(An item from ISHN Member information service) An article in the December 2012 Issue of Social Science & Medicine suggests that realist perspectives should be integrated within random controlled trials in order to better understand the complexity of interventions and how their components and their characteristics interact with the local context. The authors suggest that `Randomized trials of complex public health interventions generally aim to identify what works, accrediting specific intervention ‘products’ as effective. This approach often fails to give sufficient consideration to how intervention components interact with each other and with local context. ‘Realists’ argue that trials misunderstand the scientific method, offer only a ‘successionist’ approach to causation, which brackets out the complexity of social causation, and fail to ask which interventions work, for whom and under what circumstances. We counter-argue that trials are useful in evaluating social interventions because randomized control groups actually take proper account of rather than bracket out the complexity of social causation. Nonetheless, realists are right to stress understanding of ‘what works, for whom and under what circumstances’ and to argue for the importance of theorizing and empirically examining underlying mechanisms.`The authors also propose that ‘realist’ trials should aim to: examine the effects of intervention components separately and in combination, explore mechanisms of change, analysing how pathway variables mediate intervention effects; use multiple trials across contexts; draw on qualitative & quantitative data; and be oriented towards building theories setting out how interventions interact with context. This last suggestion resonates with recent suggestions that, in delivering truly ‘complex’ interventions, fidelity is important not so much in terms of precise activities but, rather, key intervention ‘processes’ and ‘functions’. Read more
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(An item from ISHN Member information service) We have been following articles that discuss behavioural intentions and this latest one indicates that the transparency of BI research may need improvement. An article in the November 2012 issue of Addictions reports on an analysis of BI research studies and " used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) Statement to develop the 59-question Adapted TREND Questionnaire (ATQ). Each ATQ question corresponds to a transparency guideline and asks how clearly a study reports its objectives, research design, analytical methods and conclusions". The authors noted that "The average report adhered to 38.4 (65.1%) of the 59 ATQ transparency guidelines. Each of the 59 ATQ questions received positive responses from an average of 16.9 (63.8%) of the reports." They conclude that " Gambling intervention reports need to improve their transparency by adhering to currently neglected and particularly relevant guidelines. Among them are recommendations for comparing study participants who are lost to follow-up and those who are retained, comparing study participants with the target population, describing methods used to minimize potential bias due to group assignment, and reporting adverse events or unintended effects." Given the potential challenges associated with BI and its importance as a tool for school health studies, where behavioural outcomes are expensive to track for more than a few months after the intervention, this article appears very relevant. Read more.
(An item from ISHN Member information service) Earlier this month, we noted a debate about the usefulness of RCT's in real world conditions that was initiated by a leading authors of systematic reviews, Sarah Stewart-Brown. Two articles in Issue #6, 2012 of the American Psychologist continue these revolutionary thoughts. One article questions the wisdom of basing scholarship and knowledge development on an ever-increasing number of research reviews, that examine different interventions in different contexts and often clumped together in inappropriate ways. The second article suggests that rather than trying to reframe systems in the light of accumulated evidence from research, we seek to identify "disruptive innovations" such as micro-clinics in retail chain drug stores, $2 generic eyeglasses and automatic teller machines that fit into real world situations and offer practical convenience to the intended users. Read more..
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