The use of a Delphi survey to examine maternity high dependency care (MHDC) in obstetric units remote from tertiary referral centres

Abstract

Background. Up to 5% of women in the UK will receive maternity high dependency care (MHDC), although there are varying opinions as to the defining features of this concept. This paper describes the rationale for, and design of, a modified three-round Delphi survey examining MHDC. Objectives. To obtain a consensus on the definition and defining features of MHDC in obstetric units (OUs) remote from a tertiary referral centre. To examine if the definition for, and defining features of MHDC are the same for OUs remote from tertiary referral centres with differing annual birth rates. To investigate if the definition for, and defining features of MHDC are the same for the professional groups of doctors and midwives working in OUs with similar annual birth rates. Method. The Delphi participants comprised midwives, obstetricians, and anaesthetists employed in seven OUs. Round one (qualitative) involved completion of a self-report questionnaire. During rounds two and three (quantitative), respondents rated their level of agreement or disagreement against five-point Likert items for a series of statements (n=106). The level of consensus for the combined percentage of strongly agree and agree statements was set at 80% for the second and third rounds. The round two statistical findings were not fed back to the respondents but, they were given the opportunity to provide additional qualitative comments throughout the second and third rounds. Ethical approval was granted by the local research ethics committee and the relevant NHS research and development departments. Conclusion. Where modifications are made to traditional Delphi surveys, the researcher must carefully justify the methodological decisions that have been taken.