title: Achieving Consensus for the Design and Delivery of an Online Intervention to Support Midwives in Work-Related Psychological Distress: Results From a Delphi Study.
abstract: BACKGROUND
  Some midwives are known to experience both professional and organizational sources of psychological distress, which can manifest as a result of the emotionally demanding midwifery work, and the traumatic work environments they endure. An online intervention may be one option midwives may engage with in pursuit of effective support. However, the priorities for the development of an online intervention to effectively support midwives in work-related psychological distress have yet to be explored.
  
  
  OBJECTIVE
  The aim of this study was to explore priorities in the development of an online intervention to support midwives in work-related psychological distress.
  
  
  METHODS
  A two-round online Delphi study was conducted. This study invited both qualitative and quantitative data from experts recruited via a scoping literature search and social media channels.
  
  
  RESULTS
  In total, 185 experts were invited to participate in this Delphi study. Of all participants invited to contribute, 35.7% (66/185) completed Round 1 and of those who participated in this first round, 67% (44/66) continued to complete Round 2. Out of 39 questions posed over two rounds, 18 statements (46%) achieved consensus, 21 (54%) did not. Participants were given the opportunity to write any additional comments as free text. In total, 1604 free text responses were collected and categorized into 2446 separate statements of opinion, creating a total of 442 themes. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support.
  
  
  CONCLUSIONS
  This study has identified priorities for the development of online interventions to effectively support midwives in work-related psychological distress. The impact of any future intervention of this type will be optimized by utilizing these findings in the development process.
authors.affiliation: Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom. pezaros@uni.coventry.ac.uk.
authors.forename: Sally
authors.identifier: http://orcid.org/0000-0001-5767-0708
authors.initials: S
authors.lastname: Pezaro
authors.forename: Wendy
authors.identifier: http://orcid.org/0000-0003-1523-7003
authors.initials: W
authors.lastname: Clyne
keywords: Delphi technique; Internet; health workforce; intervention studies; midwifery; psychological; self-help groups; stress