Using Internet-based nominal group technique meetings to identify provider strategies for increasing diaphragm use

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Abstract
Background and methodology The diaphragm, once the most commonly used female contraceptive method, is being re-evaluated for prevention against some sexually transmitted infections (STIs), including HIV. However, provider views about this prescription-based method are poorly understood. Using expert panels, this study aimed to identify facilitative strategies to increase diaphragm use. The nominal group technique (NGT) was employed using a novel web-based interface to systematically elicit and prioritise responses to a specific question about what can be done to encourage providers to recommend diaphragm use. Two NGT sessions were convened with 15 geographically dispersed panellists who had extensive knowledge and experience with the diaphragm. Participants were identified using purposeful and snowball sampling. Results Panel 1 identified 22 strategies for encouraging providers to recommend diaphragm use, with seven perceived as relatively more important (67% of the total available votes). Panel 2 identified 31 strategies, nine of which accounted for 77% of the votes. Both sessions highlighted that to make the diaphragm a more plausible option, educational materials and tools are needed to better inform providers and patients about the method and its specific advantages. Conclusions The enhanced, Internet-based NGT offers the family planning and reproductive health care field a powerful and inexpensive tool for systematically collecting and analysing expert opinion. Results are being used to develop a questionnaire to further examine strategies that may help promote diaphragm use and to refine ideas for intervention design. This will facilitate method reintroduction, if the diaphragm is proven effective against STIs/HIV, especially when used with a microbicide.

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