Abstract
Cluster randomized controlled trials are increasingly used in population health intervention research. Through randomization, researchers attempt to isolate the treatment effect and remove all other effects, including any effects of social context. In many cases, the constant effect assumption cannot be satisfied in cluster randomized controlled trials. We argue that when studying population health interventions, the effective mechanism of intervention lies in the interaction between the treatment and social context. Researchers should be cognizant that attempts to remove the effect of social context using CRTC may fail. The interaction between the treatment and social context should be the primary object of study in population health intervention research.
References
Bland JM (2004) Cluster randomized trials in the medical literature: two bibliometric surveys. BMC Med Res Methodol 4(21). doi:10.1186/1471-2288-4-21
Bonell CP, Hargreaves J, Cousens S, Ross D, Hayes R, Petticrew M, Kirkwood BR (2011) Altenatives to randomisation in the evaluation of public health interventions: design challenges and solutions. J Epidemiol Community Health 65(7):582–587
Campbell MK, Elbourne DR, Altman DG (2004) CONSORT statement: extension to cluster randomised trials. Br Med J 328(7441):702–708
Cousens S, Hargreaves J, Bonell C, Armstrong B, Thomas J, Kirkwood BR, Hayes R (2011) Alternatives to randomisation in the evaluation of public-health interventions: statistical analysis and causal inference. J Epidemiol Community Health 65(7):576–581
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J 337(a1655):979–983
Cronbach LJ (1975) Beyond two disciplines of scientific psychology. Am Psychol 30:116–127
Edwards SJL, Braunholtz DA, Lilford RJ, Stevens AJ (1999) Ethical issues in the design and conduct of cluster randomised controlled trials. Br Med J 318(7195):1407–1409
Eldridge SM, Ashby D, Feder GS, Rudnicka AR, Ukoumunne OC (2004) Lessons for cluster randomized trials in the twenty-first century: a systematic review of trials in primary care. Clin Trials 1:80–90
Fisher RA (1935) The design of experiments. Oliver & Boyd, Edinburgh
Hawe P, Potvin L (2009) What is population health intervention research. Can J Public Health 100(1):I8–I14
Holland PW (1986) Statistics and causal inference (with discussion). J Am Stat Assoc 81(396):945–970
Hume D (1739) A Treatise of Human Nature. Project Gutenburg
Kemm J (2006) The limitations of ‘evidence-based’ public health. J Eval Clin Pract 12(3):319–324
Macintyre S (2011) Good intentions and received wisdom are not good enough: the need for controlled trials in public health. J Epidemiol Community Health 65(7):564–567
Murray DM (1998) Design and analysis of group-randomized trials. Oxford University Press, New York
Poland B, Frohlich KL, Cargo M (2008) Context as a fundamental dimension of health promotion evaluation. In: Potvin L, McQueen DV (eds) Health promotion evaluation practices in the Americas: values and research. Springer, New York, pp 299–317
Puffer S, Torgerson DJ, Watson J (2003) Evidence for risk of bias in cluster randomised trials: review of recent trials published in three general medical journals. Br Med J 328:785
Rubin DB (1974) Estimating causal effects of treatments in randomized and non-randomized studies. J Educ Psychol 66:688–701
Shadish WR (2010) Campbell and Rubin: a primer and comparison of their approaches to causal inference in field settings. Psychol Methods 15(1):3–17
West SG, Duan N, Pequegnat W, Gaist P, Jarlais DCD, Holtgrave D, Szapocznik J, Fishbein M, Rapkin B, Clatts M, Mullen PD (2008) Alternatives to the randomized controlled trial. Am J Public Health 98(8):1359–1366
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fuller, D., Potvin, L. Context by treatment interactions as the primary object of study in cluster randomized controlled trials of population health interventions. Int J Public Health 57, 633–636 (2012). https://doi.org/10.1007/s00038-012-0357-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-012-0357-x