1
|
Leruste S, Doray B, Maillard T, Lebon C, Marimoutou C, Spodenkiewicz M. Scoping review on the role of the family doctor in the prevention and care of patients with foetal alcohol spectrum disorder. BMC PRIMARY CARE 2024; 25:66. [PMID: 38388880 PMCID: PMC10882789 DOI: 10.1186/s12875-024-02291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Foetal alcohol spectrum disorder (FASD) is the leading preventable cause of nongenetic mental disability. Given the patient care pathway, the General Practitioner (GP) is in the front line of prevention and identification of FASD. Acknowledging the importance of the prevalence of FASD, general practitioners are in the front line both for the detection and diagnosis of FASD and for the message of prevention to women of childbearing age as well as for the follow-up. OBJECTIVES The main objective of the scoping review was to propose a reference for interventions that can be implemented by a GP with women of childbearing age, their partners and patients with FASD. The final aim of this review is to contribute to the improvement of knowledge and quality of care of patients with FASD. METHODS A scoping review was performed using databases of peer-reviewed articles following PRISMA guidelines. The search strategy was based on the selection and consultation of articles on five digital resources. The advanced search of these publications was established using the keywords for different variations of FASD: "fetal alcohol syndrome," "fetal alcohol spectrum disorder," "general medicine," "primary care," "primary care"; searched in French and English. RESULTS Twenty-three articles meeting the search criteria were selected. The interventions of GPs in the management of patients with FASD are multiple: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. FASD seems still underdiagnosed. CONCLUSION The interventions of GPs in the management of patients with FASD are comprehensive: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. Prevention interventions would decrease the incidence of FASD, thereby reducing the incidence of mental retardation, developmental delays, and social, educational and legal issues. A further study with a cluster randomized trial with a group of primary care practitioners trained in screening for alcohol use during pregnancy would be useful to measure the impact of training on the alcohol use of women of childbearing age and on the clinical status of their children.
Collapse
Affiliation(s)
- Sébastien Leruste
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France.
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France.
| | - Bérénice Doray
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- Service de Génétique - CHU de La Réunion, Saint-Denis, France
- Laboratoire EPI, Université & CHU de La Réunion, Saint-Denis, France
- Centre Ressources, TSAF - Fondation Père Favron - CHU de La Réunion, Saint-Pierre, France
| | | | - Christophe Lebon
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
| | - Catherine Marimoutou
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
| | - Michel Spodenkiewicz
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, Canada
| |
Collapse
|
2
|
Rice LJ, Tsang TW, Carter E, Hand M, Davies J, Thomas S, Bedford E, Bear E, Carter C, Cannon L, Elliott EJ. Bigiswun Kid Project: a longitudinal study of adolescents living with high rates of prenatal alcohol exposure, fetal alcohol spectrum disorder and early life trauma in remote Australian Aboriginal communities. BMJ Open 2022; 12:e058111. [PMID: 35365538 PMCID: PMC8977804 DOI: 10.1136/bmjopen-2021-058111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The Lililwan Project was the first Australian population-based prevalence study of fetal alcohol spectrum disorder (FASD) using active case ascertainment. Conducted in 2010-2011, the study included 95% of all eligible children aged 7-9 years living in the very remote Aboriginal communities of the Fitzroy Valley, Western Australia. Women from Marninwarntikura Women's Resource Centre, a local Aboriginal-led organisation, are concerned that some participants from the study are struggling in adolescence so partnered with researchers from the University of Sydney to follow up the Lililwan cohort in 2020-2022 at age 17-19 years.The overarching aim of the Bigiswun Kid Project is to identify adolescents' needs and build knowledge to inform services to improve the health and well-being of adolescents in remote Aboriginal communities. The specific aims are to: (1) provide a voice to adolescents and their families to understand the health and well-being status of the Lililwan cohort at 17-19 years. (2) Examine relationships between exposures during pregnancy, birth characteristics, and health and neurodevelopment at 7-9 years, and positive/adverse adolescent outcomes at 17-19 years. This information will identify prenatal and early life factors that predict good health and well-being in adolescence. (3) Determine whether management plans provided in the Lililwan Project were followed, and identify past and present service gaps, support needs and barriers to service use. (4) Determine if key physical characteristics of FASD change between childhood and adolescence in this Aboriginal population. ETHICS AND DISSEMINATION Approved by the Kimberley Aboriginal Health Planning Forum and relevant ethics committees.
Collapse
Affiliation(s)
- Lauren J Rice
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Emily Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Marmingee Hand
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Jadnah Davies
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Sue Thomas
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Eric Bedford
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Emma Bear
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Cheyenne Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Lisa Cannon
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| |
Collapse
|
3
|
Parker RA, Manner J, Sivaramakrishnan D, Baker G, Stoddart A, Lloyd S, Jepson R. Design, rationale and analysis plan for the Stand Up for Health trial in contact centres: a stepped wedge feasibility study. Pilot Feasibility Stud 2020; 6:139. [PMID: 32983556 PMCID: PMC7513324 DOI: 10.1186/s40814-020-00683-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Contact centres are one of the most sedentary workplaces, with employees spending a very high proportion of their working day sitting down. About a quarter of contact centre staff regularly experience musculoskeletal health problems due to high levels of sedentary behaviour, including lower back pain. There have been no previous randomised studies specifically aiming to reduce sedentary behaviour in contact centre staff. To address this gap, the Stand Up for Health (SUH) study aims to test the feasibility and acceptability of a complex theory-based intervention to reduce sedentary behaviour in contact centres. Methods The Stand Up for Health study has a stepped wedge cluster randomised trial design, which is a pragmatic design whereby clusters (contact centres) are randomised to time points at which they will begin to receive the intervention. All contact centre staff have the opportunity to experience the intervention. To minimise the resource burden in this feasibility study, data collection is not continuous, but undertaken on a selective number of occasions, so the stepped wedge design is “incomplete”. Eleven contact centres in England and Scotland have been recruited, and the sample size is approximately 27 per centre (270 in total). The statistical analysis will predominantly focus on assessing feasibility, including the calculation of recruitment rates and rates of attrition. Exploratory analysis will be performed to compare objectively measured sedentary time in the workplace (measured using an activPAL™ device) between intervention and control conditions using a linear mixed effects regression model. Discussion To our knowledge, this is the first stepped wedge feasibility study conducted in call centres. The rationale and justification of our novel staircase stepped wedge design has been presented, and we hope that by presenting our study design and statistical analysis plan, it will contribute to the literature on stepped wedge trials, and in particular feasibility stepped wedge trials. The findings of the study will also help inform whether this is a suitable design for other settings where data collection is challenging. Trial registration The trial has been registered on the ISRCTN database: http://www.isrctn.com/ISRCTN11580369
Collapse
Affiliation(s)
- Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jillian Manner
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, Institute for Sport, P.E. and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Scott Lloyd
- Public Health South Tees, The Live Well Centre, Dundas House, Dundas Arcade, Middlesbrough, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle upon Tyne, UK.,School of Health and Social Care, Teesside University, Centuria Building, Middlesbrough, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
4
|
Wagner B, Latimer J, Adams E, Carmichael Olson H, Symons M, Mazzucchelli TG, Jirikowic T, Watkins R, Cross D, Carapetis J, Boulton J, Wright E, McRae T, Carter M, Fitzpatrick JP. School-based intervention to address self-regulation and executive functioning in children attending primary schools in remote Australian Aboriginal communities. PLoS One 2020; 15:e0234895. [PMID: 32579567 PMCID: PMC7314028 DOI: 10.1371/journal.pone.0234895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children's executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children's behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children's executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children's exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.
Collapse
Affiliation(s)
- Bree Wagner
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Jane Latimer
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Adams
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Heather Carmichael Olson
- Seattle Children’s Research Institute, Seattle, Washington, United States of America
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Martyn Symons
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Trevor G. Mazzucchelli
- Child and Family Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
- Brain, Behaviour and Mental Health Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Rochelle Watkins
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Western Australia, Australia
| | - Donna Cross
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Health Promotion and Education Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- CoLab–Collaborate for Kids, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children’s Hospital, Perth, Western Australia, Australia
| | - John Boulton
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Edie Wright
- Western Australian Department of Education Kimberley Education Region, Broome, Western Australia, Australia
| | - Tracy McRae
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
| | - James P. Fitzpatrick
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
5
|
Wagner B, Cross D, Adams E, Symons M, Mazzucchelli TG, Watkins R, Wright E, Latimer J, Carapetis J, Boulton J, Fitzpatrick JP. RE-AIM evaluation of a teacher-delivered programme to improve the self-regulation of children attending Australian Aboriginal community primary schools. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1672991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Bree Wagner
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Donna Cross
- Health Promotion and Education Research Team, Co-Lab – Collaborate for Kids, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Emma Adams
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Martyn Symons
- National Health and Medical Research Council FASD Research, Australia Centre of Research Excellence, Perth, Australia
| | - Trevor G. Mazzucchelli
- Child and Family Research Group and Brain, Behaviour and Mental Health Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Rochelle Watkins
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Edie Wright
- Department of Education Western Australia, Kimberley Education Region, Broome, Australia
| | - Jane Latimer
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children’s Hospital, Perth, Australia
| | - John Boulton
- The University of Newcastle, Newcastle, Australia
| | - James P. Fitzpatrick
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| |
Collapse
|
6
|
de la Fuente J, González-Torres MC, Aznárez-Sanado M, Martínez-Vicente JM, Peralta-Sánchez FJ, Vera MM. Implications of Unconnected Micro, Molecular, and Molar Level Research in Psychology: The Case of Executive Functions, Self-Regulation, and External Regulation. Front Psychol 2019; 10:1919. [PMID: 31507487 PMCID: PMC6719524 DOI: 10.3389/fpsyg.2019.01919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/05/2019] [Indexed: 01/19/2023] Open
Abstract
The proliferation of research production in Psychology as a science has been increasing exponentially. This situation leads to the necessity of organizing the research production into different levels of analysis that make it possible to delimit each research domain. The objective of this analysis is to clearly distinguish the different levels of research: micro-analysis, molecular, and molar. Each level is presented, along with an analysis of its benefits and limitations. Next, this analysis is applied to the topics of Executive Functions, Self-Regulation, and External Regulation. Conclusions, limitations, and implications for future research are offered, with a view toward a better connection of research production across the different levels, and an allusion to ethical considerations.
Collapse
Affiliation(s)
- Jesús de la Fuente
- School of Education and Psychology, University of Navarra, Pamplona, Spain.,School of Psychology, University of Almería, Almería, Spain
| | | | | | - José Manuel Martínez-Vicente
- School of Psychology, University of Almería, Almería, Spain.,Center of Research of Psychology, University of Almería, Almería, Spain
| | | | | |
Collapse
|
7
|
Day J, Freiberg K, Hayes A, Homel R. Towards Scalable, Integrative Assessment of Children's Self-Regulatory Capabilities: New Applications of Digital Technology. Clin Child Fam Psychol Rev 2019; 22:90-103. [PMID: 30737606 DOI: 10.1007/s10567-019-00282-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The assessment of self-regulation in children is of significant interest to researchers within education, clinical and developmental psychology, and clinical neuroscience, given its importance to adaptive functioning across a wide range of social, educational, interpersonal, educational and health domains. Because self-regulation is a complex, multidimensional construct, a range of assessment approaches have been developed to assess its various components including behavioural, cognitive and emotional domains. In recent years, digital technology has been increasingly used to enhance or supplement existing measurement approaches; however, developments have predominantly focused on translating traditional testing paradigms into digital formats. There is a need for more innovation in digital psychological assessments that harness modern mechanisms such as game-based design and interactivity. Such approaches have potential for the development of scalable, adaptable universal approaches to screening and assessment of children's self-regulatory capabilities, to facilitate early identification of difficulties in individuals and also guide planning and decision-making at a population level. We highlight a novel, innovative digital assessment tool for children called Rumble's Quest, a new measure of children's socio-emotional functioning that shows promise as an integrative assessment of well-being and self-regulation, and which incorporates both self-report and direct assessment of cognitive self-regulation. This tool is scalable, can be integrated into normal classroom activities, and forms part of a comprehensive prevention support system that can be used to guide stakeholders' decision-making regarding early intervention and support at the individual, classroom, school and community level. We finish by discussing other innovative possibilities for psychological assessment with children, using new and emerging technologies and assessment approaches.
Collapse
Affiliation(s)
- Jamin Day
- Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308, NSW, Australia.
| | - Kate Freiberg
- Griffith Criminology Institute, Griffith University, Mount Gravatt, 4122, QLD, Australia
| | - Alan Hayes
- Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308, NSW, Australia
| | - Ross Homel
- Griffith Criminology Institute, Griffith University, Mount Gravatt, 4122, QLD, Australia
| |
Collapse
|
8
|
Kasza J, Taljaard M, Forbes AB. Information content of stepped-wedge designs when treatment effect heterogeneity and/or implementation periods are present. Stat Med 2019; 38:4686-4701. [PMID: 31321806 DOI: 10.1002/sim.8327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 01/04/2023]
Abstract
Stepped-wedge cluster randomized trials, which randomize clusters of subjects to treatment sequences in which clusters switch from control to intervention conditions, are being conducted with increasing frequency. Due to the real-world nature of this design, methodological and implementation challenges are ubiquitous. To account for such challenges, more complex statistical models to plan studies and analyze data are required. In this paper, we consider stepped-wedge trials that accommodate treatment effect heterogeneity across clusters, implementation periods during which no data are collected, or both treatment effect heterogeneity and implementation periods. Previous work has shown that the sequence-period cells of a stepped-wedge design contribute unequal amounts of information to the estimation of the treatment effect. In this paper, we extend that work by considering the amount of information available for the estimation of the treatment effect in each sequence-period cell, sequence, and period of stepped-wedge trials with more complex designs and outcome models. When either treatment effect heterogeneity and/or implementation periods are present, the pattern of information content of sequence-period cells tends to be clustered around the times of the switch from control to intervention condition, similarly to when these complexities are absent. However, the presence and degree of treatment effect heterogeneity and the number of implementation periods can influence the information content of periods and sequences markedly.
Collapse
Affiliation(s)
- Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|