Three-round Delphi Study Research Articles

Development of an index to assess adherence to the traditional Mexican diet using a modified Delphi method.

Promoting a traditional Mexican diet (TMexD) could potentially reduce high rates of non-communicable diseases (NCD) and support food sustainability in Mexico. This study aimed to develop an index to assess adherence to the TMexD. A three-round Delphi study was conducted to examine the food groups, specific foods and food-related habits that would constitute a TMexD index. Participants selected the TMexD items using Likert scales, lists of responses, and yes/no questions. Consensus was determined using percentages of agreement, mean values and/or coefficients of variation. Online Delphi study. Seventeen nutrition and food experts in Mexico completed all three rounds. The resulting index (ranging from 0 to 21 points) consisted of 15 food groups, containing 102 individual foods. Food groups included in higher quantities were maize, other grains, legumes, vegetables, fruits, herbs, nuts and seeds, and tubers. Animal foods, vegetable fats and oils, homemade beverages, maize-based dishes, and plain water were also included, but in lower quantities. The food-related habits included were consuming homemade meals, socialising at meals and buying food in local markets. Consensus was reached for all index items apart from quantities of consumption of six food groups (herbs, nuts, grains, tubers, dairy and eggs). Although future research could improve the measures for which consensus was not reached, the TMexD index proposed in this study potentially displays a healthy and sustainable dietary pattern and could be used to examine links between the TMexD and health outcomes in Mexican populations.

Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts

BackgroundIn 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups. MethodsA three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round. ResultsOnly healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition. ConclusionGP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.

Interprofessional Education on Complementary and Integrative Medicine.

Interprofessional education and complementary and integrative medicine (CIM) strive for patient-centred medical care. Combining both concepts in education seems promising to prepare students for future health care. This article explores the question of what should be considered in undergraduate interprofessional training on complementary and integrative medicine for students of medicine and other health care professions and what benefits can be expected. A three-round Delphi study was conducted with experts from varied professional backgrounds who have experience in teaching and patient care to address CIM training in the above-mentioned setting. Presented here are the results of the third round, in which 40 experts were asked open questions about what benefits/opportunities and what barriers/challenges they expect when such training programmes are offered. The statements were inductively evaluated by content analysis, to develop categories and subcategories. The response rate was 90% (n=36). The categories (and most frequently mentioned subcategories) were as follows: Regarding benefits: patient care (strengthening holistic and patient-centred care); teaching and learning (learning together); faculty development (opening up new perspectives); and regarding barriers: teaching and learning (uncritical teaching); faculty development (lack of acceptance); implementation (difficult scheduling). Experts expect interprofessional teaching on CIM to have positive effects not only on holistic and team-oriented patient care but also on faculty development. It might be challenging to teach the topics in a critical manner and on a scientific basis to ensure high-quality teaching. The results of this study can be used to promote an appropriate implementation of such training programmes.

Barriers and Facilitators to Early Rehabilitation in the ICU: A Theory Driven Delphi Study.

There is conflicting evidence for the effectiveness of early rehabilitation in the intensive care and marked variation in rates of implementation in practice. We aimed to identify barriers and facilitators to early rehabilitation in mechanically ventilated patients and their relevance to practice, as perceived by key ICU clinicians across North America. A Delphi study using the Theoretical Domains Framework, consisting of an initial qualitative round and subsequent quantitative rounds, was conducted to gather clinician agreement and perceived importance of barriers and facilitators to early rehabilitation. The survey included questions on the range of individual, sociocultural, and broader organizational influence on behaviors. Clinical practice in North America. Four clinician groups (intensive care physicians, nurses, therapists, and respiratory therapists). A three-round Delphi study. Fifty of 74 (67%) of invited clinicians completed the study. Agreement and consensus with Delphi survey items were high in both rounds within and between professional groups. Agreement was highest for items related to the domain "Beliefs about Consequences" (e.g., mortality reduction) and lowest for items related to the domain "Behavioral Regulation" (e.g., team discussion of barriers). Beliefs expressed about improved mortality and improvements in a variety of other long-term outcomes were not consistent with the current evidence base. Individual agreement scores changed very little from Round 2 to Round 3 of the Delphi, suggesting stability of beliefs and existing consensus. This study identified a wide range of beliefs about early rehabilitation that may influence provider behavior and the success and appropriateness of further implementation. The apparent inconsistency between the optimism of stakeholders regarding mortality reductions and a low level of implementation reported elsewhere represent the most major challenge to future implementation success. Other foci for future implementation work include planning, barriers, feedback, and education of staff.

Nursing Care for Patients With Acute Mania: Exploring Experiential Knowledge and Developing a Standard of Good Care-Results of the Delphi Study.

When patients diagnosed with bipolar disorder are suffering from acute mania (involuntary), hospitalization is often necessary. Patients are often quite disruptive, which makes it difficult to regulate their behavior and manage them in their current condition. The nursing team must also ensure the safety of the other patients on the ward. Nursing practice in this domain appears to draw primarily on tradition and experience. To achieve consensus on a standard for nursing practice for patients suffering from mania who are admitted to a closed psychiatric ward. Previously, professionals, patients, and informal caregivers in the Netherlands were interviewed about the nursing care and their lived experiences. Based on these findings and on the results of a literature review, 89 statements were formulated. A three-round Delphi study among professionals, patients, and informal caregivers was carried out. The accepted statements were summarized. In the first round, 71 statements were accepted, none were rejected, and for 18 statements, no consensus could be reached. These were reformulated and presented in a second round. Thirteen of these statements were accepted, none were rejected, and five statements needed to be reformulated and were presented in the third and final round of this Delphi study. In this final round, all statements were accepted. Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.

Requirements for systemic sclerosis expert centres in the Netherlands: A Delphi consensus study.

Introduction:Systemic sclerosis is a rare and complex disease. Optimal management of patients requires knowledge and experience and, importantly, intensive collaboration between hospitals and multidisciplinary teams. Definition and recognition of expert centres in systemic sclerosis is currently lacking, which complicates collaboration between centres and leaves patients poorly informed. The aim of this study was to develop a set of requirements for two types of systemic sclerosis centres in order to establish a nationwide structure for an optimal and transparent organization of care.Methods:A three-round Delphi study was conducted among a panel of rheumatologists working at university or regional hospitals across the Netherlands. Prior to the final consensus round, a session with a patient panel (N = 22) was held. The results of this meeting were described in the last round for rheumatologists. Criteria were divided into five categories: (1) medical care, (2) case load, (3) collaboration, (4) research, (5) training of staff, and (6) other. In the first round, criteria derived from literature were proposed and participants could add criteria that were missing. For every item, participants could indicate if they thought the item should be included for two types of systemic sclerosis centres: (1) systemic sclerosis expert centre or (2) systemic sclerosis treatment centres. Consensus was reached when more than 85% of the panel agreed.Results:In total, 47 rheumatologists participated in Delphi round 1, 35 in round 2 and 43 in round 3. Additional suggestions were added by the patient panel (n = 22). Consensus was reached for the requirements of systemic sclerosis expert centres (45 items) and systemic sclerosis treatment centres (29 items) including minimal caseloads of annual suspected systemic sclerosis cases and total patients in care.Conclusion:Requirements of centres for systemic sclerosis care in the Netherlands were established in this study. Feasibility of certification should be evaluated next. Our proposed list can serve as a model for other countries.

CHALLENGES FACING ISLAMIC BANKING IN IRAN: EVALUATION AND POLICY IMPLICATIONS

Iran is one of the few countries that has instituted shariah-compliant banking nationwide and does not have a conventional banking sector. However, since the Riba-Free Banking Act (RFBA) was passed and put into practice in 1983, the Iranian Islamic banking system has experienced some significant challenges and shortcomings. The main purpose of this paper is to identify the various impediments facing the Iranian Islamic banking industry and to suggest a prioritized listing of these challenges. To achieve this goal, a three-round Delphi study (a method designed to aid consensus building) is used to determine the major challenges and rank them based on relative importance. The research panel consulted consists of 32 Iranian Islamic banking experts with in-depth knowledge and experience. The results show that the top five challenges to the Islamic banking system in Iran are (1) the governmental attitude towards Islamic banking; (2) lack of competition; (3) not revising the law (RFBA); (4) lack of shariah supervision; and (5) lack of accounting and auditing standards. This paper contributes to the literature addressing Islamic banking by critically analysing the more than three decades of Iranian experience in implementing shariah-compliant banking.

Content validity evidence for a simulation-based test of handheld otoscopy skills.

At graduation from medical school, competency in otoscopy is often insufficient. Simulation-based training can be used to improve technical skills, but the suitability of the training model and assessment must be supported by validity evidence. The purpose of this study was to collect content validity evidence for a simulation-based test of handheld otoscopy skills. First, a three-round Delphi study was conducted with a panel of nine clinical teachers in otorhinolaryngology (ORL) to determine the content requirements in our educational context. Next, the authenticity of relevant cases in a commercially available technology-enhanced simulator (Earsi, VR Magic, Germany) was evaluated by specialists in ORL. Finally, an integrated course was developed for the simulator based on these results. The Delphi study resulted in nine essential diagnoses of normal variations and pathologies that all junior doctors should be able to diagnose with a handheld otoscope. Twelve out of 15 tested simulator cases were correctly recognized by at least one ORL specialist. Fifteen cases from the simulator case library matched the essential diagnoses determined by the Delphi study and were integrated into the course. Content validity evidence for a simulation-based test of handheld otoscopy skills was collected. This informed a simulation-based course that can be used for undergraduate training. The course needs to be further investigated in relation to other aspects of validity and for future self-directed training.

WITHDRAWN: Hidden agenda in sport sponsorship – The influence of managers’ personal objectives on sport sponsorship decisions

ABSTRACT Despite companies spending billions of dollars on sport sponsorship every year, little is known about how sponsoring companies make sponsorship decisions. Sponsors are expected to enter into sponsorship agreements strategically, so as to achieve corporate objectives. However, managers who make sponsorship decisions could also be motivated by their own personal interests. As soon as managers’ personal objectives manifest themselves to influence their sponsorship decision-making, we speak of a hidden agenda. In our empirical study, we investigated corporate objectives and managers’ personal objectives, and their respective influence on sport sponsorship decisions. We conducted a three-round qualitative Delphi study with 18 participants employed at sponsor organisations, sport clubs, and sport marketing agencies. The results of our study contribute to our understanding of corporate objectives in the sport sponsorship literature. We reveal 12 different personal objectives of managers underlying sponsorship decision-making. In addition, we develop the steps and stages of the sponsorship decision-making process from a sponsor perspective. We reveal the existence of a hidden agenda in sponsorship decisions. Due to divergences in objectives, a hidden agenda leads to agency effects between the shareholders/owners of the sponsoring company (principal) and the managers (agent). The emerging agency effects can have either negative or positive effects for the sponsor. We derive a model showing the decision-making in sport sponsorship, considering managers’ hidden agendas. Managerial implications are discussed.

Using vignette methodology to study comfort with consensual and nonconsensual depictions of pornography content

ABSTRACT Spanking, whipping, and choking are examples of aggressive behaviours that can be performed in consensual sexual encounters. However, within the pornography research literature, such behaviours are often perceived as being nonconsensual, categorised as ‘violent’, and argued to predict sexual aggression. Viewing nonconsensual pornography may be associated with negative attitudes towards consent; however, viewing consensual pornography that features typically violent behaviour may not. In this study, we sought to more clearly distinguish between consensual and nonconsensual pornography depictions by using vignettes to examine individuals’ consent attitudes in relation to these pornographic vignettes. We also sought to assess the hypothesis that more frequent pornography engagement will be associated with greater comfort with the nonconsensual vignettes. A series of pornography vignettes were developed by the researchers and categorised by a group of sexual consent experts as ‘consensual’ or ‘nonconsensual’ vignettes during a three-round Delphi study. The finalised vignettes were administered to a convenience sample of Irish university students (n = 1121). More frequent pornography engagement was associated with greater comfort with the consensual and nonconsensual vignettes. Greater comfort with the nonconsensual pornography vignettes was negatively associated with attitudes towards establishing consent and the endorsement of sexual consent norms.

Extending existing recommended military casualty evacuation timelines will likely increase morbidity and mortality: a UK consensus statement

IntroductionFuture conflicts may have limited use of aviation-based prehospital emergency care for evacuation. This will increase the likelihood of extended evacuation timelines and an extended hold at a forward hospital...

Critical Success Factors for Neutralization of Airborne Threats

Decisions regarding neutralizing airborne threats in the combat environment require comprehensive knowledge of resources at hand and enemy intentions. The complexity of the situation has resulted in the emergence of various models encompassing important factors of threat neutralization. Various characteristics of airborne threats considered important for their assessment have already been identified in previous literature, which include speed, distance, approach angle, maneuverability, and so on. Due to the possible extent of loss to critical assets, literature has emphasized on identifying as many useful characteristics of threats as possible. This study is also a step in this direction to improve the weapon assignment for threat neutralization. Weapon assignment based on a well-calculated threat index is a key to success in military conflicts. The purpose of this article is to identify new factors through the involvement of experts. In this study, a set of factors has been identified through a survey of relevant literature and semi-structured interviews followed by its refinement through a three-round Delphi study. The results suggest that airborne threats are considered different from other threats due to their lethality and consequences. The top-level decision-makers require a comprehensive understanding of the criticality of the situation and the effects of poor decisions. Besides other factors, weapon stock, supply chain information, and analysis of vulnerable assets/points in threat neutralization are critical to accomplish higher efficiency. The shortlisted factors yield a foundation of a comprehensive framework for decision making in a highly dynamic environment of air defense.

Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on what to measure

IntroductionWhile laser technology has expanded the armamentarium of treatment for various skin diseases during the past years, heterogeneity in study outcomes hampers comparability and appropriate evidence synthesis. Part of these...

Conceptual framework for assisted dying for individuals with dementia: Views of experts not opposed in principle.

Dementia is one of the prominent conditions for which an aging population has been seeking end-of-life solutions such as assisted dying. Individuals with dementia, however, are often unable to meet the eligibility criteria of being mentally competent and are thus discriminated against in relation to assisted dying laws. Provided that the assisted death directive is being made in sound mind, it is still of concern whether these advance directives can be appropriately framed and safeguarded to protect the wish of these vulnerable individuals while preventing harm. Therefore, to establish consensus views of experts on primary issues of, and concerns about, assisted dying for individuals with dementia as well as exploring tentative conceptual framework to safeguard practice and application, a three-round Delphi study was conducted. A core group of 12 experts from five countries was recruited comprising expertise in domains relevant to assisted dying and dementia. A semantic-thematic approach was applied to analyze the 119 generated statements. Evaluation of these research statements resulted in full consensus of 84 (70%) items. Our primary findings highlight seven core domains: applicability of assisted dying for dementia; ethical, practical, and pathological issues regarding the application of assisted dying; and ethical, legal, and professional recommendations for the ways forward. Despite the issues surrounding the provision of assisted death for individuals with dementia, our findings lead us to cautiously conclude that devising "adequate" safeguards is achievable. The result of this research may benefit future research and practice.

International consensus: ovarian tissue cryopreservation in young Turner syndrome patients: outcomes of an ethical Delphi study including 55 experts from 16 different countries.

STUDY QUESTIONWhat is the standpoint of an international expert panel on ovarian tissue cryopreservation (OTC) in young females with Turner syndrome (TS)?SUMMARY ANSWERThe expert panel states that OTC should be offered to young females with TS, but under strict conditions only.WHAT IS KNOWN ALREADYOTC is already an option for preserving the fertility of young females at risk of iatrogenic primary ovarian insufficiency (POI). Offering OTC to females with a genetic cause of POI could be the next step. One of the most common genetic disorders related to POI is TS. Due to an early depletion of the ovarian reserve, most females with TS are confronted with infertility before reaching adulthood. However, before offering OTC as an experimental fertility preservation option to young females with TS, medical and ethical concerns need to be addressed.STUDY DESIGN, SIZE, DURATIONA three-round ethical Delphi study was conducted to systematically discuss whether the expected benefits exceed the expected negative consequences of OTC in young females with TS. The aim was to reach group consensus and form an international standpoint based on selected key statements. The study took place between February and December 2018.PARTICIPANTS/MATERIALS, SETTING, METHODSAnonymous panel selection was based on expertise in TS, fertility preservation or medical ethics. A mixed panel of 12 gynaecologists, 13 (paediatric) endocrinologists, 10 medical ethicists and 20 patient representatives from 16 different countries gave consent to participate in this international Delphi study. In the first two rounds, experts were asked to rate and rank 38 statements regarding OTC in females with TS. Participants were offered the possibility to adjust their opinions after repetitive feedback. The selection of key statements was based on strict inclusion criteria.MAIN RESULTS AND THE ROLE OF CHANCEA total of 46 participants completed the first Delphi round (response rate 84%). Based on strict selection criteria, six key statements were selected, and 13 statements were discarded. The remaining 19 statements and two additional statements submitted by the expert panel were re-evaluated in the second round by 41 participants (response rate 75%). The analysis of the second survey resulted in the inclusion of two additional key statements. After the approval of these eight key statements, the majority of the expert panel (96%) believed that OTC should be offered to young females with TS, but in a safe and controlled research setting first, with proper counselling and informed consent procedures, before offering this procedure in routine care. The remaining participants (4%) did not object but did not respond despite several reminders.LIMITATIONS, REASONS FOR CAUTIONThe anonymous nature of this study may have led to lack of accountability. The selection of experts was based on their willingness to participate. The fact that not all panellists took part in all rounds may have resulted in selection bias.WIDER IMPLICATIONS OF THE FINDINGSThis international standpoint is the first step in the global acceptance of OTC in females with TS. Future collaborative research with a focus on efficacy and safety and long-term follow-up is urgently needed. Furthermore, we recommend an international register for fertility preservation procedures in females with TS.STUDY FUNDING/COMPETING INTEREST(S)Unconditional funding (A16-1395) was received from Merck B.V., The Netherlands. The authors declare that they have no conflict of interest.

Functioning in schizophrenia: a Delphi study covering the perspective of physiotherapists

Purpose This qualitative study explores the barriers, personal characteristics/resources, and environmental factors that experienced physiotherapists identify as relevant in the assessment and treatment of persons living with schizophrenia, and whether the identified aspects are represented in the International Classification of Functioning, Disability and Health Core Sets for schizophrenia. Methods A three-round Delphi study with physiotherapists was conducted between April and July 2018. In the first round, participants had to list all the aspects they considered to be relevant when assessing and/or treating individuals with schizophrenia, and they were asked six open-ended questions. Their responses were linked to categories. In the second and third rounds, physiotherapists had to judge whether each category/personal factor was relevant for describing functioning in schizophrenia. Results Thirteen of 22 eligible physiotherapists from eight countries responded to the first round, and 10 completed all three rounds. Eighty-two (84.5%) of the 97 categories in the Comprehensive Core Set for schizophrenia and all 25 categories in the Brief Core Set were considered relevant. A total of five categories were additionally identified. Conclusions The barriers, personal characteristics/resources, and environmental factors from the physiotherapists’ perspective have been identified. The results largely confirm the content validity of the Core Sets for schizophrenia. Implications for rehabilitation This study shows which barriers, personal characteristics/resources, and environmental factors in persons with schizophrenia are relevant from physiotherapists’ perspective and should be integrated in the rehabilitation process. The content validity of the Comprehensive and Brief Core Sets for schizophrenia is largely supported from the physiotherapists’ perspective and therefore could be used in the assessment of functioning in persons with schizophrenia. The Comprehensive and Brief ICF Core Sets for schizophrenia could be used to plan and assess multidisciplinary rehabilitation interventions.

Delphi study among international expert panel to develop waterpipe-specific health warning labels

BackgroundWaterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate...

Defining the content of a minimal dataset for acquired brain injury using a Delphi procedure

BackgroundThe lack of consistency in outcome measurement within the field of acquired brain injury (ABI) leads to incomparability of collected data and, consequently, reduced generalisation of findings. We aim to develop a set of standardised measures which can be used to obtain the minimum amount of data necessary to characterise ABI-patients across all healthcare sectors and disciplines and in every stage of recovery; i.e., an ABI-specific minimal dataset (MDS-ABI). The current study was conducted to identify the core outcome domains for adults with ABI (what to measure?) and to select the most suitable measurements within these domains (how to measure it?).MethodsAn initial comprehensive set of outcome domains and measurement instruments relevant for measuring the consequences of ABI was identified by a literature study. The selection of relevant domains was based on the International Classification of Functioning, Disability and Health framework. Measurement instruments were included in the Delphi procedure when they met pre-set requirements. A three-round Delphi study was conducted among Dutch experts (n = 48) using iterative web-based surveys to prioritise the proposed domains and instruments for the MDS-ABI. Throughout all rounds, participants could recommend additional or alternative domains and measurement instruments, and were fed back the collated group responses of the previous round.ResultsResponse rates ranged from 89 to 100%. After three rounds, the expert panel reached consensus (≥51%) on the inclusion of 12 outcome domains (demographics, injury characteristics, comorbidity, cognitive functioning, emotional functioning, energy, mobility, self-care, communication, participation, social support and quality of life), measured with six measurement instruments, two screening questions and a registry of demographic- and injury information. No consensus was reached on how to measure quality of life.ConclusionsThe current study achieved consensus on the content of a minimal dataset for patients with ABI. The current version of the MDS-ABI will be evaluated and optimised if necessary in the near future.

CORE-Kids: a protocol for the development of a core outcome set for childhood fractures

IntroductionLimb fractures in children are common yet there are few trials that compare treatments for these injuries. There is significant heterogeneity in the outcomes reported in the paediatric orthopaedic literature,...

A Proposal for Holistic Assessment of Computational Thinking for Undergraduate: Content Validity

<p style="text-align:justify">Studies have acknowledged computational thinking (CT) as an efficient approach for problem-solving particularly required in digital workplaces. This research aims to identify indicators for a holistic CT assessment instrument for undergraduate students. A three-round fuzzy Delphi study has been conducted to gain comprehensive opinions and consensus from undergraduate lecturers of computer science disciplines and experts from the information technology industry. In round 1, the experts judged a set of predefined indicators describing CT skills and attitudes identified from the literature, while rounds 2 and 3 focused on variables selection. The consensus was achieved on holistic CT, and the indicators are teamwork, communication, spiritual intelligence, generalization, problem-solving, algorithmic thinking, evaluation, abstraction, decomposition, and debugging. Results demonstrate the importance of attitudes in the process of solving a problem and suggest higher education institutions to consider holistic CT in preparing qualified future graduates. Many CT studies focused only on the skills of CT. This study outlines the assessment indicators that consider both CT skills and attitudes, particularly at the undergraduate level.</p>