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The development of an online intervention designed to effectively support midwives in work-related psychological distress will be challenging due to the ethical, practical, and therapeutic issues surrounding its design. Related literature suggests that midwives may require an anonymous, confidential, and therapeutic platform that facilitates amnesty and nonpunitive approaches to remedy ill health. However, it is unclear which requirements may be most salient to midwifery populations.
The objective of this paper is to describe the design of a Delphi study, intended to achieve expert consensus on the needs of midwives in work-related psychological distress who may be supported via an online intervention. This protocol may also serve as a research framework for similar studies to be modeled upon.
A heterogeneous sample of at least thirty experts on psychological well-being and distress associated with midwifery work will be recruited. Their opinions regarding the development of an online intervention designed to support midwives in work-related psychological distress will be collected through 2 rounds of questioning, via the Delphi Technique. When 60% (≥18, assuming the minimum is 30) of panelists score within 2 adjacent points on a 7-point scale, consensus will be acknowledged. This Delphi study protocol will invite both qualitative and quantitative outcomes.
This study is currently in development. It is financially supported by a full-time scholarship at the Centre for Technology Enabled Health Research at Coventry University (Coventry, UK). The implementation of this Delphi study is anticipated to occur during the autumn of 2015.
The results of this study will direct the development of an online intervention designed to support midwives in work-related psychological distress, summarize expert driven consensus, and direct future research.
The mental health and well-being of health care professionals has gathered significant attention due to its direct correlation with quality patient care [
Midwives generally find it challenging to disclose personal experiences of psychological distress [
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 [
An online intervention may be one solution that midwives may turn to in work-related psychological distress, as a preferred option of support [
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 [
Achieving consensus is the primary aim of the Delphi study, yet the measurement of consensus varies greatly [
Rigid Delphi study designs have been criticized for their inability to allow their experts 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 [
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
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
Participant inclusion criteria.
Experts will be invited to participate by the research team. They will be invited via email and social media contact with a formal invitation to become a part of the panel (see
It is anticipated that some experts may withdraw from the study during its course [
Flowchart for participant recruitment.
The research team will consult their social, academic, and occupational networks to identify potential experts who meet the inclusion criteria. Suitable candidates will receive an email inviting them to participate in the Delphi study.
Twitter will also be used for research recruitment due to its high-quality health care, research, and academic communities. Twitter is evidenced to be a highly effective tool for health care research recruitment [
Experts within the field of midwifery, psychology, psychiatry, and health care will be identified through literature searching. The research team will identify key papers of relevance, the authors of which will then be invited to participate. They will be invited via email and social media contact with a formal invitation to become a part of the panel (see
This Delphi study will employ the principles of anonymity, repetitions at each stage of questioning, and feedback between rounds of descriptive statistics regarding the group’s response and summaries of free text responses about each item in the item panel [
Experts will only be sent further correspondence should they indicate an initial interest to participate in the study. In the absence of any response to the initial invitation sent by the research team, it will be assumed that the recipient has no interest in participating in the study, and will therefore receive no further correspondence.
Experts who continue to participate within the study but do not respond to the first Delphi round will be sent 2 reminders via email or social media contact. To withdraw from the study, experts must directly contact the research team and explicitly state their withdrawal. Unless this action is confirmed, all experts will receive reminders and survey links for each round. Two weeks will be allocated for Delphi experts to respond to each round of questioning [
Reminders will be sent to participants 1 week before each round begins in order to maximize their participation. A link to the survey will then be given to all participants.
Questions have been designed to explore consensus about the design, construction, purpose, and content of an online intervention to support midwives in work-related psychological distress (see
There will be 3 themes of questioning and 2 response options available. The 3 themes will be intervention design and practical inclusions, inclusions of therapeutic support, and ethical inclusions. The 2 response options available will be a 7-Point Likert scale and open text responses.
Bristol Online Survey [
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 [
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 [
This study is currently in development. It is financially supported by a full-time scholarship at the Centre for Technology Enabled Health Research at Coventry University (Coventry, UK). Ethical approval for this study has been granted by Coventry University Ethics Department. The implementation of this Delphi study is anticipated to occur during the autumn of 2015. Project reference id P35069.
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 [
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 [
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.
Stakeholder analysis.
Formal invitation presented to potential participants.
Informed consent form.
Delphi study questionnaire.
This study is financially supported by a full-time scholarship, funded by the Centre for Technology Enabled Health Research at Coventry University.
None declared.