By Paula T. Whitacre
Colombia’s 47 million people live in a range of environments, including urban areas, rainforests, the Andes mountains, and coastal areas. According to the World Health Organization, environmental factors contribute to about 16 percent of the country’s burden of disease.
Researchers from the Universidad Industrial de Santander in Bucaramanga and the University of Wisconsin sought to learn how environmental and occupational health experts in Colombia perceive their country’s highest-priority exposures, the impact of these exposures on health, and the research and training needed as a result.
The two institutions created and now collaborate through the GEOHealth Hub Colombia. With an initial planning grant funded by the NIH Fogarty International Center (FIC) and NIEHS, the Hub’s goal is to strengthen capacity for research, training, and policy formulation in South America.
To gain the insight necessary to meet the Hub’s goal, the researchers selected experts to participate in a hybrid Delphi survey that included three rounds of online questionnaires and an in-person meeting. At the end of the 6-month process, the experts reached a consensus on needs and opportunities, information that can help guide national research and training priorities, according to Laura Rodriguez Villamizar, M.D., of the Universidad Industrial de Santander. (See box for more information about this method.)
“Getting such heterogeneous data is complex, and there are not many studies on these issues, especially in developing countries,” said Leonelo Bautista, M.D., Dr.P.H., University of Wisconsin. “A Delphi study is a quick and effective opportunity to gather information from experts. It is a systematic approach to get an idea of perceived needs and opportunities.”
To identify the experts who would participate in the Delphi survey , the researchers invited 18 experts from academic institutions, research centers, and the government to a face-to-face meeting to introduce the study. “In Latin America, and perhaps other cultures, meeting people face to face early in the process facilitates things,” said Bautista. “After that, an online survey works, but the first contact should be personal.”
The initial group, in turn, identified other colleagues, so the researchers had a pool of almost 70 people from which to select 20 to 30 experts. Three rounds of screening included a review of potential participants’ experience in health research, training, and policy making; institutional affiliations; publication and research history; and other factors. Of the 27 experts who met the study criteria, 23 accepted the invitation to participate. About 15 completed the online questionnaires and attended an in-person meeting between the second and third rounds.
Participants had access to a website protected with usernames and passwords to provide their responses, which were anonymized when shared with the larger group.
Drawing on potential topic areas compiled by the Pan American Health Organization, the first round of the survey asked the experts to identify environmental and occupational exposures with the highest impact on health in Colombia, both currently and 10 years in the future, by assigning numeric scores ranking the exposures and their impacts. They also were asked to suggest up to three research priority areas.
In the second round, participants responded to the findings from the first round. To do this, they were asked to distribute a hypothetical amount of money in research and training within each priority area.
Between the second and third rounds, the researchers held an in-person meeting for the participants. “We wanted to capture the disparities between the experts on the topics and reach consensus in a plenary,” Rodriguez Villamizar explained. “It was also important to give them the opportunity to raise other issues that could be important for research.”
By the end of the third round, the expert consensus pointed to chemical exposures and hazardous waste as well as air pollution as the most significant exposures. The greatest research need identified through the survey: research on the effects of outdoor air pollution on cardiovascular and respiratory diseases. Priority training areas included risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology.
Identifying Next Steps
In 2014, after completing the data analysis, the team held a meeting to present the findings and other activities of the GEO HealthHub to the experts, as well as more broadly to key players in environmental and occupational health in government agencies, non-governmental organizations, and academia.
“Doing this type of work is important because you reach a consensus about needs and opportunities — and you find out the gaps,” said Rodriguez Villamizar, citing a lack of training on environmental health in Colombia’s post-graduate programs as an example. The Hub is working on filling this gap by developing a high-quality seminar on environmental health, with a longer-term goal of setting up a collaborative degree program.
The RAND Corporation developed the Delphi method in the 1950s. It involves a group of experts who anonymously reply to questionnaires and subsequently receive feedback in the form of a statistical representation of the ‘group response,’ after which the process repeats itself. The goal is to reduce the range of responses and arrive at something closer to expert consensus.
In the hybrid approach described here, the researchers interspersed in-person meetings with the questionnaires. As they explained, “This hybrid approach combined with online tools outperforms the traditional paper-based design, since reliable consensus among experts is reached in less time.” To get around the fact that a face-to-face meeting compromises the anonymity that characterizes the questionnaire responses, the team kept individual responses confidential.