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Reaching consensus on the definition of modifiable determinants of health: a Delphi study

Sebastian Stannard Orcid Logo, Kim Alipio, Ann Berrington, Shantini Paranjothy, Rebecca B Hoyle Orcid Logo, Rhiannon Owen Orcid Logo, Simon DS Fraser, Emilia Holland, Nisreen A Alwan

BMJ Public Health, Volume: 4, Issue: 1, Start page: e004189

Swansea University Author: Rhiannon Owen Orcid Logo

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DOI (Published version): 10.1136/bmjph-2025-004189

Abstract

Introduction The term ‘modifiable risk factor’ and similar variations of the expression are common across health literature. Despite this, there is no universal definition for what would be modifiable when considering the factors that increase risk of ill health or enable good health and well-being....

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Published in: BMJ Public Health
ISSN: 2753-4294
Published: BMJ Publishing Group Ltd. 2026
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We conducted a Delphi study aiming to reach consensus among interdisciplinary experts on the definition and conceptualisation of what would be considered &#x2018;modifiable&#x2019; as health determinants. Methods The Delphi statements were based on initial criteria conceptualised by the research team and published in an opinion article. 103 experts from a range of interdisciplinary backgrounds were invited to participate in the Delphi. The statements were adjusted based on the results of the first round and circulated to participants in a second round. Results 33 experts completed the first round. 4 out of 10 statements achieved consensus (&#x2265;70%). 30/33 (90%) of experts completed the second round, and a further one out of three statements achieved consensus. Combining results from both rounds, we have reached this definition: &#x2018;A modifiable health determinant must be potentially changeable through direct and/or indirect interventions at the individual or population levels, and it must be possible to quantify or describe such change in some way. Whether a health determinant is modifiable is context- and system-dependent (including the social, economic, political, commercial and environmental contexts); therefore, transparent consideration of a context-dependent definition is recommended in research design and reporting&#x2019;. Conclusions This study offers a consensus-based view on what can be considered &#x2018;modifiable&#x2019;. 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spelling 2026-02-25T14:31:20.7773665 v2 71497 2026-02-25 Reaching consensus on the definition of modifiable determinants of health: a Delphi study 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false 2026-02-25 MEDS Introduction The term ‘modifiable risk factor’ and similar variations of the expression are common across health literature. Despite this, there is no universal definition for what would be modifiable when considering the factors that increase risk of ill health or enable good health and well-being. We conducted a Delphi study aiming to reach consensus among interdisciplinary experts on the definition and conceptualisation of what would be considered ‘modifiable’ as health determinants. Methods The Delphi statements were based on initial criteria conceptualised by the research team and published in an opinion article. 103 experts from a range of interdisciplinary backgrounds were invited to participate in the Delphi. The statements were adjusted based on the results of the first round and circulated to participants in a second round. Results 33 experts completed the first round. 4 out of 10 statements achieved consensus (≥70%). 30/33 (90%) of experts completed the second round, and a further one out of three statements achieved consensus. Combining results from both rounds, we have reached this definition: ‘A modifiable health determinant must be potentially changeable through direct and/or indirect interventions at the individual or population levels, and it must be possible to quantify or describe such change in some way. Whether a health determinant is modifiable is context- and system-dependent (including the social, economic, political, commercial and environmental contexts); therefore, transparent consideration of a context-dependent definition is recommended in research design and reporting’. Conclusions This study offers a consensus-based view on what can be considered ‘modifiable’. Having a common understanding of the term facilitates interdisciplinary collaboration in health research and translation of findings to policy and practice. Journal Article BMJ Public Health 4 1 e004189 BMJ Publishing Group Ltd. 2753-4294 16 2 2026 2026-02-16 10.1136/bmjph-2025-004189 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee National Institute for Health Research Grant: NIHR203988 2026-02-25T14:31:20.7773665 2026-02-25T14:04:23.9263123 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Sebastian Stannard 0000-0002-6139-1020 1 Kim Alipio 2 Ann Berrington 3 Shantini Paranjothy 4 Rebecca B Hoyle 0000-0002-1645-1071 5 Rhiannon Owen 0000-0001-5977-376X 6 Simon DS Fraser 7 Emilia Holland 8 Nisreen A Alwan 9 71497__36315__c8c08790c336489db1f946c60f549bda.pdf 71497.VOR.pdf 2026-02-25T14:27:51.5185335 Output 664746 application/pdf Version of Record true © Author(s) (or their employer(s)) 2026. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Reaching consensus on the definition of modifiable determinants of health: a Delphi study
spellingShingle Reaching consensus on the definition of modifiable determinants of health: a Delphi study
Rhiannon Owen
title_short Reaching consensus on the definition of modifiable determinants of health: a Delphi study
title_full Reaching consensus on the definition of modifiable determinants of health: a Delphi study
title_fullStr Reaching consensus on the definition of modifiable determinants of health: a Delphi study
title_full_unstemmed Reaching consensus on the definition of modifiable determinants of health: a Delphi study
title_sort Reaching consensus on the definition of modifiable determinants of health: a Delphi study
author_id_str_mv 0d30aa00eef6528f763a1e1589f703ec
author_id_fullname_str_mv 0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
author Rhiannon Owen
author2 Sebastian Stannard
Kim Alipio
Ann Berrington
Shantini Paranjothy
Rebecca B Hoyle
Rhiannon Owen
Simon DS Fraser
Emilia Holland
Nisreen A Alwan
format Journal article
container_title BMJ Public Health
container_volume 4
container_issue 1
container_start_page e004189
publishDate 2026
institution Swansea University
issn 2753-4294
doi_str_mv 10.1136/bmjph-2025-004189
publisher BMJ Publishing Group Ltd.
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
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description Introduction The term ‘modifiable risk factor’ and similar variations of the expression are common across health literature. Despite this, there is no universal definition for what would be modifiable when considering the factors that increase risk of ill health or enable good health and well-being. We conducted a Delphi study aiming to reach consensus among interdisciplinary experts on the definition and conceptualisation of what would be considered ‘modifiable’ as health determinants. Methods The Delphi statements were based on initial criteria conceptualised by the research team and published in an opinion article. 103 experts from a range of interdisciplinary backgrounds were invited to participate in the Delphi. The statements were adjusted based on the results of the first round and circulated to participants in a second round. Results 33 experts completed the first round. 4 out of 10 statements achieved consensus (≥70%). 30/33 (90%) of experts completed the second round, and a further one out of three statements achieved consensus. Combining results from both rounds, we have reached this definition: ‘A modifiable health determinant must be potentially changeable through direct and/or indirect interventions at the individual or population levels, and it must be possible to quantify or describe such change in some way. Whether a health determinant is modifiable is context- and system-dependent (including the social, economic, political, commercial and environmental contexts); therefore, transparent consideration of a context-dependent definition is recommended in research design and reporting’. Conclusions This study offers a consensus-based view on what can be considered ‘modifiable’. Having a common understanding of the term facilitates interdisciplinary collaboration in health research and translation of findings to policy and practice.
published_date 2026-02-16T05:37:38Z
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