Classification of a Community-Based Eating Disorder Service As a Specialist Service: Delphi

Classification of a community-based eating disorder service as a specialist service: Delphi survey

Findings from Delphi Round 1

Delphi round 1 Round one of the survey consisted of six questions relating to alternative criteria for a community-based eating disorder service to be classified as a specialist service (listed in Table 1). The importance of each criterion was rated by respondents on a five point Likert scale using the following categories:

 1 = Not important  2 = Slightly important  3 = Moderately important  4 = Very important  5 = Extremely important

Three of the six criteria had sub-questions which were completed by respondents who had rated the main criterion as important (‘slightly important’, ‘moderately important’, ‘very important’ or ‘extremely important’).

Consensus Consensus decision rules for the six main criteria were finalised prior to data analysis and focused on the percentage of respondents rating each criterion as either 4 (very important) or 5 (extremely important). The decision rules are as follows:

% rating criterion as 4 Decision rule or 5 80% to 100% Consensus reached and item included in checklist 50% to 79% Consensus not reached and item entered into Round 2 0% to 49% Consensus reached and item excluded from checklist

Results Responses for the six main criteria are reported in Table 1.

Consensus reached and item included in checklist The following items were rated by greater than 80% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service:

 Offering specialist (evidence-based) outpatient treatment for eating disorders (91%)  Providing multi-disciplinary specialist outpatient clinics dedicated to eating disorders (87%)

1 Consensus was reached and these items will be included in the checklist and do not need to be re-rated in round 2 of the Delphi survey.

2 Consensus not reached The following items were rated by between 50% and 79% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service:

 Holding weekly multi-disciplinary meetings dedicated to eating disorders (78%)  Number of cases of eating disorders a service sees per year (52%)

Consensus for these items was not achieved and so these items will be included in round 2 of the Delphi survey.

Consensus reached and item excluded The following items were rated by less than 50% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service:

 Population size of the catchment area covered by the service (29%)  Length of time a service has existed (9%)

Consensus was reached and these items will be excluded from the checklist and do not need to be re-rated in round 2 of the Delphi survey.

References 1. Diamond, I.R., et al., Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol, 2014. 67(4): p. 401-9. 2. Boulkedid, R., et al., Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One, 2011. 6(6): p. e20476. 3. Hoffmann, T.C., et al., Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj-British Medical Journal, 2014. 348. 4. Keeney, S., F. Hasson, and H. McKenna, Consulting the oracle: ten lessons from using the Delphi technique in nursing research. Journal of Advanced Nursing, 2006. 53(2): p. 205-212. 5. Jorm, A.F., Using the Delphi expert consensus method in mental health research. Australian and New Zealand Journal of Psychiatry, 2015. 49(10): p. 887-897. 6. Morrison, A.P. and S. Barratt, What Are the Components of CBT for Psychosis? A Delphi Study. Schizophrenia Bulletin, 2010. 36(1): p. 136-142. 7. Sinha, I.P., R.L. Smyth, and P.R. Williamson, Using the Delphi Technique to Determine Which Outcomes to Measure in Clinical Trials: Recommendations for the Future Based on a Systematic Review of Existing Studies. Plos Medicine, 2011. 8(1).

3 Table 1: Results for the six main criteria included in Delphi survey round 1

Criterion 1=Not 2=Slightly 3=Moderatel 4=Very 5 4 or 5 Median Mode Consensus important important y important = important E x t r e m e l y i m p o r t a n t % (n) % (n) % (n) % (n) % % (n)

( n ) 0.6 (3) 1.9 (9) 6.75 (32) 31.7 (150) 5 5=extremely 5=extremely Included 9 important important . 1 Q1. Offering specialist (evidence-based) 90.7 (430) outpatient treatment for eating disorders ( 2 8 0 ) Q2. Holding weekly multi-disciplinary 1.5 (7) 2.7 (13) 17.9 (85) 38.4 (182) 3 77.9 (369) 4=very 5=extremely Uncertain meetings dedicated to eating disorders 9 important important . 5

( 1 8 7 ) 1.1 (5) 1.7 (8) 10.6 (50) 37.1 (176) 4 4=very 5=extremely Included 9 important important . 6 Q3. Providing multi-disciplinary specialist outpatient clinics dedicated to eating 86.7 (411) ( disorders 2 3 5 ) 5.7 (27) 9.3 (44) 33.1 (157) 33.1 (157) 1 4=very 3- Uncertain 8 important 4=moderately . to very 8 important Q4. Number of cases of eating disorders a 51.9 (246) service sees per year ( 8 9 ) 18.5 (85) 17.4 (80) 35.4 (163) 19.1 (88) 9 3=moderately 3=moderately Excluded . important important 5 7 Q6. Population size of the catchment area 28.7 (132) covered by the service ( 4 4 ) Q8. Length of time a service has existed 40.1 (179) 26.2 (117) 24.9 (111) 6.28 (28) 2 8.7 (39) 2=slightly 1=not Excluded . important important 4 7

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