Developing a tool for supporting health-system guidance implementation paper 1: a modified Delphi method to develop the tool components

Objectives To identify consensus-based components for a tool to support health-system guidance (HSG) implementation. Study Design and Setting This study was undertaken in two steps. First, candidate components were operationalized from a previously developed theoretical framework and refined using selected HSG examples. Second, a two-round modified Delphi study was conducted on a web-based platform to select and reach consensus on these components. An international panel of experts rated their agreement using a 7-point Likert scale, and descriptive analyses were performed. Results An initial set of 40 candidate items was evaluated through the modified Delphi process. Two survey rounds were completed, with response rates of 59% (32 invitees) in the first round and 63% (30 invitees) in the second, achieving satisfactory diversity among participants. In the first round, 31 items met the predefined criteria for inclusion, and a further six items met these criteria in the second round. Following qualitative feedback and research team discussions, several items were refined, merged, or removed, resulting in a final set of 33 components organized across six levels. Conclusion The modified Delphi study yields a final set of consensus-based components to support HSG implementation, representing a transition from a theoretical framework toward the development of a practical HSG implementation tool.