomes that comprise the core set.DiscussionA core outcome set represents the minimum measurement requirement for a research area. We aim to develop core outcome sets for use in research involving service users with schizophrenia or bipolar managed in a community setting. This will inform the wider PARTNERS2 study aims and objectives of developing an innovative primary care-based model of collaborative care for people with a diagnosis of bipolar or schizophrenia.

Consensus views on advance care planning for dementia: a Delphi study.

The uptake of advance care planning (ACP) is particularly low among people with dementia. This may reflect barriers to communication between professionals, patients and families in the face of lack of consensus about the process. This study aimed to methodically investigate consensus views of how ACP should be explained and carried out with people with dementia. A three-round Delphi study explored views of how and when ACP should be addressed, what should be covered, who should be involved and why rates of ACP are low. Seventeen participants took part comprising family members, old age psychiatrists and policy makers. Thirty-two items reached consensus. The panel agreed on 11 different areas for discussion. They concurred that ACP was best addressed after the person has come to terms with the diagnosis when the individual feels ready to do so. There was a consensus view that the process should be couched in terms of 'certain possibilities'. Consensus items emphasised personal choice and autonomy, while also prioritising the need to discuss financial aspects and to include spouses. There was no consensus that professionals should be involved, although the panel viewed them as carrying some responsibility for low uptake. It is suggested that ACP should include general discussion of values as well as coverage of specific points. Professionals need to offer discussion and information on ACP, but also make clear that the patient has the right to choose whether to pursue ACP or not.

Uganda nursing research agenda: a Delphi study.

Use a Delphi Methodology to identify nursing research priorities in Uganda. Identifying nursing research priorities, empowering researchers, and encouraging relevant studies can advance attaining global health goals. The Uganda Nurses and Midwives Union identified the need to establish a nursing research agenda. Nurse leaders have a priority of increasing the influence of nurses in practice and policy. This study was conducted as a preliminary step in a long-term strategy to build nurses' capacity in nursing research. A three-round Delphi study was conducted. The 45 study participants were nurses in practice, nurse faculty and members of the Uganda Nurses and Midwives Union. In the initial round, the participants wrote their responses during face-to-face meetings and the follow-up rounds were completed via email. Maternal and child morbidity and HIV/AIDS were identified as research priorities. Nurses also identified nursing practice, education and policy as key areas that nursing research could impact. Demographic characteristics such as length of time in nursing were not collected. Additionally, first round participants completed a pencil-paper survey and the follow-up rounds were done by email. Nurse Leaders in Uganda identified areas where research efforts could have the most impact and were most relevant to nursing practice. Health policy decisions have historically been made without nursing input. Nursing research can provide evidence to inform policy and, ultimately, improve population health. The focus of nursing research in priority areas can be used to guide nursing contribution in policy discussions.

Essential Competencies in Nursing Education for Prevention and Care Related to Unintended Pregnancy

To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. Modified Delphi study. National. Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. Expert panelists completed a three-round Delphi study using an electronic survey. Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education.

Delphi-based consensus study into a framework of community resilience to disaster

Disasters cannot be prevented but their impacts can be mitigated through adapted disaster management strategies. Several studies confirm that community resilience is a significant factor in disaster management. Saudi Arabia is (a) increasingly exposed to disasters, as reflected in recent events, and (b) lacks a credible disaster management strategy. This paper aims to develop a framework of community resilience to disaster in Saudi Arabia. A three-round Delphi study is conducted using a local and an international panel of experts with in-depth knowledge in the wide field of disaster management. General dimensions and criteria for consideration are derived from the academic literature. The latter are used by the expert panel as a starting point to achieve consensus on a framework of community resilience to disasters, focused on six resilience dimensions: social; economic; physical and environmental; governance; health and well-being; and information and communication. A total of 62 criteria are identified. Fifty-seven of these criteria achieved consensus in Round 2. An additional five criteria reached consensus in the third round. The resulting community resilience framework involves seven to fourteen criteria in each of the six identified dimensions.

On speaking terms: a Delphi study on shared decision-making in maternity care.

BackgroundFor most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women.MethodsAn international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement).ResultsConsensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role.ConclusionsSDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.

A qualitative and quantitative exploration of determinants and intervention methods for increasing condom use among internal migrants in China: results of a three-round Delphi study

Internal migrants have been repeatedly characterized as “the tipping point” for HIV epidemic in China. This study is a step towards the development of a successful behavioral HIV prevention intervention among Chinese internal migrants. It aims to explore important and changeable determinants of condom use, and inspect effective and feasible methods to increase condom use for the target population.