A Delphi survey to determine how educational interventions for evidence-based practice should be reported:Stage 2 of the development of a reporting guideline

BACKGROUND: Undertaking a Delphi exercise is recommended during the second stage in the development process for a reporting guideline. To continue the development for the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) a Delphi survey was undertaken to determine the consensus opinion of researchers, journal editors and educators in evidence-based practice (EBP) regarding the information items that should be reported when describing an educational intervention for EBP. METHODS: A four round online Delphi survey was conducted from October 2012 to March 2013. The Delphi panel comprised international researchers, educators and journal editors in EBP. Commencing with an open-ended question, participants were invited to volunteer information considered important when reporting educational interventions for EBP. Over three subsequent rounds participants were invited to rate the importance of each of the Delphi items using an 11 point Likert rating scale (low 0 to 4, moderate 5 to 6, high 7 to 8 and very high >8). Consensus agreement was set a priori as at least 80 per cent participant agreement. Consensus agreement was initially calculated within the four categories of importance (low to very high), prior to these four categories being merged into two (<7 and ≥7). Descriptive statistics for each item were computed including the mean Likert scores, standard deviation (SD), range and median participant scores. Mean absolute deviation from the median (MAD-M) was also calculated as a measure of participant disagreement. RESULTS: Thirty-six experts agreed to participate and 27 (79%) participants completed all four rounds. A total of 76 information items were generated across the four survey rounds. Thirty-nine items (51%) were specific to describing the intervention (as opposed to other elements of study design) and consensus agreement was achieved for two of these items (5%). When the four rating categories were merged into two (<7 and ≥7), 18 intervention items achieved consensus agreement. CONCLUSION: This Delphi survey has identified 39 items for describing an educational intervention for EBP. These Delphi intervention items will provide the groundwork for the subsequent consensus discussion to determine the final inclusion of items in the GREET, the first reporting guideline for educational interventions in EBP

Dimensionality Of Causal Attributions In Nonacademic Situations: The Effects Of Antecedent Information And Response Format

The dimensionality underlying causal attributions to nonacademic behaviors (an accomplishment, an emotion, and an opinion) was investigated in four studies varying antecedent information (presence or absence) and response format (rating scale or open ended). In the information present conditions, subjects given consensus, distinctiveness, consistency, and incentive information rated the importance of ten causes provided (Study 1) or generated their own causal attributions (Study 3). As Kelley\u27s (1967, 1973) model predicts, in both studies, high consensus information led to increased external attributions and low consensus to increased internal attributions; high consistency information led to increased stable attributions and low consistency to increased unstable attributions. When globality was considered, high distinctiveness information led to increased specific attributions and low distinctiveness to increased general attributions. Incentive information did not have the expected influence in Study 1 but the responses in Study 3 indicated that incentive information itself was often given as a reason for the behavior. In both studies, the information provided was used selectively and four basic causal schemata were typical of all three target behaviors: stimulus attributions (given high consensus information), personal attributions (given high consistency and low distinctiveness information), circumstantial attributions (given low consistency information), and interactional attributions (given high consistency and high distinctiveness information). Subjects\u27 causal schemata about each target behavior in the absence of specific information cues were investigated in Studies 2 and 4. For accomplishments, the dominant causal attributions were general and internal (person); for emotions, unstable and situation-specific (circumstantial); and for opinions, interactional and qualitatively more reason-like. Principal components analyses of the rating scale data (Studies 1 and 2) yielded Locus, Stability, Intentionality/Controllability (Weiner, 1974, 1979), and Globality (Abramson, Seligman, & Teasdale, 1978) factors (in various combinations) underlying the causal attributions for the three behaviors. The factor structures were more clearcut when information cues were provided as in Study 1

Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study

Background: Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective: The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods: A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results: A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions: Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals

What Research Questions Should the Next Generation of Birth Cohort Studies Address? An International Delphi Study of Experts.

OBJECTIVE: Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts. METHODS: Twenty-four (Round I, N = 17; Round II, N = 21; Round III, N = 18) experts across a wide range of fields (eg, psychology, public health, and maternal/child health) agreed to participate. In Round I, the expert panel was invited to freely respond to the question, "what are the key scientific questions future birth cohort studies should address?" Content analysis of answers was used to identify 47 questions for rating on perceived importance by the panel in Round II and consensus-achieving questions were identified. Questions that did not reach consensus in Round II were posed again for expert re-rating in Round III. RESULTS: Twenty six of 47 questions reached consensus in Round II, with an additional 6 reaching consensus in Round III. Consensus-achieving questions rated highly on importance spanned a number of topics, including environmental effects on child development, intergenerational transmission of disadvantage, and designing BCS to inform intervention strategies. CONCLUSION: Investigating the effects of family/environmental factors and social disadvantage on a child's development should be prioritized in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies

Indicators to assess the functionality of clubfoot clinics in low-resource settings: a Delphi consensus approach and pilot study.

Background: This study aims to determine the indicators for assessing the functionality of clubfoot clinics in a low-resource setting. Methods: The Delphi method was employed with experienced clubfoot practitioners in Africa to rate the importance of indicators of a good clubfoot clinic. The consistency among the participants was determined with the intraclass correlation coefficient. Indicators that achieved strong agreement (mean≥9 [SD <1.5]) were included in the final consensus definition. Based on the final consensus definition, a set of questions was developed to form the Functionality Assessment Clubfoot Clinic Tool (FACT). The FACT was used between February and July 2017 to assess the functionality of clinics in the Zimbabwe clubfoot programme. Results: A set of 10 indicators that includes components of five of the six building blocks of a health system-leadership, human resources, essential medical equipment, health information systems and service delivery-was produced. The most common needs identified in Zimbabwe clubfoot clinics were a standard treatment protocol, a process for surgical referrals and a process to monitor dropout of patients. Conclusions: Practitioners had good consistency in rating indicators. The consensus definition includes components of the World Health Organization building blocks of health systems. Useful information was obtained on how to improve the services in the Zimbabwe clubfoot programme

Indicators to assess the functionality of clubfoot clinics in low-resource settings: a Delphi consensus approach and pilot study.

Background: This study aims to determine the indicators for assessing the functionality of clubfoot clinics in a low-resource setting. Methods: The Delphi method was employed with experienced clubfoot practitioners in Africa to rate the importance of indicators of a good clubfoot clinic. The consistency among the participants was determined with the intraclass correlation coefficient. Indicators that achieved strong agreement (mean≥9 [SD <1.5]) were included in the final consensus definition. Based on the final consensus definition, a set of questions was developed to form the Functionality Assessment Clubfoot Clinic Tool (FACT). The FACT was used between February and July 2017 to assess the functionality of clinics in the Zimbabwe clubfoot programme. Results: A set of 10 indicators that includes components of five of the six building blocks of a health system-leadership, human resources, essential medical equipment, health information systems and service delivery-was produced. The most common needs identified in Zimbabwe clubfoot clinics were a standard treatment protocol, a process for surgical referrals and a process to monitor dropout of patients. Conclusions: Practitioners had good consistency in rating indicators. The consensus definition includes components of the World Health Organization building blocks of health systems. Useful information was obtained on how to improve the services in the Zimbabwe clubfoot programme

A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing

Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall's Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: "Being able to prescribe to patients is more effective and really useful working [in my area]". Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal

Does a short symptom checklist accurately diagnose ADHD?

Several abbreviated checklists perform well in distinguishing children with attention deficit/ hyperactivity disorder (ADHD) from those without ADHD under ideal conditions and in research settings. While many guidelines and experts recommend using these checklists as an efficient method to collect data from multiple sources (strength of recommendation: B, based on extrapolation from cohort studies to define test characteristics and consensus opinion), experts point out the subjective nature of responses on behavior rating scales, and the limitations in using checklists as the sole source of information

Consensus for methods and outcomes in trials of oral morphine versus transmucosal diamorphine for breakthrough pain in children in the UK: the DIPPER study

Objectives: No randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine. / Methods: The nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming. / Results: The panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools. / Conclusions: The nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial

Evaluating an instrument to measure mental load and mental effort using Item Response Theory

Measurement of cognitive load (CL) is seen as a problematic issue since no consensus about appropriate instruments has been reached. In this study, a rating scale instrument to measure mental load (ML; 6 items) and mental effort (ME; 6 items) is evaluated using Item Response Theory. N=506 students self-reported their amount of ML and ME after working on a standardised multiple choice-test. The findings propose to separately measure ML and ME instead of CL in general. Furthermore, the 7-point rating scale had to be reduced post-hoc to a 3-point scale in order to reach consistent information. Finally, there was a significant (negative) correlation between ML and test performance, but not between ME and test performance.Peer Reviewe