Example: clinical guideline study
This worked example describes a modified e-Delphi study to define core competencies for rural telehealth nursing — from design through two rounds to final report.
Research question
What competencies must registered nurses demonstrate to deliver safe, effective telehealth in rural primary care settings?
Study configuration
| Setting | Value |
|---|
| Preset | Modified e-Delphi |
| Panel target | 18 nurses (rural practice ≥ 2 years) |
| Items | 22 competency statements across 4 domains |
| Scale | 5-point agreement Likert |
| Rounds | 2 planned, max 3 |
| Consensus | ≥80%, median ≥ 4, IQR ≤ 1 |
Domain taxonomy
| Domain | Items | Example statement |
|---|
| Clinical assessment | 6 | Conducts video-based vital sign interpretation with patient coaching |
| Technology | 5 | Troubleshoots connectivity issues without abandoning the visit |
| Communication | 6 | Documents telehealth consent before each encounter |
| Equity & access | 5 | Adapts teaching for low health-literacy patients via video |
Phase 1 — Design (Week 1)
Wizard highlights:
- IRB exemption number captured on Identity step
- Expertise fields:
years_rural, primary_setting, state
- Comment required on ratings ≤ 2 (identify weak competencies)
- Round window: 12 days; reminders configured as offsets before close (5 days and 1 day)
Phase 2 — Round 1 (Weeks 2–3)
| Metric | Result |
|---|
| Invited | 18 |
| Accepted | 16 |
| Round 1 responses | 15 (94% of accepted) |
| Consensus agree | 9 items |
| Indeterminate | 11 items |
| Consensus disagree | 2 items |
Indeterminate example:
"Should interpret 12-lead ECG independently during telehealth visits."
| Stat | Value |
|---|
| Median | 3 |
| IQR | 2 |
| % agree | 47% |
Qualitative comments (approved for feedback) cited scope-of-practice concerns.
Phase 3 — Between rounds (Week 4)
| Action | Detail |
|---|
| Revise 8 items | Narrowed scope based on qual themes |
| Drop 2 items | Consensus disagree — outside nursing role |
| Retain 9 items | No re-rating needed |
| Lock feedback | Median + IQR + 3 approved comments per item |
| Plan Round 2 | 11 items (revised + indeterminate) |
Phase 4 — Round 2 (Weeks 5–6)
| Metric | Result |
|---|
| Responses | 14 (93%) |
| New consensus agree | 8 of 11 active |
| Still indeterminate | 3 |
| Stable (Δ median = 0) | 2 of 3 remaining |
Stopping decision: Max useful movement achieved; 3 items documented as unresolved in discussion. Study marked complete.
Final output set
| Category | Count |
|---|
| Retained competencies | 17 |
| Dropped | 2 |
| Unresolved (reported with caveat) | 3 |
Exports generated
| Export | Use |
|---|
| CREDES DOCX | Journal submission draft |
| Consensus table CSV | Supplementary material |
| REFI-QDA | Secondary qualitative analysis |
| Trace bundle | IRB closeout |
Methods paragraph (excerpt)
We conducted a two-round modified e-Delphi study with 16 rural telehealth nurses. Consensus was defined a priori as ≥80% agreement (rating 4–5) with median ≥ 4 and IQR ≤ 1 on a 5-point Likert scale. Controlled feedback included group median, IQR, and de-identified comments between rounds. Methodology was frozen at study activation (launch snapshot v1.2).
Lessons learned
| Lesson | Delphi Studio feature used |
|---|
| Pre-specify comment rules early | Rating & consensus step |
| Qual themes informed revision | Round qual run + codebook |
| Document unresolved items | Disposition override + report |
| Prove reproducibility | Trace bundle |
Next steps