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The Delphi Technique in Nursing and Health Research
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Table of Contents

Preface ix Acknowledgements x 1 The Delphi Technique 1 Introduction 1 History of the technique 2 What is the Delphi technique? 3 Defining the Delphi technique 3 The Delphi process 4 Original Delphi 4 Idea generation 5 Priority setting versus consensus 5 Non-consensus Delphi 5 Types of Deplhi 6 How has the Delphi evolved? 6 Sampling and the use of experts 7 Defining 'expert' 7 Employing an expert panel 8 Size of the expert panel 8 Valid opinion 9 Anonymity 9 Quasi-anonymity 9 Group dynamics 10 Delphi rounds 10 Round 1 11 Subsequent rounds 11 Response rates 12 Enhancing response rate 12 Consensus 13 Does consensus exist in expert panels? 14 Concept of consensus 14 Increasing popularity in nursing and health research 14 Comparison of the Delphi with other consensus methods 15 Nominal group technique 15 Consensus conference 16 Key learning points 16 Recommended further reading 17 2 Debates, Criticisms and Limitations of the Delphi 18 Introduction 18 The qualitative-quantitative debate - which paradigm does the Delphi belong to? 18 Criticisms of the Delphi technique 20 Lack of universal guidelines 20 Size of expert panel 21 Implications of lack of anonymity 22 Expert 'opinion' 23 Level of consensus 27 Limitations of the Delphi 28 Pressures of conformity 28 Demanding nature of the technique 29 Key learning points 30 Recommended further reading 31 3 Applications of the Delphi in Nursing and Health Research 32 Introduction 32 Historical application of the Delphi technique in nursing 32 Identification of clinical nursing research priorities 36 Trends of the Delphi in nursing 40 Key learning points 41 Recommended further reading 42 4 How to Get Started with the Delphi Technique 43 Introduction 43 Preparation and practicalities 43 Suitability of the Delphi 43 Availability of resources 44 Level of consensus 45 Identifying target sample - panel of experts 46 Who is the target population? 46 How do you select your experts? 47 Sampling criteria 47 What size does the sample have to be? 48 Response rate and attrition 53 Deciding on nature and delivery of the first round 55 Gaining names and addresses 56 Deciding on a 'return by' date 56 Administration 57 Invitation to participate 57 Explicit cover letter outlining the working of the Delphi 59 Design of questionnaire 59 Administration systems 63 Mailing 64 Maximising response rate 64 Content analysis 65 Process 66 Key learning points 67 Recommended further reading 67 5 Conducting the Research Using the Delphi Technique 69 Introduction 69 First round 69 Classical Delphi 69 Modified Delphi 70 Return of first round 71 Consideration of sample size and number of items generated 71 Bootstrapping 72 Content analysis 72 Subsequent rounds 73 Round 2 74 Cover letter explaining Round 2 74 Instructions for Round 2 75 Designing Round 2 questionnaires 76 Likert scales 77 Round 2 analysis 77 Sample motivation 78 Follow-ups/reminders 78 Round 3 78 Individual and group feedback 78 Round 3 analysis 81 Number of rounds 81 When to stop 82 When not to stop 82 Reaching consensus 82 Key learning points 83 Recommended further reading 83 6 Analysing Data from a Delphi and Reporting Results 84 Introduction 84 Analysis of Round 1 85 Content analysis - the practical aspects 85 Demographics for sample profiling 86 Analysis of middle rounds (Round 2) 86 Consensus level 86 Statistical analysis 86 Statistical feedback to panel 87 Exclusion of items with consensus 88 Analysis of end round (Round 3) 89 Determining the end of the process 89 Statistical analysis 89 Items that have gained consensus 90 Items that have not gained consensus 90 Stability of responses 91 Examples of statistical analysis used in recent Delphi studies 92 Reporting of results from a Delphi study 92 Key learning points 95 Recommended further reading 95 7 Reliability and Validity 96 Introduction 96 Reliability 96 Criteria to assess rigour 99 Response rates as a measure of rigour 99 Is the definitive answer reached? 99 Validity 100 Content validity 100 Criterion-related validity 100 Threats to validity 101 Key learning points 104 Recommended further reading 104 8 Ethical Considerations 105 Introduction 105 Ethical principles 105 Respect for human dignity 106 Justice 106 Principle of beneficence 108 Principle of non-maleficence 108 The role of the researcher 108 Ethics documentation 109 Key learning points 113 Recommended further reading 113 9 A Classical Delphi Design Case Study 114 Introduction 114 Background 114 Methods 115 Initial considerations 116 Enhancing response rates 117 Identifying and accessing the sample 117 Round 1 118 Round 2 119 Discussion 122 Lessons learned 123 Conclusion 123 Acknowledgements 123 Further information 124 Publications 124 10 A Modified Delphi Case Study 125 Introduction 125 Aims of the study 126 Methodology 126 Expert panel 126 Round 1 - focus groups 127 Delphi Round 2 - postal round 127 Round 3 - postal round 128 Consensus conference 129 Results 129 Commissioning of health and social care 129 Leadership 131 Generic and specialist roles 131 Clinical governance 132 Teamwork 133 Public involvement 133 Education 134 Practical training versus academia 135 Attitudes to nurse training and education 135 Multidisciplinary education in nurse training 135 Communication 135 Conclusion 136 Recommendations 137 Commissioning of health and social care 137 Leadership 137 Generic and specialist roles 138 Clinical governance 138 Teamwork 139 Public involvement 139 Education 140 Communication 140 Reflections on the modified Delphi 140 Acknowledgements 141 Further information 141 Publications 141 11 e-Delphi Case Study 142 Introduction 142 Sample 142 Setting a consensus level 143 Theoretical framework 143 Data collection and analysis 144 Design of instrument 144 Pilot study 144 Round 1 144 Round 2 145 Round 3 145 Ethical considerations 145 Results 146 Round 1 146 Round 2 146 Round 3 147 Discussion 147 Conclusion 148 Reflections on the e-Delphi 149 Acknowledgements 150 Further information 150 Publications 150 Annotated Bibliography 151 References 164 Index 193

About the Author

Dr Sinead Keeney is a Senior Lecturer in the Institute ofNursing Research at the University of Ulster. Felicity Hasson is Senior Lecturer in the Institute ofNursing Research at the University of Ulster. Professor Hugh McKenna is Dean of the Faculty of Life andHealth Sciences at the University of Ulster.

Reviews

"This book is easy to understand and is excellent for learning theDelphi technique. It is a must for anyone wanting to use thistechnique." (Doody's, 9 September 2011)

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