title: Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand.
abstract: BACKGROUND
  Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies.
  
  
  OBJECTIVE
  The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria.
  
  
  METHODS
  Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold.
  
  
  RESULTS
  Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark.
  
  
  CONCLUSIONS
  When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.
authors.affiliation: School of Health Sciences, Massey University, Palmerston North, New Zealand. d.j.hardy@massey.ac.nz
authors.forename: Derrylea J
authors.initials: DJ
authors.lastname: Hardy
authors.forename: Anthony P
authors.initials: AP
authors.lastname: O'Brien
authors.forename: Cadeyrn J
authors.initials: CJ
authors.lastname: Gaskin
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: O'Brien
authors.forename: Erina
authors.initials: E
authors.lastname: Morrison-Ngatai
authors.forename: Georgina
authors.initials: G
authors.lastname: Skews
authors.forename: Tom
authors.initials: T
authors.lastname: Ryan
authors.forename: Neil
authors.initials: N
authors.lastname: McNulty
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D003697:Delphi Technique; D006801:Humans; D001523:Mental Disorders / Q000451:nursing*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D011787:Quality of Health Care / Q000592:standards; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016746:Transcultural Nursing / Q000592:standards*