Criteria for designing integrated diagnosis interventions in low resource settings at the primary care level: a Delphi consensus study

Journal article

Background: Integrated diagnosis is crucial for addressing health challenges, particularly in managing comorbidities and chronic conditions. Technological advancements allow for rapid, simultaneous testing and diagnosis of multiple diseases. Integrated diagnosis interventions vary in purpose, models, diseases targeted, populations served, scale, and measured outcomes. This diversity, combined with varying levels of resource availability and health system capacity to respond effectively to positive diagnoses, makes it challenging to identify effective strategies. An effective integrated diagnosis approach can lead to early detection of critical and chronic conditions, improve patient experiences, and ultimately improve disease surveillance. This study aimed to establish core criteria for designing same-day integrated diagnosis interventions in primary care settings to enhance patient experiences and health outcomes in low- and middle-income countries (LMICs). The initial set of criteria was derived from a realist synthesis, which identified the key contextual factors and mechanisms required for such interventions to be effective. Methods: A two-round Delphi process engaged an international panel of fifty-five experts from diverse professions to establish consensus on core criteria for effective integrated diagnosis interventions. Predetermined consensus thresholds were set at 70% for critical to include. Results: A total of 55 experts participated in the first round. Participants represented various geographical regions, including Africa (n = 33), Europe (n = 17), Asia (n = 2), and the Americas (n = 2), and could be categorized into implementers (n = 36), policymakers (n = 7), and academics (n = 12). At the end of Round 1, fourteen of the thirty-three criteria reached a consensus as being critical to include, and nine criteria were removed. In Round 2, a total of 48 out of 55 experts participated and twelve criteria were considered. Four criteria reached a consensus as being critical to include. Through the two rounds of surveys, experts reached a consensus on 18 criteria. Conclusion: The study provides key criteria for prioritizing and developing integrated diagnosis interventions in primary care, in low-resource settings, particularly in Africa. The guidance might be invaluable for policymakers, funders, implementers, and manufacturers. The primary goal of integrated diagnosis is to enhance patient experiences and health outcomes. It is essential to consider all critical success factors during intervention design. These criteria may evolve as our understanding of integrated diagnosis advances.

Authors: Gwaza, GP; Plüddemann, A; MacBain McCall, M; Dittrich, S; Heneghan, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: BMC Health Services Research
• Volume: 25
• Issue: 1
• Article number: 1130
• Publication date: 2025-08-25
• Acceptance date: 2025-06-26
• DOI: 10.1186/s12913-025-13114-9
• EISSN: 1472-6963
• ISSN: 1472-6963
• Language: English
• Keywords: Integrated diagnosis; Primary health care; Delphi; Africa