The Delphi Technique In Developing International Health Policies: Experience From The SARSControl Project

摘要

The overall aim of this methodological study was to evaluate the Delphi technique as a tool to develop international policies for SARS and SARS-like diseases using criteria found in the literature and its application in the SARSControl Delphi study. The main weaknesses in the Delphi process were found to be -the lack of experts in infectious diseases amongst the Delphi team, the 9-point Likert scale without clear verbal labels, lack of representatives from countries with SARS experience, discontinuity in the Delphi panel composition from the 1st to the 2nd round to the face -to-face meeting and delays in data gathering due to collaboration with another project. It can be concluded that from the results that Delphi technique when rigorously administered, analyzed and reported is a valuable method to develop international health policy recommendations for emerging infectious diseases and aid the international policy development process creatively collecting expert opinions and suggestions. Source of funding This work was done by the authors at the Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark using data gather while working for “SARSControl : Effective and acceptable strategies for the control of SARS and new emerging infections in China and Europe”, a European Commission project funded within the Sixth Framework Programme, Thematic Priority Scientific Support to Policies, Contract number: SP22-CT-2004-003824.” Introduction Development of international health policies has proven to be an urgent and crucial issue in containing emerging infectious diseases such as SARS and threats of pandemic influenza. International Health Regulations have been updated to meet the new challenges. Surprisingly, there is hardly any published documentation on how policies are developed other than the use of methods such as consultations, technical meetings, and workshops of experts and key stakeholders. Without formal and transparent documentation on exactly how these methods have been used, and how well they have functioned, it is impossible to use available evidence in systematically developing policies. The Delphi technique, originally developed by the RAND Corporation [1], helps in structuring a group communication process that is particularly useful when there is little knowledge or uncertainty surrounding a complex area being investigated [2,3,4,5]. Van Zoligen & Klaassen [6] classify the Delphi technique into: the Classical Delphi - to establish facts; the Policy Delphi -to generate ideas; the Decision Delphi -to make decisions; and the Group Delphi -for group discussion. No studies are reported in the literature on the use of Delphi technique in developing infectious disease policies. It has been used in other areas of healthcare such as identifying priorities in clinical guideline development mental health [7], and in advocating tobacco control [8]. Barker's analysis of methods and techniques to analyse and develop health policies showed the Delphi technique to fit well for issue definition , objective/priority setting, both process and substance, prescriptive as well as explanatory use, and mostly for qualitative data [9]. The Delphi technique needs to be applied systematically and rigorously to produce reliable and valid results [7] and to avoid discrepancies [10]. Based on literature, the five core criteria when using the Delphi technique (Table 1) are: a) panel composition (geographic and professional representativeness, size, heterogeneity [11,12]; b) participant motivation (response rate, written consent, clarity of questions, reminders; c) problem exploration [13]; d) consensus definition e.g. as percentage of agreement /medians [7,14]; and e) format of feedback e.g. individual responses, measures of tendency and spread of responses [5], different statistical description using median, mean or percentage [15] which can decrease unnecessary disagreement [16]. Other criteria include - number of rounds, anon