title: [Why is perinatal and infant mortality high in the Seine-Saint-Denis district? A consultation with healthcare providers using a Delphi process].
abstract: OBJECTIVE
  In Seine-Saint-Denis, stillbirth and infant mortality rates are markedly higher than in other French departments. Before implementing an audit on stillbirths and neonatal deaths in 2014, we carried out a Delphi consensus process with healthcare providers to generate research hypotheses.
  
  
  METHODS
  A Delphi process in 3 questionnaires was conducted in 2013 with 32 healthcare providers (pediatricians, obstetricians, general practitioners, midwives, social workers, psychologists, pediatric nurses) and user representatives. The first questionnaire asked open questions about why mortality rates were higher and possible solutions to remedy the situation. In subsequent questionnaires, the panel ranked factors identified in the first questionnaires by importance.
  
  
  RESULTS
  One hundred and thirty factors were identified from 42 pages of text responses in the first round. From these, the 75 most highly ranked were grouped into 14 main topics organized around three themes: 1) more underlying health problems in the population, 2) access and organization of care, 3) the health consequences of poor socioeconomic conditions. Coordination of care, provider and patient communication, and access to care were highlighted.
  
  
  CONCLUSIONS
  The Delphi consensus process identified a wide range of hypotheses for the higher mortality in Seine-Saint-Denis which are adapted to the local context and based on the concerns of health practitioners.
authors.affiliation: Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), Inserm U1153, centre de recherche épidémiologie et biostatistique, Sorbonne Paris Cité, (CRESS), université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France; Pitié-Salpêtrière, AP-HP, 75013 Paris, France. Electronic address: priscille.sauvegrain@inserm.fr.
authors.forename: P
authors.initials: P
authors.lastname: Sauvegrain
authors.affiliation: Observatoire du Samusocial, 75011 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Rico-Berrocal
authors.affiliation: Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), Inserm U1153, centre de recherche épidémiologie et biostatistique, Sorbonne Paris Cité, (CRESS), université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D003697:Delphi Technique; D005602:France / Q000453:epidemiology; D006282:Health Personnel / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D054238:Perinatal Mortality; D050497:Stillbirth / Q000453:epidemiology*
keywords: Consultation des professionnels; Delphi; Delphi process; Health care providers consultation; Health inequalities; Infant mortality; Inégalités de santé; Mortalité infantile; Mortalité périnatale; Stillbirth