gms | German Medical Science

Background: Iodine deficiency is one of the most prevalent causes of mental development disorders in children and can lead to impaired thyroid function and other iodine deficiency disorders (IDDs). Although substantial progress has been made in the last decades in eliminating iodine deficiency, IDDs are still prevalent in European countries. Challenges remain due to fragmentation and diversity of prevention and monitoring programs and differences between countries. Additionally, already initiated IDD prevention and monitoring programs may not remain effective, for example, because of changes in the health care policy or high costs. However, the barriers against the implementation and continuation of the prevention and monitoring of IDD remain unclear. Therefore, the objective of our study was to identify potential barriers for implementing pan-European IDD prevention and monitoring programs and to find solutions for the different barriers.

Methods: We applied a modified Delphi method (RAND/UCLA Appropriateness Method), including the possibility to discuss given answers within the different Delphi rounds. We selected potential participants with expertise and experience in relevant fields including policy makers, healthcare professionals, health scientists, and patient representatives from all European countries. The Delphi method was conducted with open-ended questions and item ranking to achieve group consensus on potential barriers against pan-European IDD prevention and monitoring programs and related solutions to overcome those barriers. The answers of the Delphi rounds were analyzed using qualitative content analysis and descriptive statistical analysis methods. In addition, we conducted two expert interviews to analyze and discuss the results of the Delphi study.

Results: 80 experts from 36 countries and different fields of work participated in the first Delphi round, 52 in the second and 46 in the third Delphi round. The work field-specific response rate in the first Delphi round ranged from five to 38 percent. More than 90 percent of the experts rated national and pan-European IDD prevention and monitoring programs important or very important. Potential barriers for the implementation of national prevention and monitoring programs include challenges in the fields of knowledge and information, implementation and management, and communication and cooperation. Mentioned barriers for the implementation of a pan-European prevention program were differences between the countries, lack of political support and challenges in the field of implementation and management. Solutions addressing these barriers were suggested by the experts and include cooperation with different stakeholders, gaining knowledge, sharing information, as well as the development of a European program with national specification, European guidelines/recommendations and European monitoring.

Conclusion: In our study, we derived key information and first insights with regard to barriers against IDD prevention programs from a broad range of stakeholders. The Delphi technique is an innovative approach to gain a broad overview of possible barriers and to involve experts from different countries and fields of work. The results raise awareness of challenges and potential solutions for the implementation of national and pan-European IDD prevention and monitoring program. This information may help decision makers in health policy for the development IDD prevention strategies.

This work was supported by EUthyroid. The project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 634453.

The authors declare that a positive ethics committee vote has been obtained.