The mental health and well-being of health care professionals has gathered significant attention due to its direct correlation with quality patient care [1]. Midwives may be at an increased risk of developing psychological distress due to the traumatic work environments they endure [2]. These environments report incidents of workplace bullying, emotionally demanding clinical case loads, and a pressure to work despite feeling unwell enough to do so [1,2]. Interventions designed to support midwives in work-related psychological distress are required if the global shortage of midwives and the poor effects that midwives’ psychological distress has on patient care are to be remedied. It is unclear who may be responsible for the well-being of health care staff in the United Kingdom, yet it is clear that there is a paucity of support for midwives in distress [3].

Midwives generally find it challenging to disclose personal experiences of psychological distress [4,5]. In addition, health care professionals who experience the distressing effects of functioning within traumatic work environments may not recognize mental ill health in themselves [6,7].

To enable midwives to seek help with the consequences of work-related psychological distress, a platform of amnesty, confidentiality, and anonymity may be required before any benefits may accrue [8,9].

An online intervention may be one solution that midwives may turn to in work-related psychological distress, as a preferred option of support [10]. To develop an online intervention that fits the needs of midwives, their employers, and professional bodies, it will be important to first define what characteristics an online intervention should have.

This paper outlines a protocol for a Delphi study designed to achieve expert consensus about what midwives in work-related psychological distress may need to be supported via an online intervention and peer support platform. The expert consensus will be used to inform the development and content of an online intervention for midwives in work-related psychological distress.

The Delphi Technique has been used extensively within health, social science, and intervention research [11-13]. It involves rounds of discussion whereby experts are invited to disclose their opinions on particular topics for which there is a paucity of knowledge. It is assumed that the opinions of many outweigh those of the individual, and thus, any consensus generated may be considered to be a valid expert opinion [14,15]. Because there is an incomplete state of knowledge about what midwives in work-related psychological distress may require when accessing an online intervention designed to effectively support them, a Delphi study was considered to be a suitable research tool to augment unanimity in opinion [16]. The distinct characteristics of the Delphi technique are (1)anonymity, (2) iteration, (3) controlled feedback, and (4) statistical “group response” [17].

Achieving consensus is the primary aim of the Delphi study, yet the measurement of consensus varies greatly [18]. There is no firm consensus as to what may be considered a consensus within a Delphi study. Within this Delphi study, a primary criterion is that at least 60% (≥18, assuming the minimum is 30) of Delphi panel members must indicate a preference within 2 adjacent response points on a7-point Likert scale for consensus to be reached.

Rigid Delphi study designs have been criticized for their inability to allow their experts to elaborate on their opinions [12]. Therefore, this Delphi design will be a modified one [15,19]. Free text response options will accompany each statement put to panel members [20] to provide experts with the opportunity to elaborate on their opinions.

The research team who will conduct this Delphi study includes 6 academics with professional backgrounds in midwifery, general medicine, psychology, and academic research.

There are no clear guidelines in relation to what panel size is most appropriate for a Delphi study design [20]. A minimum of 30 experts will be recruited to this Delphi panel. Heterogeneity within the expert panel will play an essential part in ensuring study quality [16]. Therefore, panel members will be selected from different fields relating to midwifery care, health care, psychological distress, professional practice, and academia. They will be identified through a stakeholder analysis (see Multimedia Appendix 1). These experts will be midwives, researchers, lecturers, health care professionals, students, patient groups, and maternity-based organizations. Inclusion criteria are shown in Figure 1.

Once experts have been identified, they will be directed toward information about the aim and content of the Delphi study. A formal invitation will also be given (see Multimedia Appendix 2 and [21-31]). Potential participants will be invited to consent to participate as the online Delphi study begins (see Multimedia Appendix 3). Potential and recruited panel members will also be asked to refer other suitable individuals. This layer of recruitment aims to eliminate any bias from the research teams’ recruitment selection. Solicitation of nominations of appropriate field experts is typically recommended as best practice in the Delphi study design [32].

Informed consent will be obtained from all participants as the first round of questioning begins online, and will include the consensual agreement to publish anonymized data and nonidentifiable data results (see Multimedia Appendix 3). Participants will be directed to appropriate support services both online and offline due to the sensitive nature of the subject matter. Participants will also receive copies of any publications that may result from the study and a summary of outcomes.

Bristol Online Survey [40] will be used to administer the Delphi study. Round 1 will consist of a structured questionnaire. Respondents will be asked to indicate their priority rating for a series of items via Likert scale responses. They will also have the option to disclose why they chose to mark each item with lower or higher priority within an open text field. Respondents will also be invited to provide additional comments through the provision of a free text response. Finally, panelists will have the opportunity to suggest new questions to be put forward during the second round of questioning.

Round 2 will consist of a second questionnaire that is based on the information provided in the first round. The primary aim of this round will be to offer the panel the opportunity to reconsider their responses from Round 1 for those items for which consensus was not achieved in Round 1. This opportunity will be offered in light of feedback about the groups’ responses in Round 1. New questions may also be added to this second round in response to suggestions put forward by the panel during the first round. Respondents will be asked to review these new questions and indicate their priority rating. Respondents will be invited to provide comments through the provision of a free text response option for each item in the second questionnaire. They will also again be given the opportunity to disclose why they have chosen to mark each item with lower or higher priority within an open text field.

Because there are no conclusive guidelines for establishing consensus in Delphi literature [41], taking account of the average accord and the 7-point scale, consensus will be reached if 60% (≥18, assuming the minimum is 30) of respondents are within 2 adjacent response points on the 7-point scale (eg, if 60%, ≥18 assuming the minimum is 30, of participants select 2 and 3 in response to a specific item). Items which do not achieve consensus in Round 1 will be re-presented in Round 2.

The mean, minimum, and maximum scores for each item will also be calculated and reported to panel members as feedback after each round.

Any free text responses provided by participants to specific items will be analyzed with thematic analysis [42]. Themes may be reframed, reviewed, and revised throughout this thematic analysis, as coherent patterns are formed. This thematic analysis of qualitative open responses will be presented in a table format and feedback will be provided to panel members after each round.

The aim of this Delphi study is to reach consensus on the salient themes and elements to be included within an online intervention to support midwives in work-related psychological distress.The results of this research will be used to inform the development of an online intervention designed to support midwives in psychological distress.

A key weakness of the Delphi technique is that it lacks a theoretical framework [14]. The advantage of using a Delphi study technique within this research will be that ideas, definitions, and experiences of a variety of experts can be synthesized to inform development of the intervention. Panel members will be drawn from a variety of backgrounds, and as such will be able to contribute a variety of evidence and multidisciplinary perspectives.

Biases may occur in Delphi studies that could also distort the consensus. Desirability bias from both the experts and the research team could impede the achievement of a “true”consensus [43]. There is also the risk of ambiguity and conditional statements given within thequestionnaire [44]. In this case, panel members may be interpreting the questions and statements differently. This may also lead to a polarization in results. A 7-point judgment scale is used to avoid elements of ambiguity; however, this may not protect results against some polarity [45]. To mitigate these risks, the questionnaire has been reviewed and piloted among peers.

This paper describes the design of a Delphi study. This will be the first Delphi study to explore the online support needs of midwives in work-related psychological distress.