Assessing best practices on short-term medical service trips: an eDelphi-based theoretical model

Abstract

Background: Short-term, primary-care medical service trips (MSTs) are a controversial modality for addressing the health of marginalised populations and responding to the burden of communicable and non-communicable diseases. As a health-care delivery model, MSTs are challenged by concerns over sustainability, fragmentation of care in host communities, and degree of preparedness among volunteers. Despite the increasing prevalence of such trips, no single framework is routinely used to evaluate their quality. We aimed to develop a literature-based tool for assessing the practices of volunteer MSTs and to validate this tool among stakeholders. Methods: We reviewed recent literature to construct a preliminary list of commonly discussed MST best practices. A multidisciplinary panel of academic experts, medical professionals, MST programme coordinators, and non-medical MST volunteers participated in a three-round e-Delphi consensus-building exercise to revise the preliminary list. A 7-point Likert scale was used, with mean scores of 4–7 resulting in rejection of the element, scores less than 2 resulting in acceptance, and scores in between being redistributed for further discussion in rounds two and three. Findings: The preliminary framework consisted of 30 elements sorted into six domains: preparedness, impact and safety, efficiency, cost-effectiveness, sustainability, and education. The 26 stakeholders on the eDelphi panel reached consensus on 18 desirable elements to include in the final framework for an effective MST. The elements of the final framework were directly adapted to create a rating scale for medical professionals and trainees to evaluate the practices of volunteer-sending organisations listed in a large online database (http://www.medicalservicetrip.com). Interpretation: Evaluation of such practices will allow volunteers to select quality opportunities with effective, sustainable health-care delivery models. Future research should extend this study by initiating a dialogue on best practices between host communities, local clinicians, and MST-sending organisations. Funding: None.