Article Figures & Data
Figures
- Figure 1.
Study activities and outputs.
ICHOM = International Consortium for Health Outcomes Measurement.
Tables
Activity Guiding questions Stage 1 Introduction and explanation
Set rules of engagement (Chatham House Rules) and remind participants that they may end their participation at any time.Say your name and mention something you care about and want to promote in your community. The community can be your family, neighborhood, workplace, relatives, or friends. Stage 2 Silent generation of ideas
After being introduced to each question, participants were given a few minutes to write down their own ideas so they could then listen to others’ ideas.What is your response to the result of the questionnaire presented? Is there any information that resonates with you? Do you agree? Are you surprised? Is there anything you would like to add? Stage 3 Round-robin sharing of ideas (item generation)
Participants were asked to share their ideas in response to the question. This process continued until all participants shared their ideas and no new ones were generated. To prevent bias, the facilitator did not provide ideas.Can you share a personal or professional experience that has contributed to how you think about the topic we are discussing today? Stage 4 Group discussion and clarification of ideas
Participants were invited to discuss and clarify what the ideas meant by asking questions of each other. They grouped similar ideas, suggested modifications of terminology, and added new ideas. Participants led the conversation. The facilitator did not direct participants during this process.Are you curious to know more about what someone has said, or is there something you would like to understand something better? Stage 5 Voting and ranking
The facilitator summarized the main content of the discussion while the document with team member notes (convergence and divergence of ideas) was shared on screen. Participants were invited to confirm whether they agreed with the summary or had other ideas to discuss further. (Adapted final concensus validation.)These are the main convergences (and divergences, if any) of opinion within the priority areas and indicators. Is there anything you would like to add or change? If so, what should be discussed further and who should continue the discussion? Stakeholder Group Initial Invitations (n = 62) Completed Individual Activity (n = 28) Participated in Group Discussiona (n = 20) Current Role (No. Genderb) Older persons, No. 13 5 4 Retired (3W, 1M) Clinicians, No. 20 10 7 Family physician (1W)
Geriatrician (2W, 1M)
Nurse (2W)
Occupational therapist (1M)Managers, No. 16 8 5 Director of support program for home care and assisted living facilities or nursing home (1W, 1M)
Director of family medicine clinic (1M)
Responsible for the Alzheimer’s Plan in 1 Quebec region (1W)
Chief nurse in a hospital (1W)Decision makers, No. 13 5 4 Deputy Minister (1W)
Responsible for the policy on informal caregivers (1W)
Director of the integrated health and social services centers (1W, I M)Responses to 5-Point Likert Scale, No. Comments to Open-Ended Questionsa Questionnaire Item Disagree, No. Neither Agree Nor Disagree, No. Agree, No. Strongly Agree, No. Strengths Areas for Improvement The purpose of the activity was clearly explained 1 1 7 5 “Better document the essential elements for good care of older adults along the care trajectory”
“As time went on and the project got under way, my questions were answered”“Better explain the objective of prioritization”
“Perhaps better specify the tangible objectives to improve the trajectory”The supports I needed to participate were available 0 0 2 12 “I like the Zoom platform”
“The presentation was clear”
“Visual tool to support the discussion”
“The meeting was excellent in every way. What’s more, the researchers present were excellent communicators”“Allow more time for personal reflection” I had enough information to contribute to the topic being discussed 0 0 6 8 “Since I received the agenda and presentation materials in advance, I was able to prepare for the meeting”
“It was interesting to see all the elements that had been added following the individual exercise carried out by each participant before the discussion”“It would have been interesting to give a little more context before the meeting to fully understand the objective of the meeting in the project”
“In my opinion, to improve sharing, a questionnaire covering the same questions could have been made available before the exchange to go into greater depth”I was able to express my views freely 0 0 0 14 “I appreciated that we all had the opportunity to express ourselves. The screen tour after each question was very helpful in allowing everyone to participate” … I feel that my views were heard 0 0 0 14 “I really liked the dynamism of the group. It was a very respectful environment” … A wide range of views on the topics discussed was shared 0 0 5 9 “People with extensive experience in the health and social services network” “It would have been interesting to have a few more people working in the community”
“It would have been interesting to have a wider range of professionals. Most of the participants were doctors”The individuals participating in the activities represented a broad range of perspectives on the topic 0 3 3 8 “I really liked the diversity of the group” “It would have been interesting to have a wider range of experience. A variety of patient partners in their personal experience”
“I don’t know if there were other groups, but the sample seemed small to me, and we didn’t have people from the regions or medical specialists”I think that the project achieved its objectives 0 1 8 5 “This project is a synthesis of all the needs and concerns of seniors and also caregivers” “I hope that the points raised can help to improve the health care system. It’s difficult even for health care workers to navigate this system…” I am confident that the research team has taken the information gathered into consideration 0 0 0 14 “An excellent team that has the well-being of seniors at heart. A presenter who knows her subject very well. A researcher who is concerned about innovation in supporting a meeting” … I think the input provided through this activity will make a difference 0 3 6 5 “I sincerely believe that we are in the midst of a change in senior care. Each new initiative is one step closer to getting there” “I am not sure that there is ministerial listening which has more quantitative than qualitative indicators, and because the vision of older people and their needs is based on a hospital-centric approach” As a result of my participation, I am better informed 0 3 5 6 “Thank you for allowing me to participate. It allowed me to add new elements to my toolbox which will serve as a reflection in other projects on the subject” “It could have been interesting to have managers with clinicians. There is often a lack of communication and listening between managers and clinicians” Overall, I was satisfied with this engagement initiative 0 0 4 10 “I greatly appreciated the initiative of this project” “It might be a good idea to give each participant as much time as possible” This engagement initiative was a good use of my time 0 0 6 8 “It’s a pleasure to participate, share, and learn” “Interested in knowing the results” Note: The strongly disagree option was never chosen and is not presented.
↵a Translated from French.
1. Recruit diverse participants from research network. 2. Repeat the research objectives and potential implications throughout the study. 3. Use effective communication tools (ie, remote technologies and visual representations) as much as possible. 4. Add an individual pre-elicitation activity before group discussions and explicitly state the objective of the activity. 5. Adapt discussions to the needs and preferences of stakeholder group. 6. Hold 1 or 2 rounds of group discussions depending on if consensus reached and time constraints.
PLAIN-LANGUAGE ARTICLE SUMMARY
Methodology
Adapted Nominal Group Technique Effectively Builds Timely Consensus on Health Care Priorities for Older Adults
Background and Goal:The participatory research approach is an important tool of family medicine and primary health care research, but standard consensus methods like the Delphi and nominal group techniques can be time-consuming and may not represent a broad range of opinions. To address these issues, researchers developed an adapted nominal group technique (aNGT) to efficiently build consensus among stakeholders with diverse perspectives.
Approach:This study focused on shaping care trajectories for adults aged 65 and older, aiming to prioritize key domains and identify new care indicators. Researchers used four main strategies: (1) recruiting four diverse stakeholder groups (older adults, clinicians, managers, and decision makers) through purposeful and snowball sampling; (2) using remote tools to maximize participation; (3) adding a pre-elicitation activity so participants could individually review study materials and rank domains before group discussions; and (4) tailoring discussions to each group’s needs by, for example, scheduling meetings around lunch for clinicians and avoiding jargon.
Main Results:Of 28 participants who completed the questionnaire, 20 joined a group discussion. Through the pre-elicitation activity and one round of discussions, participants reached a consensus on prioritizing “symptoms, functioning, and quality of care.” Tailored discussions and remote tools were the most effective strategies in the process.
Why It Matters:By addressing traditional consensus-building challenges, the aNGT fosters inclusivity, efficiency, and relevance, making it a valuable approach for research that informs care standards. This study provides a practical model for inclusive research design, showing how to streamline consensus-building while ensuring that stakeholder voices drive meaningful health care outcomes.
Building Timely Consensus Among Diverse Stakeholders: An Adapted Nominal Group Technique
Deniz Cetin-Sahin, MD, PhD, et al
Lady Davis Institute for Medical Research at the Jewish General Hospital, Montreal, Quebec, Canada
Department of Family Medicine, McGill University,
Montreal, Quebec, Canada
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