The instrument for Round One comprised of two parts. The first part collected socio-demographic data on contact details (name, work title, email
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address and phone number), gender, age, country of origin, geographical work location, work title, current occupation, main activity in current job, years of experience in this role and their interest in the study. Obtaining this data allowed for clustering of the responses of the different expert groups and allowed for matching respondents data across rounds, and for sending follow-up rounds to panellists, including statistical feedback (Mead & Moseley 2001a). The items were developed by the researcher, informed by a literature review on demographic questionnaires in similar studies, and limited to ones directly relevant to the purpose of the study (Kotowski 2015; Lane et al. 2017; McKenna et al. 2015).
The second part of the instrument consisted of seven open-ended questions, typical for the first round of a Delphi process (Hsu & Sandford 2007). These open-ended questions were designed to directly address the second and third research questions of the study. Panellists’ responses depend on the exact wording of the questions, which is vulnerable to researcher bias and to errors in comprehension (Mead & Moseley 2001b). A strong instrument design is
therefore essential to the success of the study and vital for replicability (Mead & Moseley 2001b). To minimise researcher bias and comprehension errors, a pre- test was undertaken to test the Round One instrument, the choice of the web- based survey tool Qualtrics (2015) and associated analysis (Clibbens, Walters & Baird 2012). It has been argued that the complexity of managing pre-tests and a full study simultaneously can result in considerable intervals between rounds and, therefore, participant attrition (Clibbens, Walters & Baird 2012). For this reason, most researchers only pre-test their first round (Clibbens, Walters & Baird 2012). This procedure was adopted in this study. The instruments of Round Two and Three were only checked for wording, flow, grammatical errors and technical problems by a few known contacts of the researcher.
For the pre-test of the instrument, an invitation letter was sent to a convenience sample of 25 experts. All experts were connected to Deakin
University, Melbourne, and had a similar professional or interest background as the intended panel members. The pre-test asked participants to provide
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feedback, via a short questionnaire, on the language and phrasing of the PLSC, the demographic and open-ended questions, and on potential ambiguities in the questions. Further, feedback was sought on the instructions provided; for
example, if they were easy to follow, and if participants encountered any technical problems (Clibbens, Walters & Baird 2012). Feedback was specifically requested regarding the wording of the seven open-ended questions, as correct wording was crucial to the outcome of the study. Seven people participated. Five were ‘experts by profession’, and two panellists were classified as ‘experts by experience’.
The feedback resulted in the correction of typographical errors and a rephrasing of some of the Round One questions to clarify intended meaning. Additionally, the question: ‘What do you think needs to be done to improve this role of general practitioners/the primary health care nurse?’ (in the provision of early MA in regional/rural Victoria) was changed into: ‘How do you think the role of general practitioners/primary health care nurses in the provision of MA could be improved?’ Further, feedback from an ‘expert by experience’ resulted in the inclusion of an explanation of the term ‘MA’ in the instrument.
The final Round One instrument included the following open-ended questions:
1. What do you think is the current role of general practitioners and primary health care nurses in the provision of early medication abortion in
regional/rural Victoria?
2. How do you think the role of general practitioners in the provision of medication abortion could be improved?
3. How do you think the role of primary health care nurses in the provision of medication abortion could be improved?
4. What factors facilitate or hinder regional and rural primary health care nurses when they are or want to be involved in the delivery of medication abortion services in regional/rural Victoria?
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5. What do you believe are solutions or recommendations to improve primary health nurse participation in the provision of medication abortion in
regional/rural Victoria?
6. What obstacles can potentially prevent these improvements? 7. How do you think the obstacles of question six can be addressed?
The full instrument is provided in Appendix F.
Data were collected online using Qualtrics (2015). A link to the Round One instrument was included in the invitation letter or flyer. This link directed potential panellists to the PLSC, which provided information about the study’s background, the Delphi procedure, confidentiality and privacy guidelines, the contact details of the researcher and a consent statement (Boulkedid et al. 2011). Clicking on the consent statement opened the instrument (see Appendix G for the PLSC of the Delphi study).
In the following three months, a total of 52 experts opened the link. Three did not read the PLSC and 12 decided, after reading the PLSC, not to continue. Nine experts expressed their wish to continue but never opened the questionnaire, and five only finished the demographic questions. The most common reason provided for not continuing with the Round One questionnaire related to not knowing enough of the subject. A first reminder was sent six weeks after the start of the study, and a final reminder was sent four weeks later. This resulted in a total panel size of 23.