ADAPTE with modified Delphi supported developing a National Clinical Guideline: stratification of clinical risk in pregnancy

Clyne, Barbara; Tyner, Barrie; O’Neill, Michelle; Jordan, Kelvin; Carty, P; Phillips, Mike; Power, K; Turner, Michael J.; Smith, Stuart; Ryan, Máirín

doi:10.1016/j.jclinepi.2022.03.005

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…The majority of these were from one guideline, Stratification of Clinical Risk in Pregnancy [ 24 ]. This guideline followed an ADAPTE process [ 19 ], and in the absence of any suitable guideline being identified to be adapted to the Irish healthcare setting, a modified Delphi approach was undertaken to support guideline development [ 35 ]. In certain clinical fields, as was the case with this guideline, applicable evidence may be particularly limited, necessitating the use of expert opinion.…”

Section: Discussionmentioning

confidence: 99%

Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines

Chong¹,

Sharp²,

Smith

et al. 2023

BMC Med Res Methodol

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Background Clinical guidelines should be based on a thorough evaluation of the evidence and generally include a rating of the quality of evidence and assign a strength to recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against making strong recommendations when the certainty of the evidence is low or very low, but has identified five paradigmatic situations (e.g. life-threatening situations) where this may be justified. Aims and objectives We aimed to characterize the strength of recommendations and certainty of the evidence in Irish National Clinical Guidelines using the GRADE approach. Methods All National Clinical Guidelines from the National Clinical Effectiveness Committee (NCEC) website using the GRADE approach (fully or partially) were included. All recommendations and their corresponding certainty of the evidence, strength of recommendations and justifications were extracted. Authors classified instances of strong recommendations with low certainty evidence (referred to as discordant recommendations) into one of the five paradigmatic situations. Descriptive statistics were calculated. Results From the 29 NCEC Clinical Guidelines available at the time of analysis, we identified 8 guidelines using GRADE with a total of 240 recommendations; 38 recommendations did not use the GRADE approach and were excluded. Half of the included guidelines focused on emergency situations. In the final dataset of 202 recommendations, 151 (74.7%) were classified as strong and 51 (25.3%) as conditional. Of the 151 strong recommendations, 55 (36.4%) were supported by high or moderate certainty evidence and 96 (63.6%) by low or very low certainty evidence and were considered discordant. Of these 96 discordant recommendations, 55 (73.7%) were consistent with one of the five paradigmatic situations. However, none were specifically described as such within the guidelines. Conclusions The proportion of discordant recommendations identified in this analysis was higher than some previous international studies (range of all strong recommendations being discordant 30–50%), but similar to other guidelines focused on emergency situations. The majority of discordant recommendations could be mapped to one of the five situations, but no National Clinical Guideline explicitly referenced this. Guideline developers require further guidance to enable greater transparency in the reporting of the reasons for discordant recommendations.

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Section: Discussionmentioning

confidence: 99%

Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines

Chong¹,

Sharp²,

Smith

et al. 2023

BMC Med Res Methodol

Self Cite

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“…We defined a consensus as a collective agreement among participants on the topics discussed,42 who rated their opinions using a 5-point Likert scale,47 which ranged from ‘very strongly disagree’ to ‘very strongly agree’ 47. While consensus in different studies has varied from 60%,48 70%32 49 to 80%,34 36 we predetermined that there should be a 70% consensus on each item. We also included a measure of central tendency (ie, a median) to avoid skewed results 43 48…”

Section: Methodsmentioning

confidence: 99%

“…We applied the modified Delphi study characterised by the structured and iterative process, participants’ anonymity and the ability to modify their responses based on group feedback 33 34. The modified Delphi study differs from the traditional approach as it offers less time for study completion,35 and the integration of literature reviews before the rounds 34 36. The systematic review offers Delphi study to identify and focus on relevant issues, given the complex nature of health issues 34.…”

Section: Introductionmentioning

confidence: 99%

“…One critical characteristic of the Delphi study is the ability to obtain expert input from individuals who were widely dispersed geographically and at any time they felt like responding within the given duration of time 37. The findings of Delphi study can generate recommendations for future studies or strategies 36 38. Thus, gathering the expert’s collective opinion is critical, suggesting innovative strategies to intervene in future disease burdens 33 39…”

Section: Introductionmentioning

confidence: 99%

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International modified Delphi study on malaria preventive behaviour: new themes, contexts and framework for future research onPlasmodium knowlesimalaria

et al. 2023

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IntroductionPlasmodium knowlesimalaria is a non-human simian malaria that threatens Southeast Asian rural communities. Studies indicate that non-compliant bednet usage, travelling into the forest and working as farmers and rubber tappers put communities at risk for infection. Despite guidelines, malaria incidence increases yearly and has become a public health concern. In addition to research gaps addressing factors that influence malaria prevention behaviour in these communities, there are no specific guidelines to facilitate strategies against the threat ofP. knowlesimalaria.MethodTo examine potential factors that influence malaria-prevention behaviour in communities exposed toP. knowlesimalaria, 12 malaria experts participated in a modified Delphi study; every participant maintained their anonymity throughout the study. Three Delphi rounds were conducted via different online platforms between 15 November 2021 and 26 February 2022, and consensus was achieved when 70% of the participants agreed on a particular point with a 4–5 median. The results from the open-ended questions were then subjected to thematic analysis, and the dataset generated by this study was analysed using a deductive and inductive approach.ResultsAfter a systematic, iterative process, knowledge and belief, social support, cognitive and environmental factors, past experience as a malaria patient, and the affordability and feasibility of a given intervention were critical contributors to malaria-prevention behaviour.ConclusionFuture research onP. knowlesimalaria could adapt this study’s findings for a more nuanced understanding of factors that influence malaria-prevention behaviour and improveP. knowlesimalaria programmes based on the expert consensus.

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“…Based on previous studies and suggestions of several experts invited by the Delphi method, 29 , 30 we invited experts from medical institutions across China from September to November 2022 using a convenience sampling method. The experts were from center for disease control, universities, and associations engaged in vaccine policy and management, or from enterprises engaged in vaccine production and sales, ensuring the representativeness and authority.…”

Section: Methodsmentioning

confidence: 99%

Construction of an indicator framework for vaccine inclusion in public health programs: A Delphi-entropy method study

Wang,

Dai,

Jia

et al. 2023

Human Vaccines & Immunotherapeutics

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Governments must decide which vaccine priority to include in their public health programs. Using the modified Delphi and entropy method, we developed an indicator framework for vaccine inclusion at the national, provincial, municipal, and district/county levels, each containing three dimensions. In total, 4 primary indicators, 17 secondary indicators, and 45 tertiary indicators were selected, covering vaccine-preventable diseases, candidate vaccines, and social drivers of the supply and demand sides. From a subjective perspective, there was no significant weighting difference in the primary and secondary indicators at all administrative levels. “Vaccine-preventable diseases” as a primary indicator had the greatest weight in the peer group, of which “Health burden” had the highest weight among the secondary indicators. From the objective perspective, the social drivers on the supply and demand sides of the primary indicators accounted for 65% and higher. Among the secondary indicators, “the characteristics of the candidate vaccine” and “vaccine-related policies on the supply side” held 8% of weights or more at both national and provincial levels. “Demographic characteristics” held the highest weight at the municipal (13.50) and district/county (15.45) level. This study indicates that China needs different considerations when using WHO-recommended vaccines at the national, provincial, municipal, and district/county levels. In addition, this study highlights that behavioral and social drivers are important indicators that need to be considered for decision-making. This framework provides a tool for policymakers to determine the inclusion priority of candidate vaccines.

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ADAPTE with modified Delphi supported developing a National Clinical Guideline: stratification of clinical risk in pregnancy

Cited by 8 publications

References 21 publications

Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines

Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines

International modified Delphi study on malaria preventive behaviour: new themes, contexts and framework for future research onPlasmodium knowlesimalaria

Construction of an indicator framework for vaccine inclusion in public health programs: A Delphi-entropy method study

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