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

Abstract 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 outcomes, which complicates identifying 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). 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 is 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. The study emphasizes taking a holistic approach that addresses the full spectrum of patient needs and integrates with other aspects of the healthcare system. These criteria may evolve as our understanding of integrated diagnosis advances.