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our study, we composed an assessment tool in the form of a
checklist based on them. Because our research is focusing on the
concept of “intercultural opening” as it moves at an abstract and
cross- institutional level, tailoring different modules for different
settings of institutions was deemed unnecessary. For general
information about the institutions in the study, we used one part
of a questionnaire from a former study project. The preliminary
assessment tool we developed included 17 different parts and
17.5 pages.
A further review of the instrument was essential in order
to insure that the developed tool incorporated all facets of
“intercultural opening”, that it was applicable to every type of
institution later assessed and to shorten it. We used two methods
combining theoretical and practical views in two subsequent
steps.
3.2. Web- based, two- round
consensus- oriented Delphi process
As the concept of “intercultural opening” is an expertdesigned
concept, in a fi rst step, we used a web- based expert
interview, based on a two- round consensus- oriented Delphi
process [21] to review the developed instrument for missing
aspects of the instrument and, if possible, to shorten it.
The general idea of the Delphi approach is to collect expert
opinions on a topic in successive interview rounds and to publish
the anonymous results from each round to everybody in the
next round. Some Delphi approaches are consensus- oriented,
which means that the desired goal of the Delphi process is
consensus. The number of participants in Delphi processes
has varied in other studies [11]. We decided to interview 12
leading German experts (see acknowledgment) with experience
and/or expertises in the fi elds of immigration, improving
access to care for migrants, and the concept of “intercultural
opening”. These experts come from both scientifi c and practical
background, which also speaks to their different views on the
topic of “intercultural opening”. The participants were chosen
by conducting a research for experts in these fi elds as well
as by recommendations of experts [11]. They were contacted
by email and asked for their participation. Only four out of
the twelve selected experts declined participation and were
substituted by four different recommended experts from the
same areas as those who had declined to participate. One expert
had to be excluded after the fi rst round due to incomplete
answers.
3.2.1. First round of Delphi process
The first round of the Delphi process via internet was
conducted from October 2010 until early January 2011. A
website was created displaying the preliminary assessment
tool as developed to that point. In the fi rst round, three questions
were used to evaluate each item in the assessment tool
and its corresponding response categories. The fi rst question
concerned the signifi cance of the particular items in the context
of “intercultural opening”, with the response categories “very
important”, “important”, “less important” and “not important
S. Penka et al. / European Psychiatry 27 (2012) / supplement n°2 / S63-S69 S65
at all”. The other questions asked for an assessment of the question’s
wording and for comments on the questions/items and
response categories in general. Overall 170 items had to be rated
by the interviewed experts. After the data were collected, the
results of the fi rst round were analysed.
Because of our primary goal of shortening the tool, essential
criterion were defi ned as being rated “important” or “very
important” by every expert. Each item that was judged as either
“important” or “very important” by all experts (“Md” 12) was
considered consensual and essential for determining the status of
“intercultural opening”. Items reaching this criterion were kept
in the assessment tool. Those which did not reach the criterion
were presented again for evaluation in the following round.
3.2.2. Results of the fi rst round of Delphi process
In the first round, 62 items reached the definition of
consensus and were therefore approved for use in the assessment
tool, thus playing no further role in the second round.
108 items, on the other hand, had failed this condition, not
having been judged as “important” or “very important” by all
experts. However, the majority of these items were judged as
less or not important by only one or two experts. 41 items, for
example, had been rated by only one expert as “less important”,
while 13 by only one expert as “not at all important”.
54 items thereby only reached Md= 10 within the fi eld of
“importance”. 31 items had been judged by two experts as
not (very) important (Md= 9).
In addition, we worked some changes into the questionnaire
based on the comments given regarding the open questions.
Some items were made more specifi c, as experts had told us that
they could easily be misunderstood. Some response categories
were added that experts had missed. Some questions were split
into two, which explains the higher number of items to be judged
in the second round.
Proofs
3.2.3. Second round of Delphi process
The second round of Delphi process took place between
January and February 2011. We displayed the revised questionnaire
on the website. Only the 116 items and the corresponding
response not found consensual in the fi rst round were included.
Every participant was asked to evaluate them again. We published
the ratings of each of these items in the fi rst Delphi round.
In order to get new refl ections and judgement of the topic and
to avoid simple repetition, we did not inform participants about
their own previous judgements [11].
3.2.4. Results of the second round of Delphi process
We analysed the collected data using the same criterion
as in the fi rst round. However, after the second round items
which did not reach the criterion of consensus were taken
out of the assessment tool. 65 items reached consensus in the
second round while 51 did not. Again the majority of these
items were judged as less or not important by no more than