The Delphi Technique in Nursing and Health Research

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