Delphi Process

We applied a standard consensus-based Delphi methodology to refine the framework, operational definitions, and instrument [^{35, 36}]. The Delphi approach was selected as it is designed to transform expert opinion into group consensus through rounds of individual voting [³⁵]. In the current study, during each Delphi round, panelists were asked to rate the importance and appropriateness of item language on a 3- or 5-item Likert-scale (see Table ​Table2).2). Table ​Table22 provides a summary of the focus and results of each round of the Delphi panel. Panelists were provided opportunities to explain their quantitative ratings, to suggest additional wording changes, and to provide suggestions for new domains, subdomains, key terms, definitions, and questions. Rounds 1, 2, 4, and 5 were disseminated using the online Qualtrics platform. Items were added and modified after feedback from each round. For the third Delphi round, panelists were presented with the full CREAT instrument, and asked to rate whether the question stem and responses should be excluded, included with revisions, or included as is (306 different questions included in round 3). Panelists were also encouraged to propose changes and indicate if question instructions were clear enough. Due to the length of the CREAT instrument, the round 3 questionnaire was e-mailed to panelists as pdf and word files. In round 2, one panelist’s responses were excluded because quantitative and qualitative responses to the same questions were inconsistent, thus raising concerns of reverse scoring by that respondent. Repeated attempts to clarify the inconsistencies were not successful.

Summary of Delphi rounds

¹Accepted – IQR < 1.5 & median > 3.5

²Needs revision – (median < 3.5 or IQR ≥ 1.5)

³As participation varied across rounds, this column reports the proportion of community researchers completing each round

⁴Three panelists withdrew between rounds 3 and round 4