Skip to main content

Exploring International Views on Key Concepts for Mass-gathering Health through a Delphi Process

  • Malinda Steenkamp (a1) (a2), Alison E. Hutton (a1) (a3), Jamie C. Ranse (a4), Adam Lund (a5) (a6) (a7), Sheila A. Turris (a5) (a6) (a7), Ron Bowles (a7), Katherine Arbuthnott (a8) and Paul A. Arbon (a1) (a2) (a3)...

The science underpinning mass-gathering health (MGH) is developing rapidly. However, MGH terminology and concepts are not yet well defined or used consistently. These variations can complicate comparisons across settings. There is, therefore, a need to develop consensus and standardize concepts and data points to support the development of a robust MGH evidence-base for governments, event planners, responders, and researchers. This project explored the views and sought consensus of international MGH experts on previously published concepts around MGH to inform the development of a transnational minimum data set (MDS) with an accompanying data dictionary (DD).


A two-round Delphi process was undertaken involving volunteers from the World Health Organization (WHO) Virtual Interdisciplinary Advisory Group (VIAG) on Mass Gatherings (MGs) and the MG section of the World Association for Disaster and Emergency Medicine (WADEM). The first online survey tested agreement on six key concepts: (1) using the term “MG HEALTH;” (2) purposes of the proposed MDS and DD; (3) event phases; (4) two MG population models; (5) a MGH conceptual diagram; and (6) a data matrix for organizing MGH data elements. Consensus was defined as ≥80% agreement. Round 2 presented five refined MGH principles based on Round 1 input that was analyzed using descriptive statistics and content analysis. Thirty-eight participants started Round 1 with 36 completing the survey and 24 (65% of 36) completing Round 2. Agreement was reached on: the term “MGH” (n=35/38; 92%); the stated purposes for the MDS (n=38/38; 100%); the two MG population models (n=31/36; 86% and n=30/36; 83%, respectively); and the event phases (n=34/36; 94%). Consensus was not achieved on the overall conceptual MGH diagram (n=25/37; 67%) and the proposed matrix to organize data elements (n=28/37; 77%). In Round 2, agreement was reached on all the proposed principles and revisions, except on the MGH diagram (n=18/24; 75%).


Event health stakeholders require sound data upon which to build a robust MGH evidence-base. The move towards standardization of data points and/or reporting items of interest will strengthen the development of such an evidence-base from which governments, researchers, clinicians, and event planners could benefit. There is substantial agreement on some broad concepts underlying MGH amongst an international group of MG experts. Refinement is needed regarding an overall conceptual diagram and proposed matrix for organizing data elements.

Steenkamp M , Hutton AE , Ranse JC , Lund A , Turris SA , Bowles R , Arbuthnott K , Arbon PA . Exploring International Views on Key Concepts for Mass-gathering Health through a Delphi Process. Prehosp Disaster Med. 2016;31(4):443453.

Corresponding author
Correspondence: Malinda Steenkamp, PhD Torrens Resilience Institute, Flinders University Box 15, Mark Oliphant Building Laffer Drive, Bedford Park South Australia 5042 E-mail:
Hide All
1. World Health Organization. Public Health for Mass Gatherings: Key Considerations. Geneva, Switzerland: World Health Organization; 2015: 1-177.
2. Arbon, P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131-135.
3. Lund, A, Turris, SA, Bowles, R, et al. Mass-gathering health research foundational theory: part 1 - population models for mass gatherings. Prehosp Disaster Med. 2014;29(6):648-654.
4. Ranse, J, Hutton, A, Turris, S, et al. Enhancing the minimum data set for mass-gathering research and evaluation: an integrative literature review. Prehosp Disaster Med. 2014;29(3):280-289.
5. Arbon, P, Cusack, L, Verdonk, N. Mass gathering public health and emergency medicine literature review: levels of evidence. Australasian Journal of Paramedicine. 2013;10(1):1-5.
6. Turris, SA, Steenkamp, M, Lund, A, et al. International consensus on key concepts and data definitions for mass gathering health: process and progress. Prehosp Disaster Med. In press.
7. Keeney, S, Hasson, F, McKenna, H. “Analyzing data from a Delphi and reporting results.” In: Keeney S, McKenna H, (eds). The Delphi Technique in Nursing and Health Research. Malaysia: Wiley-Blackwell; 2011: 84-95.
8. Homer, J, Hirsch, G. System dynamics modeling for public health: background and opportunities. Am J Public Health. 2006;96(3):452-458.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed