Search results for: Delphi%20method

Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

Abstract:

Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Taghrid Asfar, Olusanya J. Oluwole, Michael Schmidt, Alejandra Casas, Zoran Bursac, Wasim Maziak.

Abstract:

Waterpipe (WP) smoking (a.k.a. hookah) has increased dramatically in the US mainly due to the misperception that it is safer than cigarette smoking. Mounting evidence show that WP smoking is addictive and harmful. Health warning labels (HWLs) are effective in communicating smoking-related risks. Currently, the FDA requires that WP tobacco packages have a textual HWL about nicotine. While this represents a good step, it is inadequate given the established harm of WP smoking beyond addiction and the superior performance of pictorial HWLs over text-only ones. We developed 24 WP pictorial HWLs in a Delphi study among international expert panel. HWLs were grouped into 6 themes: addiction, harm compared to cigarettes, harm to others, health effects, quitting, and specific harms. This study aims to compare the effect of the pictorial HWLs compared to the FDA HWL, and 2) the effect of pictorial HWLs between the 6 themes. A 2x7 between/within subject online factorial experimental study was conducted among a national convenience sample of 300 (50% current WP smokers; 50% nonsmokers) US adults (females 71.1%; mean age of 31.1±3.41 years) in March 2022. The first factor varied WP smoking status (smokers, nonsmokers). The second factor varied the HWL theme and type (text, pictorial). Participants were randomized to view and rate 7 HWLs: 1 FDA text HWL (control) and 6 HWLs, one from each of the 6 themes, all presented in random order. HWLs were rated based on the message impact framework into five categories: attention, reaction (believability, relevance, fear), perceived effectiveness, intentions to quit WP among current smokers, and intention to not initiate WP among nonsmokers. measures were assessed on a 5-point Likert scale (1=not at all to 5=very much) for attention and reaction and on a 7-point Likert scale (1=not at all to 7=very much) for the perceived effectiveness and intentions to quit or not initiate WP smoking. Means and SDs of outcome measures for each HWL type and theme were calculated. Planned comparisons using Friedman test followed by pairwise Wilcoxon signed-rank test for multiple comparisons were used to examine distributional differences of outcomes between the HWL type and themes. Approximately 74.4 % of participants were non-Hispanic Whites, 68.4% had college degrees, and 41.5% were under the poverty level. Participants reported starting WTS on average at 20.3±8.19 years. Compared with the FDA text HWL, pictorial HWLs elicited higher attention (p<0.0001), fear (p<0.0001), harm perception (p<0.0003), perceived effectiveness (p<0.0001), and intentions to quit (p=0.0014) and not initiate WP smoking (p<0.0003). HWLs in theme 3 (harm to others) achieved the highest rating in attention (4.14±1), believability (4.15±0.95), overall perceived effectiveness (7.60±2.35), harm perception (7.53±2.43), and intentions to quit (7.35±2.57). HWLs in theme 2 (WP harm compared to cigarettes) achieved the highest rating in discouraging WP smoking initiation (7.32±2.54). Pictorial HWLs were superior to the FDA text-only for several communication outcomes. Pictorial HWLs related to WP harm to others and WP harm compared to cigarette are promising. These findings provide strong evidence for the potential implementation of WP-specific pictorial HWLs.

Keywords: health communication, waterpipe smoking, factorial experiment, reaction, harm perception, tobacco regulations

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Authors: V. Howard, R. Maguire, S. Corrigan

Abstract:

Background: Type 1 Diabetes (T1D) is a chronic autoimmune disease, typically diagnosed in childhood. T1D puts an enormous strain on families; controlling blood-glucose in children is difficult and the consequences of poor control for patient health are significant. Successful illness management and better health outcomes can be dependent on quality of caregiving. On diagnosis, parent-caregivers face a steep learning curve as T1D care requires a significant level of knowledge to inform complex decision making throughout the day. The majority of illness management is carried out in the home setting, independent of clinical health providers. Parent-caregivers vary in their level of knowledge and their level of engagement in applying this knowledge in the practice of illness management. Enabling researchers to quantify these aspects of the caregiver experience is key to identifying targets for psychosocial support interventions, which are desirable for reducing stress and anxiety in this highly burdened cohort, and supporting better health outcomes in children. Currently, there are limited tools available that are designed to capture this information. Where tools do exist, they are not comprehensive and do not adequately capture the lived experience. Objectives: Development of quantitative tools, informed by lived experience, to enable researchers gather data on parent-caregiver knowledge and engagement, which accurately represents the experience/cohort and enables exploration of questions that are of real-world value to the cohort themselves. Methods: This research employed an engaged approach to address the problem of quantifying two key aspects of caregiver diabetes management: Knowledge and engagement. The research process was multi-staged and iterative. Stage 1: Working from a constructivist standpoint, literature was reviewed to identify relevant questionnaires, scales and single-item measures of T1D caregiver knowledge and engagement, and harvest candidate questionnaire items. Stage 2: Aggregated findings from the review were circulated among a PPI (patient and public involvement) expert panel of caregivers (n=6), for discussion and feedback. Stage 3: In collaboration with the expert panel, data were interpreted through the lens of lived experience to create a long-list of candidate items for novel questionnaires. Items were categorized as either ‘knowledge’ or ‘engagement’. Stage 4: A Delphi-method process (iterative surveys) was used to prioritize question items and generate novel questions that further captured the lived experience. Stage 5: Both questionnaires were piloted to refine wording of text to increase accessibility and limit socially desirable responding. Stage 6: Tools were piloted using an online survey that was deployed using an online peer-support group for caregivers for Juveniles with T1D. Ongoing Research: 123 parent-caregivers completed the survey. Data analysis is ongoing to establish face and content validity qualitatively and through exploratory factor analysis. Reliability will be established using an alternative-form method and Cronbach’s alpha will assess internal consistency. Work will be completed by early 2024. Conclusion: These tools will enable researchers to gain deeper insights into caregiving practices among parents of juveniles with T1D. Development was driven by lived experience, illustrating the value of engaged research at all levels of the research process.

Keywords: caregiving, engaged research, juvenile type 1 diabetes, quantified engagement and knowledge

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