The Delphi Technique in Developing International Health Policies: Experience from the SARSControl Project

Intro:The Delphi technique, according to the author, helps in structuring a group communication process that is particularly useful when there is little knowledge or uncertainty surrounding a complex area being investigated. This paper uses the criteria defined in the literature to assess the process of using the Delphi technique in developing international emerging infectious disease policies. The evaluation was done using the qualitative description of the SARSControl Delphi and carrying out a critical analysis of different aspects of each criterion.

The Delphi technique can be classified as follows:

• The Classical Delphi-to establish facts
• The Policy Delphi- to generate ideas
• The Decision Delphi- to make decisions
• The Group Delphi- for group discussions

Criteria: The Delphi technique must be applied systematically using the following 5 criteria:

1. Panel Composition (geographic and professional representativeness, size, heterogeneity)
2. Participant Motivation (response rate, written consent, clarity of questions, reminders)
3. Problem Exploration, e.g. as percentage of agreement /medians
4. Consensus Definition, e.g. as percentage of agreement /medians
   
5. Format of Feedback, e.g. individual responses, measures of tendency and spread of responses

Other criteria includes: number of rounds, anonymity to encouraging open expression of opinions, and sufficient resources which include time and administrative services.

How Delphi was used for this project:

Panel Composition: The Delphi process, which was carried out over a period of nine months consisted of a pilot round, two written rounds and a final face-to-face meeting. Thirty-eight infectious disease experts (from 22 countries) participated in the 1st written round and 28 experts (from 19 countries) in the 2nd written round; and 11 newly recruited experts with similar expertise as the participants from the written rounds from 9 countries participated in the face-to-face meeting.

Problem Exploration: Thirteen policy components considered important in terms of emerging diseases were used to formulate statements for the written Delphi rounds.
The two written rounds of the Delphi and a face-to-face meeting were found sufficient to obtain the outcomes in terms of generating policy options and alternatives. The 2nd Delphi round was crucial in clarifying issues from the 1 st round.

Round 1: Closed-ended questionnaire with a possibility to make comments.
The written comments (qualitative data) provided by the respondents were individually analyzed. (Took 2 months to complete)

Round 2: The questionnaire for the 2nd round was based on the results and comments received in the 1st round. (Took 2 months to complete)

• Questions which had reached consensus in the 1 st round were excluded from the 2 nd
  
• Unclear and confusing questions were either rephrased or new questions were formulated based on the panellists' comments
  
• Unclear questions from the 1 st round to the 2 nd were dropped in the course of the Delphi written process.

Feedback for the Face-to-Face Meeting: Panel members were fed back with percentages of agreement within the panel for each statement in every round. Summaries of the comments from the previous rounds were also given.

• Prior to the face-to-face Delphi meeting, its participants were informed via email about the Delphi technique and about the results of the written Delphi rounds. This was done to ensure that the participants had a common starting point as none of them had participated in the written rounds. The questionnaire responses were anonymous to other participants.

Conclusion:
The SARSControl Delphi process succeeded in its aim to generate policy options and alternatives — this in spite of the discontinuity in the involvement of the experts throughout the Delphi process. 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:
Syed, A., Hjarnoe, L., & Aro, A. (2009). The Delphi Technique In Developing International Health Policies: Experience From The SARSControl Project. Internet Journal of Health, 8(2), 5. Retrieved from Academic Search Complete database.