Symposium 22 Consulting the oracle: Use of the delphi technique in nursing
Symposium lead:
Sinead Keeney, Senior Lecturer, Nursing, University of Ulster, Newtownabbey, Northern Ireland, United Kingdom sr.keeney@ulster.ac.uk
Symposium chair:
Professor Hugh McKenna, Dean of Faculty of Life and Health Sciences, University of Ulster, Jordanstowm, Northern Ireland, United Kingdom
Symposia focus:
This symposium will begin with an introduction to the Delphi technique and its use in nursing research (Paper 1). The main features of the Delphi technique will be explored and the different modifications of the approach will be outlined. The second paper will build on this introduction by illustrating the features of the Delphi with real-life examples taken from three researchers’ work over a ten year period. An insight will be provided into the main difficulties that researchers may encounter when using the Delphi. This paper will also offer useful advice and solutions to deal with many of these difficulties. Paper 3 will use an example of the Delphi in practice to show how it can be applied to a specific topic and to share some of its limitations in researching district nursing. The final paper will examine one innovative approach to Delphi work when trying to achieve consensus among experts. This paper will use read data to actively engage delegates through the use of radio controlled voting sets so that they can experience being in the role as Delphi experts.
Source of Funding: N/A
Level of Funding: N/A
Abstract 1:
Aims:
This paper aims to outline the main concepts and principles to the Delphi Technique and present examples of how it has been used in nursing research.
Background:
The Delphi technique is an adaptive research tool which is growing in popularity in the nursing. The technique will be outlined and illustrated with examples from previous research.
Methods:
The methodology will be defined and issues such as identification of experts and the number of rounds, will be discussed.
Discussion:
A review of the nursing literature identified a selection of studies that illustrate a variety of methodological interpretations in the use of this technique. Findings indicate that whilst the Delphi shares a number of common features, such as a structured process for seeking opinion from experts. However, its widespread use by numerous researchers over a prolonged period has resulted in it being modified to the point where there is now have a family of `Delphi-inspired techniques'. This raises questions about methodological rigour which will be addressed in the presentation.
Conclusion:
Whilst few guidelines exist to advise researchers on the correct application of this method the Delphi technique has been accepted as an established research method. Like all research approaches it has its weaknesses and I will discuss how best these can be ameliorated.
Abstract 2:
Aim:
The aim of this presentation is to provide insight into the Delphi technique by outlining the personal experiences of three researchers during use of the Delphi technique in nursing research over a 10 year period (McKenna, 1994; Hasson, 2001; Keeney, 2003).
Background:
As a means of achieving consensus on an issue, the Delphi technique has become widely used in healthcare research in general and in nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how experts are selected and how non-respondents are pursued.
Discussion:
The issues that arise when planning and carrying out a Delphi study include the definition of consensus, anonymity versus quasi anonymity for participants, how to estimate the time needed to collect the data, analysis of each round, feedback to participants, responses to feedback, definition and selection of experts, enhancing response rates and the number of rounds to conduct. While these issues are noted in much of the Delphi literature, the experiences of researchers who have used the Delphi are invaluable in providing insight and guidance to novice Delphi researchers.
Conclusion:
Many challenges and questions are raised using the Delphi technique but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. While it is clear that researchers are, and need to, adapt the method to suit their particular study, this has been the main issue under which the Delphi had been criticised. This paper will address these criticisms in relation to personal experience of the technique.
References:
- Hasson, F. (2001) See McKenna, H.P. & Hasson, F. (2001) A study of skills mix issues in midwifery: a multi-method approach Journal of Advanced Nursing 37(1) 52-61
- Keeney, S. (2000) See McIlfatrick, S.J. & Keeney, S. (2003) Identifying cancer nursing research priorities using the Delphi technique Journal of Advanced Nursing 42(6) 629-636
- McKenna, H.P. (1994) The Delphi Technique: a worthwhile approach for nursing? Journal of Advanced Nursing 19, 1221-1225
Abstract 3:
Aim:
Whilst the Delphi technique has observable strengths that make it a consequential method for nursing research, it also has drawbacks. This paper will examine the limitations of the Delphi technique and consider how these can be overcome using a study that explored the competencies that district nurses require to undertake health promotion effectively as an exemplar.
Background:
The Delphi technique is a well established method in nursing research, offering an alternative to direct debate to elicit the judgment of an expert panel. It is a multi-staged approach involving a series of questionnaires, from which the responses are summarized and fed back to participants in order to achieve consensus.
Discussion:
Specifically, I will consider the issues of:
- Scientific credibility and discuss how the method can be used and what claims can be made from its findings.
- Achieving consensus, where I will examine various techniques that have been used in the literature and offer an analytical approach developed by Greatorex and Dexter (2000) that surmounts the accusation of arbitrariness
- Response rates, by exploring what is an acceptable response rate at the point where consensus is reached and how attrition over rounds can best be eluded
- The size and composition of the panel, considering the published literature that explores how a balance can be struck between managing data, avoiding attrition and ensuring representativeness
- Dealing with unwieldy amounts of data, a potential problem that I will show can be managed through the careful use of qualitative and quantitative techniques
- Practical issues where I will discuss concerns about the cost and the time needed to execute a Delphi study.
Conclusion:
I will demonstrate that with careful management of the threats to its viability, the Delphi technique offers nursing a useful method for achieving consensus in an area when none existed previously.
References:
- Greatorex J & Dexter T (2000) An accessible analytical approach for investigating what happens between round in a Delphi study. Journal of Advanced Nursing, 232 (4), 1016-1024
Abstract 4:
Aim:
It aims to inform the audience of the ways in which the Delphi technique can be used with technology.
Background:
The Delphi is characterised by its flexibility as a method for generating consensus. One of its consistent features, however, is the anonymity afforded to members of the expert panel. This occurs to overcome the group psychological approaches which might prevent genuine consensus being achieved in face-to-face meetings. One other advantage of the traditional Delphi is that respondents can participate without leaving home. The process usually involves two or three rounds of questionnaires which are designed to measure consensus, by the generation of, and subsequent attrition of ideas. The process can become protracted.
Discussion:
Technology provides a means to reconcile the two issues:
- Using questionnaires as a means of ensuring the anonymity of participants
- Avoiding the inevitable delays in completing several rounds of questionnaires. It is possible to use electronic voting systems
Voting is carried out anonymously. The expert panel come together and the consensus gathering process can be completed during a meeting. Likert type scales which are common features in the second and third round of the Delphi can be administered very quickly so that there is immediate feedback to participants who can vote again on seeing the results from each round. The advantage of this method is that it permits discussion of the issues whilst voting remains anonymous. Would such a process fatally undermine the integrity of the Delphi method?
Conclusion:
During the session an attempt will be made to answer that question. Wireless voting sets will be used. Participants will be given the opportunity to participate in two rounds of the Delphi. At the end participants will be asked to vote on the experience and whether it had undermined the Delphi principle.