Population health intervention research: what is the place for pilot studies? (original) (raw)
Related papers
Assessing the Population Impact of Published Intervention Studies
NAM Perspectives, 2015
Background: Despite greater spending on health care and biomedical research, the United States has poorer health outcomes than competitive nations. Information is needed on the potential impact of interventions to better guide resources allocation. Objective: To assess whether research on interventions is concentrated in areas with the greatest potential population health benefit. Design: Secondary data analysis to perform a best-case study of the potential population impact of published intervention studies. Study selection: A random sample of 20 intervention studies published in the New England Journal of Medicine in 2011. Data extraction: One reviewer extracted data using a standardized form, and another reviewer verified the data. Measurements: The incremental gain of applying the intervention versus the control estimated in quality-adjusted life years (QALY) at the population level. Results: Of the 20 studies, 13 had a statistically significant effect size, and 3 studies accounted for 80 percent of the total population health impact. Studies of less common conditions had smaller population health impact, though greater individual level impact. Studies generally did not report the information required to estimate the anticipated population health impact. Limitations: The heterogeneity of outcome measures and the use of multiple data sources result in a large degree of uncertainty in the estimates. The use of an intervention effect measured in a study setting is likely to overestimate its real-world impact. Although random, the sample of studies selected here may not be representative of intervention studies in general. Conclusions: Research priorities should be heavily informed by the potential population health impact. Researchers, proposal reviewers, and funders should understand those impacts before intervention studies are initiated. We recommend that this information be uniformly included in research proposals and reports. * Indicates articles describing a secondary analysis of a study; n/a, not applicable based on the criterion that there was no significant gain in effect between intervention and control procedure; HR, hazard ratio. Only the first author's name of each study is cited here; see references for full citations.
Improving the reporting of public health intervention research: advancing TREND and CONSORT
Journal of Public Health, 2008
Background Evidence-based public health decision-making depends on high quality and transparent accounts of what interventions are effective, for whom, how and at what cost. Improving the quality of reporting of randomized and non-randomized study designs through the CONSORT and TREND statements has had a marked impact on the quality of study designs. However, public health users of systematic reviews have been concerned with the paucity of synthesized information on context, development and rationale, implementation processes and sustainability factors.
Journal of Public Health, 2007
Evidence-informed practice is a key component of public health and the focus of much discussion, of which the nature of evidence and how it is best gathered and appraised has formed a large part. Prospective registration of trials is now a key component of rigour and quality in clinical research and has been supported at an international level through the WHO International Clinical Trials Registry Program. This paper discusses the scope and benefits of trial registration in clinical research, including greater transparency and reduced publication bias. It then considers the potential for a Prospective Public Health Intervention Studies Register specific to the needs of public health and aspects to be included in such a register.
The challenges of systematically reviewing public health interventions
Journal of Public Health, 2004
Evidence-based public health concerns the development and implementation of effective programmes and policies. 1 For policy makers and practitioners to implement effective programmes they must have considered the information that is available on which interventions have been shown to work, or not to work (or caused harm). 2 One form of high quality evidence-based information available to decision makers is a systematic review of research of effectiveness. A systematic review is defined as 'a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies included in the review'. Many of the tools of research synthesis were developed by American social scientists in the 1960s. 4 However, today's focus on evidence in health has been largely driven by the evidencebased medicine movement. Some authors have argued that there are concerns that in cost-conscious environments only those interventions for which there is sufficient evidence to complete a review would be supported. 5 In public health the infrastructure that supports and enables the conduct of a review lags behind that of evidence-based medicine and extends beyond the employment of randomized controlled trials. This increased complexity has resulted in an unfortunate focus on the appropriateness (or not) of randomized controlled trials as the priority study design rather than what constitutes evidence in public health and how this should be evaluated. 6,7 However, after diverging views, the focus has now moved towards ensuring that reviews in public health meet the needs of public health practitioners.
Population health intervention research: myths and misconceptions
International Journal of Public Health
While great strides have been made in Population Health Intervention Research (PHIR), uptake by public health researchers has been suboptimal (Hawe and Potvin 2009; Di Ruggiero et al. 2017). Common PHIR myths account for some of this lag in uptake, and misconceptions lead researchers to forgo PHIR, since the challenges seem insurmountable. As a result, the most common type of population health research remains the non-interventional observational study. Given that a ''simple myth is more cognitively attractive than an overcomplicated correction'' (Cook and Lewandowsky 2011), we will attempt to address a subset of myths with brevity, at the risk of oversimplification. Of course, in reality, the issues are more nuanced.
Frequently Asked Questions About Population Health Intervention Research
Canadian Journal of Public Health, 2012
Population health intervention research requires stronger definition. There are overlaps and differences between it and established domains such as evaluation, health impact assessment, knowledge translation, health services research, and social and public policy analysis. The value added of this growing field is its potential to draw more resources as well as diverse expertise, methods and ways of knowing under one umbrella at a critical time in history. That is, at a time when actions to reduce health inequities have become paramount.
Applicability and transferability of interventions in evidence-based public health
Health Promotion International, 2005
The context in which public health programmes operate can play an important role in influencing their implementation and effectiveness. An intervention that has been shown to be effective in one setting may turn out to be ineffective somewhere else, even supposing it can be implemented there. Therefore, systematic reviews of public health interventions should appraise the applicability of the intervention process and the transferability of the intervention effectiveness to other localities. However, applicability and transferability appraisal is seldom reported in systematic reviews of public health and health promotion interventions. This paper aims to introduce an innovative approach to bridging this gap. A list of attributes that may impact on applicability and transferability can be developed, based on knowledge of the proposed intervention. Then the applicability and transferability of the intervention to the local setting can be rated, and given a score, based on knowledge of the local setting. This approach provides a useful tool for evaluating public health interventions and provides a reliable basis for informed decision making in resource-poor settings, where rigorous primary studies are lacking and where very limited resources put a high demand on evidence-based approaches to health promotion.