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Arango C, Martín-Babarro J, Abregú-Crespo R, Huete-Diego MÁ, Alvariño-Piqueras M, Serrano-Marugán I, Díaz-Caneja CM. A web-enabled, school-based intervention for bullying prevention (LINKlusive): a cluster randomised trial. EClinicalMedicine 2024; 68:102427. [PMID: 38318124 PMCID: PMC10839589 DOI: 10.1016/j.eclinm.2024.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Background There is a need for more sustainable interventions and for assessing the effectiveness of school-based universal anti-bullying programmes in vulnerable populations. We assessed the efficacy of a multicomponent, web-enabled, school-based intervention that aims to improve school climate and reduce bullying (LINKlusive) relative to conventional practices (control condition). Methods We conducted a cluster randomised controlled trial in primary and secondary schools in Madrid, Spain. The primary outcome measure was peer-reported bullying victimisation after the 12-week intervention (study endpoint). We analysed data using longitudinal mixed-effects models. The trial was registered with the ISRCTN registry (15719015). Findings We included 20 schools (10 in each group); 6542 students participated at baseline; 6403 were assessed at study endpoint. After the intervention, there was a statistically significant reduction in bullying victimisation in both the intervention (OR 0.61, 95% CI [0.41, 0.90]) and control groups (OR 0.69, 95% CI [0.51, 0.92]), with no evidence of differences in the whole sample (OR 0.89, 95% CI [0.58, 1.36]; aOR 0.89, 95% CI [0.58, 1.37]). Subgroup analyses showed a statistically significant effect of LINKlusive on bullying victimisation in primary education (aOR 0.68, 95% CI [0.47, 0.98]). In students with peer-reported bullying victimisation at baseline, LINKlusive showed a statistically significant effect on depression (-1.43, 95% CI [-2.46, -0.40], adjusted standardised mean difference (SMD) -0.41) and quality of life (2.18, 95% CI [0.80, 3.56], adjusted SMD 0.45). Interpretation LINKlusive could be effective in reducing bullying victimisation in primary school students. Sustainable whole-school interventions to promote mental health and reduce risk factors are warranted to improve outcomes in young people, especially in the early years of education. Funding Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
| | - Javier Martín-Babarro
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Campus de Somosagua, Ctra. de Húmera, s/n, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Renzo Abregú-Crespo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
- Department of Personality, Assessment, and Psychological Treatments, School of Psychology, Universidad Nacional de Educación a Distancia, C/ Juan del Rosal, 10, 28040, Madrid, Spain
| | - Miguel Á. Huete-Diego
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
| | - María Alvariño-Piqueras
- Department of Research and Psychology in Education, School of Psychology, Universidad Complutense, Campus de Somosagua, Ctra. de Húmera, s/n, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Isabel Serrano-Marugán
- Consejería de Educación, Ciencia y Universidades, Comunidad de Madrid, Calle General Díaz Porlier 35, 28001, Madrid, Spain
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Calle Ibiza, 43, 28009, Madrid, Spain
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Watson SI, Girling A, Hemming K. Optimal study designs for cluster randomised trials: An overview of methods and results. Stat Methods Med Res 2023; 32:2135-2157. [PMID: 37802096 PMCID: PMC10683350 DOI: 10.1177/09622802231202379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
There are multiple possible cluster randomised trial designs that vary in when the clusters cross between control and intervention states, when observations are made within clusters, and how many observations are made at each time point. Identifying the most efficient study design is complex though, owing to the correlation between observations within clusters and over time. In this article, we present a review of statistical and computational methods for identifying optimal cluster randomised trial designs. We also adapt methods from the experimental design literature for experimental designs with correlated observations to the cluster trial context. We identify three broad classes of methods: using exact formulae for the treatment effect estimator variance for specific models to derive algorithms or weights for cluster sequences; generalised methods for estimating weights for experimental units; and, combinatorial optimisation algorithms to select an optimal subset of experimental units. We also discuss methods for rounding experimental weights, extensions to non-Gaussian models, and robust optimality. We present results from multiple cluster trial examples that compare the different methods, including determination of the optimal allocation of clusters across a set of cluster sequences and selecting the optimal number of single observations to make in each cluster-period for both Gaussian and non-Gaussian models, and including exchangeable and exponential decay covariance structures.
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Birk N, Oakley LL, Mallinson PAC, R D, Babu GR, Nyirenda M, Kinra S. Statistical analysis plan and protocol updates for Gestational diabetes in Uganda and India: Design and Evaluation of Educational Films for Improving Screening and Self-management (GUIDES) trial. Trials 2023; 24:520. [PMID: 37568171 PMCID: PMC10422739 DOI: 10.1186/s13063-023-07508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Timely detection and management of gestational diabetes mellitus (GDM) have been identified as a high priority for policymakers in low- and middle-income countries (LMICs). The GUIDES trial will evaluate a package of three interconnected film-based interventions aimed at improving the timely detection and management of GDM. The protocol for this trial has previously been published; this publication outlines the statistical analysis plan for the trial. METHODS AND DESIGN The GUIDES study is a multi-country cluster-randomised controlled trial consisting of one trial conducted in Uganda and one in India (30 clusters in each country). Mixed effects models will be used to compare the primary study outcomes of the proportion of women who are tested for GDM between 24 and 32 weeks of pregnancy and the mean fasting blood sugar of women with GDM at 34-week follow-up while accounting for clustering. Secondary analyses will compare the proportion of women with self-reported GDM diagnosis at 32 weeks of pregnancy and the proportion of women with adverse perinatal outcomes related to GDM up to 4 weeks after birth in each trial arm. TRIAL STATUS AND DISCUSSION Follow-up is expected to end in March 2023 in Uganda and in May 2023 in India. Analyses will be carried out following this statistical analysis plan in the month following trial completion. TRIAL REGISTRATION ClinicalTrials.gov NCT03937050. Registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605. Registered on 26 February 2020.
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Affiliation(s)
- Nick Birk
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura L Oakley
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, P.O. box 222, N-0213, Oslo, Norway.
| | - Poppy A C Mallinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Deepa R
- Indian Institute of Public Health-Bengaluru, Public Health Foundation of India (PHFI), Bengaluru, India
| | - Giridhara R Babu
- Indian Institute of Public Health-Bengaluru, Public Health Foundation of India (PHFI), Bengaluru, India
| | - Moffat Nyirenda
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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McMahon A, Kaptoge S, Walker M, Mehenny S, Gilchrist PT, Sambrook J, Akhtar N, Sweeting M, Wood AM, Stirrups K, Chung R, Fahle S, Johnson E, Cullen D, Godfrey R, Duthie S, Allen L, Harvey P, Berkson M, Allen E, Watkins NA, Bradley JR, Kingston N, Miflin G, Armitage J, Roberts DJ, Danesh J, Di Angelantonio E. Evaluation of interventions to prevent vasovagal reactions among whole blood donors: rationale and design of a large cluster randomised trial. Trials 2023; 24:512. [PMID: 37563721 PMCID: PMC10413586 DOI: 10.1186/s13063-023-07473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/23/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Vasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors. METHODS STRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site ("cluster") has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions is compared to NHSBT's current practices: (i) 500-ml isotonic drink before donation (vs current 500-ml plain water); (ii) 3-min rest on donation chair after donation (vs current 2 min); (iii) new modified AMT (vs current practice of AMT); and (iv) psychosocial intervention using preparatory materials (vs current practice of nothing). The primary outcome is the number of in-session VVRs with loss of consciousness (i.e. episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e. with and without loss of consciousness), all delayed VVRs (i.e. those occurring after leaving the venue) and any in-session non-VVR adverse events or reactions. DISCUSSION The STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency. TRIAL REGISTRATION ISRCTN: 10412338. Registration date: October 24, 2019.
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Affiliation(s)
- Amy McMahon
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK.
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Matthew Walker
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Susan Mehenny
- NHS Blood & Transplant, Blood Donation, Barnsley, UK
| | - Philippe T Gilchrist
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Jennifer Sambrook
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Michael Sweeting
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- University of Leicester, Leicester, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Cambridge Centre of Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK
| | - Kathleen Stirrups
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Sarah Fahle
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Elisha Johnson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Donna Cullen
- NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
| | | | - Shannon Duthie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | | | - Paul Harvey
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Michael Berkson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Elizabeth Allen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Nicholas A Watkins
- Data, Analytics and Surveillance, UK Health Security Agency, Nobel House, London, UK
| | - John R Bradley
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Nathalie Kingston
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Jane Armitage
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David J Roberts
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
- Radcliffe Dept of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, 20157, Italy
- NHS Blood and Transplant, Cambridge, UK
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Venn ML, Knowles CH, Li E, Glasbey J, Morton DG, Hooper R. Implementation of a batched stepped wedge trial evaluating a quality improvement intervention for surgical teams to reduce anastomotic leak after right colectomy. Trials 2023; 24:329. [PMID: 37189166 PMCID: PMC10184073 DOI: 10.1186/s13063-023-07318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Large-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe Anastomosis proGramme in CoLorectal SurgEry (EAGLE), intended to reduce anastomotic leak following right colectomy, and reflect on lessons learned about the implementation of quality improvement programmes on an international scale. METHODS Surgical units were recruited and randomised in batches to receive a hospital-level education intervention designed to reduce anastomotic leak, either before, during, or following data collection. All consecutive patients undergoing right colectomy were included. Online learning, patient risk stratification and an in-theatre checklist constituted the intervention. The study was powered to detect an absolute risk reduction of anastomotic leak from 8.1 to 5.6%. Statistical efficiency was optimised using an incomplete stepped wedge trial design and study batches analysed separately then meta-analysed to calculate the intervention effect. An established collaborative group helped nurture strong working relationships between units/countries and a prospectively designed process evaluation will enable evaluation of both the intervention and its implementation. RESULTS The batched trial design allowed sequential entry of clusters, targeted research training and proved to be robust to pandemic interruptions. Staggered start times in the incomplete stepped wedge design with long lead-in times can reduce motivation and engagement and require careful administration. CONCLUSION EAGLE's robust but flexible study design allowed completion of the study across globally distributed geographical locations in spite of the pandemic. The primary outcome analysed in conjunction with the process evaluation will ensure a rich understanding of the intervention and the effects of the study design. TRIAL REGISTRATION National Institute of Health Research Clinical Research Network portfolio IRAS ID: 272,250. Health Research Authority approval 18 October 2019. CLINICALTRIALS gov, identifier NCT04270721, protocol ID RG_19196.
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Affiliation(s)
- Mary L Venn
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK.
| | - Charles H Knowles
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - Elizabeth Li
- University of Birmingham, Rm 31, Fourth floor, Heritage Building, Academic Department of Surgery, Birmingham, B15 2TT, UK
| | - James Glasbey
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, Heritage Building, Birmingham, B15 2TH, UK
| | - Dion G Morton
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, Heritage Building, Birmingham, B15 2TH, UK
| | - Richard Hooper
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Institute of Population Health Sciences, 58 Turner Street, London, E1 2AB, UK.
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Rouyard T, Endo M, Nakamura R, Moriyama M, Stanyon M, Kanke S, Nakamura K, Chen C, Hara Y, Ii M, Kassai R. Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change (FEEDBACK): study protocol for a cluster randomised controlled trial. Trials 2023; 24:317. [PMID: 37158959 PMCID: PMC10169507 DOI: 10.1186/s13063-023-07345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present FEEDBACK study (Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change) aims to evaluate the effects of a novel behaviour change intervention designed to be easily implemented and scaled across a wide range of primary care settings. METHODS A cluster randomised controlled trial (RCT) with a 6-month follow-up will be conducted to evaluate the effects of the FEEDBACK intervention. FEEDBACK is a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. It consists of five steps aimed at enhancing doctor-patient partnership to motivate self-management behaviour: (1) communication of cardiovascular risks using a 'heart age' tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan (cluster units) that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up. Secondary outcome measures include the change in cardiovascular risk score, the probability to achieve the recommended glycaemic target (HbA1c <7.0% [53mmol/mol]) at 6-month follow-up, and a range of behavioural and psychosocial variables. The planned primary analyses will be carried out at the individual level, according to the intention-to-treat principle. Between-group comparisons for the primary outcome will be analysed using mixed-effects models. This study protocol received ethical approval from the research ethics committee of Kashima Hospital, Fukushima, Japan (reference number: 2022002). DISCUSSION This article describes the design of a cluster RCT that will evaluate the effects of FEEDBACK, a personalised, multicomponent intervention aimed at enhancing doctor-patient partnership to engage adults with T2DM more effectively in self-management behaviour. TRIAL REGISTRATION The study protocol was prospectively registered in the UMIN Clinical Trials Registry (UMIN-CTR ID UMIN000049643 assigned on 29/11/2022). On submission of this manuscript, recruitment of participants is ongoing.
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Affiliation(s)
- Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan.
| | - Mei Endo
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Michiko Moriyama
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Maham Stanyon
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Satoshi Kanke
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Koki Nakamura
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Yasushi Hara
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
- Graduate School of Business Administration, Kobe University, 2-1 Rokkōdaichō, Nada Ward, Kobe, Hyogo, 657-0013, Japan
| | - Masako Ii
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1247, Japan
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Kinra S, Mallinson PA, Debbarma A, Walls HL, Lieber J, Bhogadi S, Addanki S, Pande R, Kurpad AV, Kannuri NK, Aggarwal S, Kulkarni B, Finkelstein EA, Deo S. Impact of a financial incentive scheme on purchase of fruits and vegetables from unorganised retailers in rural India: a cluster-randomised controlled trial. Lancet Reg Health Southeast Asia 2023; 12:100140. [PMID: 37384059 PMCID: PMC10305860 DOI: 10.1016/j.lansea.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/28/2022] [Accepted: 12/22/2022] [Indexed: 06/30/2023]
Abstract
Background Inadequate intake of fruits and vegetables is prevalent in rural areas of India, where around 65% of the population reside. Financial incentives have been shown to increase the purchase of fruits and vegetables in urban supermarkets, but their feasibility and effectiveness with unorganised retailers in rural India is unclear. Methods A cluster-randomised controlled trial of a financial incentive scheme involving ∼20% cashback on purchase of fruits and vegetables from local retailers was conducted in six villages (3535 households). All households in three intervention villages were invited to participate in the scheme which ran for three months (February-April 2021), while no intervention was offered in control villages. Self-reported (pre-intervention and post-intervention) data on purchase of fruits and vegetables were collected from a random sub-sample of households in control and intervention villages. Findings A total of 1109 households (88% of those invited) provided data. After the intervention, the weekly quantity of self-reported fruits and vegetables purchased were (i) 18.6 kg (intervention) and 14.2 kg (control), baseline-adjusted mean difference 4 kg (95% CI: -6.4 to 14.4) from any retailer (primary outcome); and (ii) 13.1 kg (intervention) and 7.1 kg (control), baseline-adjusted mean difference 7.4 kg (95% CI: 3.8-10.9) from local retailers participating in the scheme (secondary outcome). There was no evidence of differential effects of the intervention by household food security or by socioeconomic position, and no unintended adverse consequences were noted. Interpretation Financial incentive schemes are feasible in unorganised food retail environments. Effectiveness in improving diet quality of the household likely hinges on the percentage of retailers willing to participate in such a scheme. Funding This research has been funded by the Drivers of Food Choice (DFC) Competitive Grants Program, which is funded by the UK Government's Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health, USA; however, the views expressed do not necessarily reflect the UK Government's official policies.
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Affiliation(s)
- Sanjay Kinra
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Arindam Debbarma
- Indian School of Business, Hyderabad, 500111, India
- University of Minnesota, Minneapolis, MN, 55455, USA
| | - Helen L. Walls
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Judith Lieber
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Santhi Bhogadi
- Indian Institute of Public Health, Hyderabad, 500033, India
| | | | - Richa Pande
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, 50007, India
| | | | | | | | - Bharati Kulkarni
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, 50007, India
| | | | - Sarang Deo
- Indian School of Business, Hyderabad, 500111, India
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San Pío MJ, Clotas C, Espelt A, López MJ, Bosque-Prous M, Juárez O, Bartroli M. Effectiveness of a preschool emotional education programme administered over 3 grades: a cluster randomised controlled trial. Public Health 2023; 218:53-59. [PMID: 36965464 DOI: 10.1016/j.puhe.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Emotional education programmes are universal preventive strategies for health promotion, especially mental health. The aim of this study is to evaluate the effectiveness and implementation of '1,2,3, emoció!': a preschool-based programme designed to improve emotional competence and targeted to 3-5-year-old children in Barcelona during three academic years. STUDY DESIGN Cluster randomised trial, using schools as clusters. METHODS The study's population included preschoolers 3-5 years old from Barcelona. Teachers offered the programme during one or three academic years in the intervention groups. We evaluated the emotional competence of each child at the beginning and the end of the academic year with the Emotional Competence Assessment Questionnaire (30-180 scale). We studied the implementation process and analysed the outcomes with nested linear regression models. Considering sociodemographic variables and implementation outcomes, we obtained the individual differences in emotional competence at the end of the school year-segregated by sex-for intervention and comparison groups. RESULTS 1586 children participated in the study. The emotional competence level increased significantly after one year (4.1 in boys; 5.6 in girls; P < 0.05) and after three years of intervention (5.5 in boys; 8.0 in girls; P < 0.01), compared to comparison group. The level of emotional competence was the highest for the 3-year intervention group: we obtained an average ECAQ score of 131.1 (95% CI 126.9-135.2) for boys and 141 (95% CI 137.2-144.9) for girls. We observed that an accurate implementation improved its results. CONCLUSIONS The programme '1,2,3, emoció!' effectively increases preschool children's emotional competence, especially when the programme is rigorously implemented for three years.
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Affiliation(s)
- M J San Pío
- Agència de Salut Pública de Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) Barcelona, Spain
| | - C Clotas
- Agència de Salut Pública de Barcelona, Spain.
| | - A Espelt
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic- Universitat Central de Catalunya, Spain; Departament de Psicobiologia i Metodologia de les ciències de la salut, Universitat Auntònoma de Barcelona, Spain; CIBER de Epidemiologia y Salud Pública (CIBERESP), Spain
| | - M J López
- Agència de Salut Pública de Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) Barcelona, Spain; CIBER de Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica Sant Pau. Barcelona, Spain
| | - M Bosque-Prous
- Departament de Psicobiologia i Metodologia de les ciències de la salut, Universitat Auntònoma de Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Spain
| | - O Juárez
- Agència de Salut Pública de Barcelona, Spain; CIBER de Epidemiologia y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica Sant Pau. Barcelona, Spain
| | - M Bartroli
- Agència de Salut Pública de Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau. Barcelona, Spain
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Jones BG, Reardon T, Creswell C, Dodd HF, Hill C, Jasper B, Lawrence PJ, Morgan F, Rapee RM, Violato M, Placzek A, Ukoumunne OC. Minimising Young Children's Anxiety through Schools (MY-CATS): statistical analysis plan for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders. Trials 2022; 23:1054. [PMID: 36575433 PMCID: PMC9795669 DOI: 10.1186/s13063-022-06899-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Minimising Young Children's Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided cognitive behavioural therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in children aged 4-7 deemed 'at risk' of anxiety disorders. This update article describes the detailed statistical analysis plan for the MY-CATS trial and reports a review of the underpinning sample size assumptions. METHODS AND DESIGN The MY-CATS study is a two-arm, definitive superiority pragmatic parallel group cluster randomised controlled trial in which schools will be randomised 1:1 to receive either the intervention (in addition to usual school practice) or the usual school practice only. This update to the (published) protocol provides a detailed description of the study methods, the statistical principles, the trial population and the planned statistical analyses, including additional analyses comprising instrumental variable regression and mediation analysis. TRIAL REGISTRATION ISRCTN82398107 . Prospectively registered on 14 January 2021.
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Affiliation(s)
- Benjamin G. Jones
- grid.8391.30000 0004 1936 8024NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK ,grid.8391.30000 0004 1936 8024Exeter Clinical Trials Unit (ExeCTU), University of Exeter, Exeter, UK
| | - Tessa Reardon
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Helen F. Dodd
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire Hill
- grid.9435.b0000 0004 0457 9566School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Peter J. Lawrence
- grid.5491.90000 0004 1936 9297Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | | | - Ronald M. Rapee
- grid.1004.50000 0001 2158 5405Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Mara Violato
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Placzek
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Obioha C. Ukoumunne
- grid.8391.30000 0004 1936 8024NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
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10
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Quigley M, Earnest A, Andrikopoulos S, Wischer N, Green S, Zoungas S. ANDA-Evaluating Facilitated Feedback Enhancement - a Cluster randomised Trial (ANDA-EFFECT): protocol for a cluster randomised trial of audit feedback augmented with education and support, compared to feedback alone, on acceptability, utility and health outcomes in diabetes centres in Australia. Trials 2022; 23:976. [PMID: 36471424 PMCID: PMC9720980 DOI: 10.1186/s13063-022-06910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People living with diabetes must manage a range of factors for optimal control of glycaemia and to minimise the risk of diabetes-related complications. Diabetes practitioners are expected to follow guidelines for the key process of care and clinical outcomes, to help people living with diabetes achieve clinical targets. In Australia, the performance of diabetes centres against guidelines is evaluated by the Australian National Diabetes Audit, an annual clinical audit and feedback activity. Previous work has identified areas for improvement in the feedback provided to participating diabetes centres and suggested additional educational and support resources to assist in using audit feedback for the development of quality improvement activities. This cluster randomised trial will test the acceptability, utility and impact on selected clinical outcomes of the developed study intervention (audit feedback and a tailored educational and peer support cointervention). METHODS Two-armed cluster randomised trial with Australian Diabetes Centres that participated in the Australian National Diabetes Audit in 2021 as the clusters, stratified by location and type of centre. We aim to recruit 35 diabetes centres in each arm. Both the intervention and control arms will receive an augmented feedback report, accompanied by a partially pre-populated slide deck. In addition, the intervention arm will receive a tailored theory-based intervention designed to address identified, modifiable barriers to utilising and implementing the recommendations from diabetes audit feedback. The co-primary outcomes are (1) HbA1c at the patient level, measured at 6 months after delivery of the intervention, and (2) the acceptability and utility of the augmented feedback and cointerventions at the practitioner level, measured at 3 months after delivery of the intervention. DISCUSSION This trial aims to test the effects of systematic development and implementation of theory and evidence-informed changes to the audit feedback delivered to diabetes centres participating in an established national clinical diabetes audit. Potential benefits of improved audit feedback include more optimal engagement with the feedback by end clinical users which, ultimately, may lead to improvements in care for people living with diabetes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12621000765820. Prospectively registered on June 21, 2021.
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Affiliation(s)
- Matthew Quigley
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Arul Earnest
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Sofianos Andrikopoulos
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,grid.470804.f0000 0004 5898 9456Australian Diabetes Society, Sydney, NSW 2000 Australia
| | - Natalie Wischer
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,National Association of Diabetes Centres, Sydney, NSW 2000 Australia
| | - Sally Green
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Sophia Zoungas
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia ,grid.419789.a0000 0000 9295 3933Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC 3168 Australia
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11
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Arthur YA, Boardman GH, Morgan AJ, McCann TV. Cluster randomised controlled trial of a problem-solving, Story-bridge mental health literacy programme for improving Ghanaian community leaders' knowledge of depression. J Ment Health 2022; 31:748-756. [PMID: 32755441 DOI: 10.1080/09638237.2020.1793122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Low levels of mental health literacy about depression in the community impact negatively on attitudes towards people with the disorder and their help-seeking. AIMS The aim of this study was to assess the effectiveness of a problem-solving, Story-bridge mental health literacy programme, in improving community leaders' knowledge about helpful interventions for, and recognition of, depression. METHODS A cluster randomised controlled trial involving 140 assembly members, intervention (n = 70) and control (n = 70) groups. The intervention group received a three-hour mental health literacy programme. The control group received a plain language basic brochure about mental health issues. Data were collected at baseline and 12-week follow-up. RESULTS The intervention group demonstrated greater improvement in knowledge about helpful interventions for, and recognition of, depression compared to the control group at follow-up; however, the differences in both measures were small and not statistically significant. CONCLUSION The programme has the potential to improve participants' knowledge about helpful interventions for, and recognition of, depression. Positive outcomes have public mental health implications as they might enhance early help-seeking and contribute to better outcomes for individuals with mental health problems. TRIAL REGISTRATION ACTRN12617000033347. Date of registration - 9 January 2017.
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Affiliation(s)
- Yaw Amankwa Arthur
- Discipline of Nursing and Midwifery, Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Gayelene H Boardman
- Discipline of Nursing and Midwifery, Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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12
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Bakoyannis G, Bandyopadhyay D. Nonparametric tests for multistate processes with clustered data. ANN I STAT MATH 2022; 74:837-867. [PMID: 36090245 PMCID: PMC9455730 DOI: 10.1007/s10463-021-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/11/2021] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
In this work, we propose nonparametric two-sample tests for population-averaged transition and state occupation probabilities for continuous-time and finite state space processes with clustered, right-censored, and/or left-truncated data. We consider settings where the two groups under comparison are independent or dependent, with or without complete cluster structure. The proposed tests do not impose assumptions regarding the structure of the within-cluster dependence and are applicable to settings with informative cluster size and/or non-Markov processes. The asymptotic properties of the tests are rigorously established using empirical process theory. Simulation studies show that the proposed tests work well even with a small number of clusters, and that they can be substantially more powerful compared to the only, to the best of our knowledge, previously proposed test for this problem. The tests are illustrated using data from a multicenter randomized controlled trial on metastatic squamous-cell carcinoma of the head and neck.
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Affiliation(s)
- Giorgos Bakoyannis
- Department of Biostatistics and Health Data Science, Indiana University, 410 West 10th Street, Suite 3000, Indianapolis, Indiana 46202, U.S.A
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street Richmond, Virginia 23219, U.S.A
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Pericas C, Clotas C, Espelt A, López MJ, Bosque-Prous M, Juárez O, Bartroli M. Effectiveness of school-based emotional education program: a cluster-randomized controlled trial. Public Health 2022; 210:142-8. [PMID: 35970016 DOI: 10.1016/j.puhe.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The acquisition of emotional competencies through emotional education programs improves both short- and long-term health outcomes. The 1,2,3,emoció! program directed at children aged 3-5 years aims to promote health through the development of emotional competencies. This study evaluated the effectiveness of the program during its first year of implementation. STUDY DESIGN Cluster randomized trial. METHODS The information sources were an ad-hoc questionnaire to evaluate emotional competencies and focus group discussions with the teachers implementing the program. For the quantitative data analysis, we compared mean emotional competencies scores pre- and postintervention for the intervention group and the comparison group. We also conducted a multilevel regression with repeated measures, adjusted by sociodemographic variables and stratified by gender and school year. For the qualitative data, we performed a thematic content analysis. RESULTS The sample consisted of 2625 children (48.4% girls and 49.2% intervention group). Emotional competencies improved in both groups after the school year (P-value < 0.001), but the increase was greater in the intervention group. The multilevel analysis showed an improvement in the final scores attributed to the intervention, especially for those in the first year of preschool [boys: 12.33 points (95% CI 5.51-19.15), girls: 9.66 points (95% CI 3.36-15.96)]. The thematic content analysis also highlighted enhanced emotional competencies in the intervention group. The final scores did not vary by sociodemographic variables. CONCLUSIONS The 1,2,3,emoció! program had a positive effect on emotional competencies among children, with effectivity being higher among younger children.
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14
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Metcalfe JJ, McCaffrey J, Schumacher M, Kownacki C, Prescott MP. Community-based nutrition education and hands-on cooking intervention increases farmers' market use and vegetable servings. Public Health Nutr 2022; 25:2601-13. [PMID: 35311633 DOI: 10.1017/S1368980022000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the current study was to evaluate the impact of the Market to MyPlate (M2MP) program on participants' reported farmers' market (FM) attitudes and shopping behaviours, frequency of serving vegetables to their families, food resource management behaviours and food security. A secondary objective was to identify facilitators and barriers to shopping at FM and food waste reduction techniques used by low-income families. DESIGN The current study used a mixed methods evaluation embedded within a cluster randomised trial of the M2MP intervention. SETTING The 7-week M2MP program was delivered at Extension offices and community centres in central Illinois. PARTICIPANTS Participants included 120 adults and their families. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45). RESULTS Compared with control participants, PAE participants were significantly more likely to report shopping at FM (P = 0·029) and reported serving more vegetables to their families (P = 0·010) (EO participants did not differ from the control group on any outcomes). There were no differences between conditions in survey-based measures of food security or food resource management behaviours. Interview results describe facilitators and barriers to shopping at FM and a variety of food waste reduction techniques (including food placement and food resource management). CONCLUSIONS These findings suggest that fresh produce provision coupled with nutrition and culinary education can positively impact shopping and dietary behaviours.
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Thompson JA, Leyrat C, Fielding KL, Hayes RJ. Cluster randomised trials with a binary outcome and a small number of clusters: comparison of individual and cluster level analysis method. BMC Med Res Methodol 2022; 22:222. [PMID: 35962318 PMCID: PMC9375419 DOI: 10.1186/s12874-022-01699-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 07/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cluster randomised trials (CRTs) are often designed with a small number of clusters, but it is not clear which analysis methods are optimal when the outcome is binary. This simulation study aimed to determine (i) whether cluster-level analysis (CL), generalised linear mixed models (GLMM), and generalised estimating equations with sandwich variance (GEE) approaches maintain acceptable type-one error including the impact of non-normality of cluster effects and low prevalence, and if so (ii) which methods have the greatest power. We simulated CRTs with 8-30 clusters, altering the cluster-size, outcome prevalence, intracluster correlation coefficient, and cluster effect distribution. We analysed each dataset with weighted and unweighted CL; GLMM with adaptive quadrature and restricted pseudolikelihood; GEE with Kauermann-and-Carroll and Fay-and-Graubard sandwich variance using independent and exchangeable working correlation matrices. P-values were from a t-distribution with degrees of freedom (DoF) as clusters minus cluster-level parameters; GLMM pseudolikelihood also used Satterthwaite and Kenward-Roger DoF. RESULTS Unweighted CL, GLMM pseudolikelihood, and Fay-and-Graubard GEE with independent or exchangeable working correlation matrix controlled type-one error in > 97% scenarios with clusters minus parameters DoF. Cluster-effect distribution and prevalence of outcome did not usually affect analysis method performance. GEE had the least power. With 20-30 clusters, GLMM had greater power than CL with varying cluster-size but similar power otherwise; with fewer clusters, GLMM had lower power with common cluster-size, similar power with medium variation, and greater power with large variation in cluster-size. CONCLUSION We recommend that CRTs with ≤ 30 clusters and a binary outcome use an unweighted CL or restricted pseudolikelihood GLMM both with DoF clusters minus cluster-level parameters.
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Affiliation(s)
- Jennifer A. Thompson
- grid.8991.90000 0004 0425 469XDepartment of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Clemence Leyrat
- grid.8991.90000 0004 0425 469XDepartment of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine L. Fielding
- grid.8991.90000 0004 0425 469XDepartment of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J. Hayes
- grid.8991.90000 0004 0425 469XDepartment of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
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McNamee P, Matanov A, Jerome L, Kerry S, Walker N, Feng Y, Molodynski A, Scott S, Guruvaiah L, Collinson S, McCabe R, Geddes J, Priebe S, Bird V. Clinical- and cost-effectiveness of a technology-supported and solution-focused intervention (DIALOG+) in treatment of patients with chronic depression-study protocol for a multi-site, cluster randomised controlled trial [TACK]. Trials 2022; 23:237. [PMID: 35346348 PMCID: PMC8960207 DOI: 10.1186/s13063-022-06181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Background Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression. Methods Patients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months. Discussion This definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit. Trial registration ISRCTN11301686. Registered on 13 Jun 2019.
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Affiliation(s)
- Philip McNamee
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Cherry Tree Way, London, S13 8SP, UK.
| | - Aleksandra Matanov
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Cherry Tree Way, London, S13 8SP, UK
| | - Lauren Jerome
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Cherry Tree Way, London, S13 8SP, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Queen Mary University, London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Neil Walker
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Queen Mary University, London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Yan Feng
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Queen Mary University, London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Andrew Molodynski
- Oxford Health NHS Foundation Trust, Research & Development, Warneford Lane, Headington, Oxford, OX3 7JX, UK
| | - Shonagh Scott
- Sheffield Health and Social Care NHS Foundation Trust, Research & Development, Fulwood House, Old Fulwood Road, Sheffield, S10 3TH, UK
| | - Latha Guruvaiah
- Gloucestershire Health and Care NHS Foundation Trust, Research & Development, Fritchie Centre, Charlton Lane, Cheltenham, GL53 9DZ, UK
| | - Sue Collinson
- Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Rose McCabe
- Centre for Mental Health Research, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, OX3 7JX, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Cherry Tree Way, London, S13 8SP, UK
| | - Victoria Bird
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Cherry Tree Way, London, S13 8SP, UK.
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Smith D, Bhangu A. Study protocol for a cluster randomised trial of sterile glove and instrument change at the time of wound closure to reduce surgical site infection in low- and middle-income countries (CHEETAH). Trials 2022; 23:204. [PMID: 35264227 PMCID: PMC8905008 DOI: 10.1186/s13063-022-06102-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/10/2022] [Indexed: 01/22/2023] Open
Abstract
Background Surgical site infection (SSI) represents a major burden for patients, doctors, and health systems around the world. The aim of this trial is to assess whether the practice of using separate sterile gloves and instruments to close wounds at the end of surgery compared to current routine hospital practice can reduce surgical site infection at 30-days post-surgery for patients undergoing clean-contaminated, contaminated, or dirty abdominal surgery. Methods This study protocol describes a pragmatic, international, multi-centre, 2-arm, cluster randomised controlled trial, with an internal pilot. Clusters are defined as hospitals within low- and middle-income countries (LMICs) defined by the Development Assistance Committee (DAC) Official Development Assistance (ODA) list, where there are at least 4 eligible hospitals per country. Hospitals (clusters) must be in LMICs where glove and instrument change are not currently routine practice. Patients (adults and children) undergoing emergency or elective abdominal surgery for a clean-contaminated, contaminated, or dirty operation are eligible for inclusion. Before closing the abdominal wall, surgeons and the scrub nurse will change gloves and use separate, sterile instruments (intervention), versus no changing gloves or using separate, sterile instruments (standard practice, control). The primary outcome is SSI within 30 days after surgery, using the Centre for Disease Control (CDC) criteria. Secondary outcomes are SSI before point of hospital discharge, and readmission, reoperation, length of hospital stay, return to normal activities, and death up to 30-days after surgery. A 12-month internal pilot, including 12 clusters and approximately 600 participants, aims to assess adherence to allocation and follow-up of patients. The main trial is powered to detect a minimum reduction in the primary outcome from 16 to 12%. A total of 12,800 participants will be recruited from 64 clusters (hospitals) each including at least 200 participants. Discussion Change of gloves and sterile instruments prior to fascial closure in abdominal surgery is a low-cost, simple, intraoperative intervention which involves all members of the surgical and scrub team. If effective at reducing SSI, this practice could be readily implemented across all contexts. The findings of this trial will inform future guideline updates from international healthcare organisations, including the World Health Organization. Trial registration ClinicalTrials.gov NCT03980652. Registered on 9 July 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06102-5.
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Affiliation(s)
- Donna Smith
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham, B152TH, UK.
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham, B152TH, UK
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18
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Msellemu D, Ross A, Temu L, Moshi I, Hofer L, Mwanziva C, Kohi YM, Moore SJ. Effect of interventions to reduce malaria incidence among military personnel on active duty: study protocol for a cluster randomised controlled trial of the impact of etofenprox-treated uniforms, permethrin-treated uniforms and DEET insect repellent. Trials 2021; 22:825. [PMID: 34802455 PMCID: PMC8607639 DOI: 10.1186/s13063-021-05801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While there is strong evidence that bite protection methods such as permethrin-treated clothing and topical insect repellents are protective against insect bites, there are few studies assessing the impact on malaria infection. This study will estimate the protective efficacy of treated uniforms and DEET insect repellent on the incidence of malaria infection among military personnel in an operational setting. Permethrin-treated uniforms used with DEET lotion will be compared to etofenprox-treated uniforms with DEET lotion. The effect of DEET lotion will be estimated by comparing permethrin-treated uniforms with DEET or placebo lotion. METHOD A cluster randomised double-blind placebo-controlled trial is planned to evaluate the effectiveness of the interventions on preventing malaria infections in soldiers on active duty at Mgambo National Service Camp in Tanga, Tanzania. The arms are (1) permethrin-treated uniform with 30% DEET liposome formula; (2) permethrin-treated uniform with placebo lotion; (3) candidate insect repellent system, i.e. etofenprox-treated uniform with 30% DEET liposome formula; and (4) placebo, i.e. untreated uniforms with placebo lotion. The primary outcome is the incidence of Plasmodium falciparum malaria infection detected by polymerase chain reaction (PCR) by active case detection using surveys every 2 weeks for 12 months. Rapid diagnostic tests will be used for the diagnosis of participants with symptoms. The unit of randomisation will be combania: companies formed by recruits aged 18 to 25 years; combania do activities together and sleep in the same dormitory. Unequal randomisation will be used to optimise statistical power for the primary comparison between permethrin-treated uniforms with DEET and etofenprox-treated uniforms with DEET. DISCUSSION This trial will provide the estimate of the effects of permethrin with DEET compared to those of the new fabric treatment etofenprox with DEET and any additional effect of using DEET. The results will inform strategies to protect military personnel and civilians who have more outdoor or occupational malaria exposure than the general public. TRIAL REGISTRATION ClinicalTrials.gov NCT02938975 .
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Affiliation(s)
- Daniel Msellemu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Lucky Temu
- HJF Medical Research International (HJFMRI), Walter Reed Program, Tanzania, P.O. Box 13303, Dar es Salaam, Tanzania
| | - Irene Moshi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Lorenz Hofer
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Charles Mwanziva
- Tanzania People’s Defence Force, Magore Upanga, P.O. Box 9203, Dar es Salaam, Tanzania
| | - Yadon M. Kohi
- Tanzania People’s Defence Force, Magore Upanga, P.O. Box 9203, Dar es Salaam, Tanzania
| | - Sarah J. Moore
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
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Amudhan S, Jangam K, Mani K, Murugappan NP, Sharma E, Mahapatra P, Burma AD, Tiwari HK, Ashok A, Vaggar S, Rao GN. Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents. BMC Public Health 2021; 21:2034. [PMID: 34742284 PMCID: PMC8572074 DOI: 10.1186/s12889-021-12086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health. Methods Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools. Discussion This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India. Trial registration Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).
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Affiliation(s)
- Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India.
| | - Kavita Jangam
- Department of Psychiatric Social Work, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Payel Mahapatra
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Ajit Deo Burma
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Hemant Kumar Tiwari
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Ashi Ashok
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Sangappa Vaggar
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Girish Nagaraja Rao
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
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20
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Jones CI, Bremner S, Hooper R, Gu J, Bartl G, Greenwood K. Statistical analysis plan for the Early Youth Engagement in first episode psychosis (EYE-2) study: a pragmatic cluster randomised controlled trial of implementation, effectiveness and cost-effectiveness of a team-based motivational engagement intervention to improve engagement. Trials 2021; 22:732. [PMID: 34688283 PMCID: PMC8541800 DOI: 10.1186/s13063-021-05670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium-long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and health services. This study will evaluate the effectiveness of a team-based motivational engagement intervention, the Early Youth Engagement (EYE-2) intervention. METHODS AND DESIGN The EYE-2 trial is a cluster randomised controlled trial comparing the EYE-2 intervention plus standardised EIP service to standardised EIP service alone, with randomisation at the clinical team (cluster) level. The study aimed to enrol 950 young people (aged 14-35 years) with first episode psychosis in 10 teams per arm. RESULTS The primary outcome is time to disengagement: days from the date of allocation to care coordinator to date of the last contact following either refusal to engage with an EIP team or lack of response to EIP contact for 3 consecutive months which will be analysed using a shared frailty model. Secondary outcomes are Health of the Nation Outcome Scale (HoNOS), Process of Recovery Questionnaire (QPR), DIALOG (a service user-reported measure of quality of life and treatment satisfaction) and service use outcomes which will be analysed using mixed effects regression models. DISCUSSION This paper is the detailed statistical analysis plan for the EYE-2 trial. Any changes to, or deviations from, this plan will be described and justified in the final trial report. TRIAL REGISTRATION ISRCTN 51629746 . Prospectively registered on 7 May 2019. Date assigned 10 May 2019.
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Affiliation(s)
| | | | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Jenny Gu
- School of Psychology, University of Sussex, Falmer, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Falmer, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Falmer, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Hove, UK
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Hensen B, Phiri M, Schaap A, Floyd S, Simuyaba M, Mwenge L, Sigande L, Belemu S, Shanaube K, Simwinga M, Fidler S, Hayes R, Ayles H. Yathu Yathu ("For us, by us"): Design of a cluster-randomised trial of the impact of community-based, peer-led comprehensive sexual and reproductive health services for adolescents and young people aged 15 to 24 in Lusaka, Zambia. Contemp Clin Trials 2021; 110:106568. [PMID: 34543725 DOI: 10.1016/j.cct.2021.106568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In sub-Saharan Africa, the growing population of adolescents and young people aged 15 to 24 face a high burden of HIV, and other preventable and treatable sexually transmitted infections. Despite this burden, adolescents and young people are the population least served by available sexual and reproductive (SRH) services. This trial aims to evaluate the impact of community-based peer-led SRH services, combined with a novel incentivised "loyalty card" system, on knowledge of HIV status and coverage of SRH services. METHODS A cluster-randomised trial (CRT) with embedded process and economic evaluation. DISCUSSION With little available evidence of the impact of community-based, peer-led services on coverage of SRH services, our study will provide evidence critical to expanding our knowledge of how to reach adolescents and young people. The "loyalty card" system is also a novel approach to providing SRH services. The delivery of community-based services supported by incentives in the form of loyalty cards is innovative, and may prove a simple strategy to improve access to SRH services. Adolescents and young people remain underserved by available SRH services; there remains a critical need to identify ways to provide adolescents and young people with access to SRH services. Rigorous evidence of whether this innovative strategy, with strong links to the local health facility, increases coverage of critical SRH services would add to the evidence-base of how to reach adolescents and young people.
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Affiliation(s)
- B Hensen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - A Schaap
- Zambart, Lusaka, Zambia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | | - S Fidler
- Imperial College and Imperial College NIHR BRC, London, United Kingdom
| | - R Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H Ayles
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Zambart, Lusaka, Zambia
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Neuman M, Hensen B, Mwinga A, Chintu N, Fielding KL, Handima N, Hatzold K, Johnson C, Mulubwa C, Nalubamba M, Otte im Kampe E, Simwinga M, Smith G, Tsamwa D, Corbett EL, Ayles H. Does community-based distribution of HIV self-tests increase uptake of HIV testing? Results of pair-matched cluster randomised trial in Zambia. BMJ Glob Health 2021; 6:bmjgh-2020-004543. [PMID: 34275868 PMCID: PMC8287620 DOI: 10.1136/bmjgh-2020-004543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Ending HIV by 2030 is a global priority. Achieving this requires alternative HIV testing strategies, such as HIV self-testing (HIVST) to reach all individuals with HIV testing services (HTS). We present the results of a trial evaluating the impact of community-based distribution of HIVST in community and facility settings on the uptake of HTS in rural and urban Zambia. DESIGN Pair-matched cluster randomised trial. METHODS In catchment areas of government health facilities, OraQuick HIVST kits were distributed by community-based distributors (CBDs) over 12 months in 2016-2017. Within matched pairs, clusters were randomised to receive the HIVST intervention or standard of care (SOC). Individuals aged ≥16 years were eligible for HIVST. Within communities, CBDs offered HIVST in high traffic areas, door to door and at healthcare facilities. The primary outcome was self-reported recent testing within the previous 12 months measured using a population-based survey. RESULTS In six intervention clusters (population 148 541), 60 CBDs distributed 65 585 HIVST kits. A recent test was reported by 66% (1622/2465) in the intervention arm compared with 60% (1456/2429) in SOC arm (adjusted risk ratio 1.08, 95% CI 0.94 to 1.24; p=0.15). Uptake of the HIVST intervention was low: 24% of respondents in the intervention arm (585/2493) used an HIVST kit in the previous 12 months. No social harms were identified during implementation. CONCLUSION Despite distributing a large number of HIVST kits, we found no evidence that this community-based HIVST distribution intervention increased HTS uptake. Other models of HIVST distribution, including secondary distribution and community-designed distribution models, provide alternative strategies to reach target populations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02793804).
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Affiliation(s)
- Melissa Neuman
- Department of Infectious Disease Epidemiology, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernadette Hensen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Namwinga Chintu
- Society for Family Health, Lusaka, Zambia,Population Services International, Cape Town, South Africa
| | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Eveline Otte im Kampe
- Department of Infectious Disease Epidemiology, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gina Smith
- Society for Family Health, Lusaka, Zambia,Population Services International, Cape Town, South Africa
| | | | - Elizabeth Lucy Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK,Zambart, Lusaka, Zambia
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Indravudh PP, Fielding K, Chilongosi R, Nzawa R, Neuman M, Kumwenda MK, Nyirenda R, Johnson CC, Taegtmeyer M, Desmond N, Hatzold K, Corbett EL. Effect of door-to-door distribution of HIV self-testing kits on HIV testing and antiretroviral therapy initiation: a cluster randomised trial in Malawi. BMJ Glob Health 2021; 6:bmjgh-2020-004269. [PMID: 34275866 PMCID: PMC8287599 DOI: 10.1136/bmjgh-2020-004269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Reaching high coverage of HIV testing remains essential for HIV diagnosis, treatment and prevention. We evaluated the effectiveness and safety of door-to-door distribution of HIV self-testing (HIVST) kits in rural Malawi. METHODS This cluster randomised trial, conducted between September 2016 and January 2018, used restricted 1:1 randomisation to allocate 22 health facilities and their defined areas to door-to-door HIVST alongside the standard of care (SOC) or the SOC alone. The study population included residents (≥16 years). HIVST kits were provided door-to-door by community-based distribution agents (CBDAs) for at least 12 months. The primary outcome was recent HIV testing (in the last 12 months) measured through an endline survey. Secondary outcomes were lifetime HIV testing and cumulative 16-month antiretroviral therapy (ART) initiations, which were captured at health facilities. Social harms were reported through community reporting systems. Analysis compared cluster-level outcomes by arm. RESULTS Overall, 203 CBDAs distributed 273 729 HIVST kits. The endline survey included 2582 participants in 11 HIVST clusters and 2908 participants in 11 SOC clusters. Recent testing was higher in the HIVST arm (68.5%, 1768/2582) than the SOC arm (48.9%, 1422/2908), with adjusted risk difference (RD) of 16.1% (95% CI 6.5% to 25.7%). Lifetime testing was also higher in the HIVST arm (86.9%, 2243/2582) compared with the SOC arm (78.5%, 2283/2908; adjusted RD 6.3%, 95% CI 2.3% to 10.3%). Differences were most pronounced for adolescents aged 16-19 years (adjusted RD 18.6%, 95% CI 7.3% to 29.9%) and men (adjusted RD 10.2%, 95% CI 3.1% to 17.2%). Cumulative incidence of ART initiation was 1187.2 and 909.0 per 100 000 population in the HIVST and SOC arms, respectively (adjusted RD 309.1, 95% CI -95.5 to 713.7). Self-reported HIVST use was 42.5% (1097/2582), with minimal social harms reported. CONCLUSION Door-to-door HIVST increased recent and lifetime testing at population level and showed high safety, underscoring potential for HIVST to contribute to HIV elimination goals in priority settings. TRIAL REGISTRATION NUMBER NCT02718274.
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Affiliation(s)
- Pitchaya P Indravudh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | | | - Rebecca Nzawa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Moses K Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Cheryl C Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneve, Switzerland.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Washington, DC, USA
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Sibanda EL, Neuman M, Tumushime M, Mangenah C, Hatzold K, Watadzaushe C, Mutseta MN, Dirawo J, Napierala S, Ncube G, Terris-Prestholt F, Taegtmeyer M, Johnson C, Fielding KL, Weiss HA, Corbett E, Cowan FM. Community-based HIV self-testing: a cluster-randomised trial of supply-side financial incentives and time-trend analysis of linkage to antiretroviral therapy in Zimbabwe. BMJ Glob Health 2021; 6:e003866. [PMID: 34275865 PMCID: PMC8287602 DOI: 10.1136/bmjgh-2020-003866] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) requires linkage to post-test services to maximise its benefits. We evaluated effect of supply-side incentivisation on linkage following community-based HIVST and evaluated time-trends in facility-based antiretroviral therapy (ART) initiations. METHODS From August 2016 to August 2017 community-based distributors (CBDs) in 38 rural Zimbabwean communities distributed HIVST door-to-door in 19-25 day campaigns. Communities were allocated (1:1) using constrained randomisation to either one-off US$50 remuneration per CBD (non-incentive arm), or US$50 plus US$0.20 incentive per client visiting mobile-outreach services (conditional-incentive arm). The primary outcome, assessed by population survey 6 weeks later, was self-reported uptake of any clinic service, analysed with random-effects logistic regression. Separately, non-randomised difference-in-differences in monthly ART initiations were analysed for three time periods (6 months baseline; HIVST campaign; 3 months after) at public clinics with (40 clinics) and without (124 clinics) HIVST distribution in catchment area. FINDINGS A total of 445 conditional-incentive CBDs distributed 39 205 HIVST kits (mean/CBD: 88; 95% CI: 85 to 92) and 447 non-incentive CBDs distributed 41 173 kits (mean/CBD: 93; 95% CI: 89 to 96). Survey participation was 7146/8566 (83.4%), with 3593 (50.3%) reporting self-testing including 1305 (18.3%) previously untested individuals. Use of clinic services post-HIVST was similar in conditional-incentive (1062/3698, 28.7%) and non-incentive (1075/3448, 31.2%) arms (adjusted risk ratio (aRR) 0.94, 95% CI: 0.86 to 1.03). Confirmatory testing by newly diagnosed/untreated HIVST+clients was, however, higher (conditional-incentive: 25/33, 75.8% vs non-incentive: 20/40, 50.0%: aRR: 1.59, 95% CI: 1.05 to 2.39). In total, 12 808 ART initiations occurred, with no baseline or postcampaign differences between initiation rates in HIVST versus non-HIVST clinics, but initiation rates increased from 7.31 to 9.59 initiations per month in HIVST clinics during distribution, aRR: 1.27, 95% CI 1.17 to 1.39. CONCLUSIONS Community-based HIVST campaigns achieved high testing uptake, temporally associated with increased demand for ART. Small supply-side incentives did not affect general clinic usage but may have increased confirmatory testing for newly diagnosed HIVST positive participants. TRIAL REGISTRATION NUMBER PACTR201607001701788.
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Affiliation(s)
- Euphemia Lindelwe Sibanda
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Melissa Neuman
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Karin Hatzold
- HIV and Tuberculosis, Population Services International Global, Washington, DC, USA
| | | | - Miriam N Mutseta
- Department of Sexual Reproductive Health Rights and Innovations, Population Services International Zimbabwe, Harare, Zimbabwe
| | | | - Sue Napierala
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Getrude Ncube
- HIV and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Corbett
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Harris-Fry H, O'Hearn M, Pradhan R, Krishnan S, Nair N, Rath S, Rath S, Koniz-Booher P, Danton H, Aakesson A, Pradhan S, Mishra NK, Kumar A, Upadhay A, Prost A, Kadiyala S. How to design a complex behaviour change intervention: experiences from a nutrition-sensitive agriculture trial in rural India. BMJ Glob Health 2021; 5:bmjgh-2020-002384. [PMID: 32513863 PMCID: PMC7282327 DOI: 10.1136/bmjgh-2020-002384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022] Open
Abstract
Many public health interventions aim to promote healthful behaviours, with varying degrees of success. With a lack of existing empirical evidence on the optimal number or combination of behaviours to promote to achieve a given health outcome, a key challenge in intervention design lies in deciding what behaviours to prioritise, and how best to promote them. We describe how key behaviours were selected and promoted within a multisectoral nutrition-sensitive agriculture intervention that aimed to address maternal and child undernutrition in rural India. First, we formulated a Theory of Change, which outlined our hypothesised impact pathways. To do this, we used the following inputs: existing conceptual frameworks, published empirical evidence, a feasibility study, formative research and the intervention team’s local knowledge. Then, we selected specific behaviours to address within each impact pathway, based on our formative research, behaviour change models, local knowledge and community feedback. As the intervention progressed, we mapped each of the behaviours against our impact pathways and the transtheoretical model of behaviour change, to monitor the balance of behaviours across pathways and along stages of behaviour change. By collectively agreeing on definitions of complex concepts and hypothesised impact pathways, implementing partners were able to communicate clearly between each other and with intervention participants. Our intervention was iteratively informed by continuous review, by monitoring implementation against targets and by integrating community feedback. Impact and process evaluations will reveal whether these approaches are effective for improving maternal and child nutrition, and what the effects are on each hypothesised impact pathway.
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Affiliation(s)
- Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | | | - Sneha Krishnan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | | - Audrey Prost
- University College London Institute of Child Health, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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26
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McCann RS, Kabaghe AN, Moraga P, Gowelo S, Mburu MM, Tizifa T, Chipeta MG, Nkhono W, Di Pasquale A, Maire N, Manda-Taylor L, Mzilahowa T, van den Berg H, Diggle PJ, Terlouw DJ, Takken W, van Vugt M, Phiri KS. The effect of community-driven larval source management and house improvement on malaria transmission when added to the standard malaria control strategies in Malawi: a cluster-randomized controlled trial. Malar J 2021; 20:232. [PMID: 34022912 PMCID: PMC8140568 DOI: 10.1186/s12936-021-03769-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Current standard interventions are not universally sufficient for malaria elimination. The effects of community-based house improvement (HI) and larval source management (LSM) as supplementary interventions to the Malawi National Malaria Control Programme (NMCP) interventions were assessed in the context of an intensive community engagement programme. METHODS The study was a two-by-two factorial, cluster-randomized controlled trial in Malawi. Village clusters were randomly assigned to four arms: a control arm; HI; LSM; and HI + LSM. Malawi NMCP interventions and community engagement were used in all arms. Household-level, cross-sectional surveys were conducted on a rolling, 2-monthly basis to measure parasitological and entomological outcomes over 3 years, beginning with one baseline year. The primary outcome was the entomological inoculation rate (EIR). Secondary outcomes included mosquito density, Plasmodium falciparum prevalence, and haemoglobin levels. All outcomes were assessed based on intention to treat, and comparisons between trial arms were conducted at both cluster and household level. RESULTS Eighteen clusters derived from 53 villages with 4558 households and 20,013 people were randomly assigned to the four trial arms. The mean nightly EIR fell from 0.010 infectious bites per person (95% CI 0.006-0.015) in the baseline year to 0.001 (0.000, 0.003) in the last year of the trial. Over the full trial period, the EIR did not differ between the four trial arms (p = 0.33). Similar results were observed for the other outcomes: mosquito density and P. falciparum prevalence decreased over 3 years of sampling, while haemoglobin levels increased; and there were minimal differences between the trial arms during the trial period. CONCLUSIONS In the context of high insecticide-treated bed net use, neither community-based HI, LSM, nor HI + LSM contributed to further reductions in malaria transmission or prevalence beyond the reductions observed over two years across all four trial arms. This was the first trial, as far as the authors are aware, to test the potential complementary impact of LSM and/or HI beyond levels achieved by standard interventions. The unexpectedly low EIR values following intervention implementation indicated a promising reduction in malaria transmission for the area, but also limited the usefulness of this outcome for measuring differences in malaria transmission among the trial arms. Trial registration PACTR, PACTR201604001501493, Registered 3 March 2016, https://pactr.samrc.ac.za/ .
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Affiliation(s)
- Robert S McCann
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Alinune N Kabaghe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Paula Moraga
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Steven Gowelo
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monicah M Mburu
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tinashe Tizifa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael G Chipeta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Malawi-Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - William Nkhono
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Aurelio Di Pasquale
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicolas Maire
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lucinda Manda-Taylor
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Themba Mzilahowa
- MAC Communicable Diseases Action Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Peter J Diggle
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Dianne J Terlouw
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Michèle van Vugt
- Center for Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Kamija S Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
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27
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Maldonado LY, Bone J, Scanlon ML, Anusu G, Chelagat S, Jumah A, Ikemeri JE, Songok JJ, Christoffersen-Deb A, Ruhl LJ. Improving maternal, newborn and child health outcomes through a community-based women's health education program: a cluster randomised controlled trial in western Kenya. BMJ Glob Health 2021; 5:bmjgh-2020-003370. [PMID: 33293295 PMCID: PMC7725102 DOI: 10.1136/bmjgh-2020-003370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Community-based women’s health education groups may improve maternal, newborn and child health (MNCH); however, evidence from sub-Saharan Africa is lacking. Chamas for Change (Chamas) is a community health volunteer (CHV)-led, group-based health education programme for pregnant and postpartum women in western Kenya. We evaluated Chamas’ effect on facility-based deliveries and other MNCH outcomes. Methods We conducted a cluster randomised controlled trial involving 74 community health units in Trans Nzoia County. We included pregnant women who presented to health facilities for their first antenatal care visits by 32 weeks gestation. We randomised clusters 1:1 without stratification or matching; we masked data collectors, investigators and analysts to allocation. Intervention clusters were invited to bimonthly, group-based, CHV-led health lessons (Chamas); control clusters had monthly, individual CHV home visits (standard of care). The primary outcome was facility-based delivery at 12-month follow-up. We conducted an intention-to-treat approach with multilevel logistic regression models using individual-level data. Results Between 27 November 2017 and 8 March 2018, we enrolled 1920 participants from 37 intervention and 37 control clusters. A total of 1550 (80.7%) participants completed the study with 822 (82.5%) and 728 (78.8%) in the intervention and control arms, respectively. Facility-based deliveries improved in the intervention arm (80.9% vs 73.0%; risk difference (RD) 7.4%, 95% CI 3.0 to 12.5, OR=1.58, 95% CI 0.97 to 2.55, p=0.057). Chamas participants also demonstrated higher rates of 48 hours postpartum visits (RD 15.3%, 95% CI 12.0 to 19.6), exclusive breastfeeding (RD 11.9%, 95% CI 7.2 to 16.9), contraceptive adoption (RD 7.2%, 95% CI 2.6 to 12.9) and infant immunisation completion (RD 15.6%, 95% CI 11.5 to 20.9). Conclusion Chamas participation was associated with significantly improved MNCH outcomes compared with the standard of care. This trial contributes robust data from sub-Saharan Africa to support community-based, women’s health education groups for MNCH in resource-limited settings. Trial registration number NCT03187873.
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Affiliation(s)
- Lauren Y Maldonado
- Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA .,Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Jeffrey Bone
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael L Scanlon
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gertrude Anusu
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sheilah Chelagat
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Anjellah Jumah
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Justus E Ikemeri
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Julia J Songok
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - Astrid Christoffersen-Deb
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada.,Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Laura J Ruhl
- Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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28
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Makata K, Ensink J, Ayieko P, Hansen C, Sichalwe S, Mngara J, Mcharo O, Mazigo H, Seni J, Dreibelbis R, Rockowitz S, Okello E, Grosskurth H, Kinung'hi S, Kapiga S. Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania. BMC Med 2021; 19:125. [PMID: 34016091 PMCID: PMC8139108 DOI: 10.1186/s12916-021-01987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania. METHODS We conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders. RESULTS At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28-2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74-1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59-2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73-1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study. CONCLUSIONS The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children's handwashing behaviour. TRIAL REGISTRATION The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number ( ISRCTN45013173) .
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Affiliation(s)
- Kenneth Makata
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Jeroen Ensink
- London School of Hygiene and Tropical Medicine, London, UK
| | - Philip Ayieko
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Christian Hansen
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Sichalwe
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Onike Mcharo
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Humphrey Mazigo
- Department of Medical Parasitology and Entomology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
| | | | - Sarah Rockowitz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Heiner Grosskurth
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Safari Kinung'hi
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania. .,London School of Hygiene and Tropical Medicine, London, UK. .,National Institute for Medical Research (NIMR), Mwanza, Tanzania.
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29
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Dunkle K, Stern E, Chatterji S, Heise L. Effective prevention of intimate partner violence through couples training: a randomised controlled trial of Indashyikirwa in Rwanda. BMJ Glob Health 2021; 5:bmjgh-2020-002439. [PMID: 33355268 PMCID: PMC7757483 DOI: 10.1136/bmjgh-2020-002439] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background Between 2015 and 2018, three civil society organisations in Rwanda implemented Indashyikirwa, a four-part intervention designed to reduce intimate partner violence (IPV) among couples and within communities. We assessed the impact of the programme’s gender transformative curriculum for couples. Methods Sectors (n=28) were purposively selected based on density of village savings and loan association (VLSA) groups and randomised (with stratification by district) to either the full community-level Indashyikirwa programme (n=14) or VSLA-only control (n=14). Within each sector, 60 couples recruited from VSLAs received either a 21-session curriculum or VSLA as usual. No blinding was attempted. Primary outcomes were perpetration (for men) or experience (for women) of past-year physical/sexual IPV at 24 months post-baseline, hypothesised to be reduced in intervention versus control (ClinicalTrials.gov: NCT03477877). Results We enrolled 828 women and 821 men in the intervention sectors and 832 women and 830 men in the control sectors; at endline, 815 women (98.4%) and 763 men (92.9%) in the intervention and 802 women (96.4%) and 773 men (93.1%) were available for intention-to-treat analysis. Women in the intervention compared with control were less likely to report physical and/or sexual IPV at 24 months (adjusted relative risk (aRR)=0.44, 95% CI 0.34 to 0.59). Men in the intervention compared with control were also significantly less likely to report perpetration of physical and/or sexual IPV at 24 months (aRR=0.54, 95% CI 0.38 to 0.75). Additional intervention benefits included reductions in acceptability of wife beating, conflict with partner, depression, and corporal punishment against children and improved conflict management, communication, trust, self-efficacy, self-rated health, household earnings, food security and actions to prevent IPV. There were no study-related harms. Conclusions The Indashyikirwa couples’ training curriculum was highly effective in reducing IPV among male/female couples in rural Rwanda. Scale-up and adaptation to similar settings should be considered.
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Affiliation(s)
- Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Erin Stern
- Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, Locon, UK
| | - Sangeeta Chatterji
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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30
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Kinyanda E, Kyohangirwe L, Mpango RS, Tusiime C, Ssebunnya J, Katumba K, Tenywa P, Mugisha J, Taasi G, Sentongo H, Akena D, Laurence Y, Muhwezi W, Weiss HA, Neuman M, Greco G, Knizek B, Levin J, Kaleebu P, Araya R, Ssembajjwe W, Patel V. Effectiveness and cost-effectiveness of integrating the management of depression into routine HIV Care in Uganda (the HIV + D trial): A protocol for a cluster-randomised trial. Int J Ment Health Syst 2021; 15:45. [PMID: 33980299 PMCID: PMC8114695 DOI: 10.1186/s13033-021-00469-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An estimated 8-30 % of people living with HIV (PLWH) have depressive disorders (DD) in sub-Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD among PLWH, but no evidence on how these can be integrated into routine HIV care. This protocol describes a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the HIV + D model for the integration of a collaborative stepped care intervention for DD into routine HIV care, which we have developed and piloted in Uganda. METHODS Forty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts will be randomly selected to participate in the trial. Each facility will recruit 10-30 eligible PLWH with DD and the total sample size will be 1200. The clusters will be randomised 1:1 to receive Enhanced Usual Care alone (EUC, i.e. HIV clinicians trained in Mental Health Gap Action Programme including guidelines on when and where to refer patients for psychiatric care) or EUC plus HIV + D (psychoeducation, Behavioural Activation, antidepressant medication and referral to a supervising mental health worker, delivered in a collaborative care stepwise approach). Eligibility criteria are PLWH attending the clinic, aged ≥ 18 years who screen positive on a depression screening questionnaire (Patient Health Questionnaire, PHQ-9 ≥ 10). The primary outcome is the mean depressive disorder symptom severity scores (assessed using the PHQ-9) at 3 months' post-randomisation, with secondary mental health, disability, HIV and economic outcomes measured at 3 and 12 months. The cost-effectiveness of EUC with HIV + D will be assessed from both the health system and the societal perspectives by collecting health system, patient and productivity costs and mean DD severity scores at 3 months, additional to health and non-health related quality of life measures (EQ-5D-5 L and OxCAP-MH). DISCUSSION The study findings will inform policy makers and practitioners on the cost-effectiveness of a stepped care approach to integrate depression management in routine care for PLWH in low-resource settings. TRIAL REGISTRATION ISRCTN, ISRCTN86760765. Registered 07 September 2017, https://doi.org/10.1186/ISRCTN86760765 .
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Affiliation(s)
- Eugene Kinyanda
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | - Leticia Kyohangirwe
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda.
| | - Richard S Mpango
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | - Christine Tusiime
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | | | - Kenneth Katumba
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | - Patrick Tenywa
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | | | | | | | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yoko Laurence
- Department for Global Health and Development, Public Health and Policy, London School of Hygiene & Tropical Medicine, Centre for Health Economics in London, London, England
| | - Wilson Muhwezi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group LSHTM, London, England
| | - Melissa Neuman
- MRC International Statistics and Epidemiology Group LSHTM, London, England
| | - Giulia Greco
- Department for Global Health and Development, Public Health and Policy, London School of Hygiene & Tropical Medicine, Centre for Health Economics in London, London, England
| | - Birthe Knizek
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonathan Levin
- Department Statistics, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ricardo Araya
- Centre for Global Mental Health, Kings College London, London, England
| | - Wilber Ssembajjwe
- MRC/UVRI & LSHTM Uganda Research Unit, Mental Health Section, Entebbe, Uganda
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Jones BG, Streeter AJ, Baker A, Moyeed R, Creanor S. Bayesian statistics in the design and analysis of cluster randomised controlled trials and their reporting quality: a methodological systematic review. Syst Rev 2021; 10:91. [PMID: 33789717 PMCID: PMC8015172 DOI: 10.1186/s13643-021-01637-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In a cluster randomised controlled trial (CRCT), randomisation units are "clusters" such as schools or GP practices. This has methodological implications for study design and statistical analysis, since clustering often leads to correlation between observations which, if not accounted for, can lead to spurious conclusions of efficacy/effectiveness. Bayesian methodology offers a flexible, intuitive framework to deal with such issues, but its use within CRCT design and analysis appears limited. This review aims to explore and quantify the use of Bayesian methodology in the design and analysis of CRCTs, and appraise the quality of reporting against CONSORT guidelines. METHODS We sought to identify all reported/published CRCTs that incorporated Bayesian methodology and papers reporting development of new Bayesian methodology in this context, without restriction on publication date or location. We searched Medline and Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Reporting quality metrics according to the CONSORT extension for CRCTs were collected, as well as demographic data, type and nature of Bayesian methodology used, journal endorsement of CONSORT guidelines, and statistician involvement. RESULTS Twenty-seven publications were included, six from an additional hand search. Eleven (40.7%) were reports of CRCT results: seven (25.9%) were primary results papers and four (14.8%) reported secondary results. Thirteen papers (48.1%) reported Bayesian methodological developments, the remaining three (11.1%) compared different methods. Four (57.1%) of the primary results papers described the method of sample size calculation; none clearly accounted for clustering. Six (85.7%) clearly accounted for clustering in the analysis. All results papers reported use of Bayesian methods in the analysis but none in the design or sample size calculation. CONCLUSIONS The popularity of the CRCT design has increased rapidly in the last twenty years but this has not been mirrored by an uptake of Bayesian methodology in this context. Of studies using Bayesian methodology, there were some differences in reporting quality compared to CRCTs in general, but this study provided insufficient data to draw firm conclusions. There is an opportunity to further develop Bayesian methodology for the design and analysis of CRCTs in order to expand the accessibility, availability, and, ultimately, use of this approach.
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Affiliation(s)
- Benjamin G Jones
- Medical Statistics, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Room N15, ITTC Building 1, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK. .,NIHR ARC South West Peninsula (PenARC), College of Medicine and Health, University of Exeter, Exeter, Devon, UK.
| | - Adam J Streeter
- Medical Statistics, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Room N15, ITTC Building 1, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.,Klinische Epidemiologie, Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Amy Baker
- Medical Statistics, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Room N15, ITTC Building 1, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK
| | - Rana Moyeed
- School of Computing, Electronics and Mathematics, Faculty of Science and Engineering, University of Plymouth, Plymouth, Devon, UK
| | - Siobhan Creanor
- Medical Statistics, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Room N15, ITTC Building 1, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.,Peninsula Clinical Trials Unit, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, Devon, UK.,Exeter Clinical Trials Unit, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Goulao B, Scott C, Black I, Clarkson J, McArthur L, Ramsay C, Young L, Duncan E. Audit and feedback with or without training in-practice targeting antibiotic prescribing (TiPTAP): a study protocol of a cluster randomised trial in dental primary care. Implement Sci 2021; 16:32. [PMID: 33781284 PMCID: PMC8007384 DOI: 10.1186/s13012-021-01098-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is an increasingly serious threat to global public health and patient safety. Overuse of antibiotics has aggravated this issue. Around 7% of all antibiotics in Scotland are prescribed by dentists. Audit and feedback has been shown to decrease these prescriptions, but there is evidence that dentists still prescribe unnecessarily. Our aim is to compare the effectiveness of a theory-informed in-practice training session (TiPTAP) in addition to individualised audit and feedback, with audit and feedback alone for reducing antibiotic prescribing by NHS dentists working in NHS primary care dental practices. METHODS We will conduct a 2-arm parallel cluster randomised trial: out of 228 practices, 114 will be randomised to the theory-informed in-practice training session targeting antibiotic prescribing and individualised audit and feedback; 114 practices will be randomised to audit and feedback alone. The theory-informed session will include (a) an introductory session including several behaviour change techniques; (b) problem solving discussion, setting and recording action plans; (c) practice-level prescribing feedback discussion. The primary outcome is the number of antibiotic items per 100 NHS treatment claims over a 1-year period post-randomisation for each dentist. Secondary outcomes are the number of amoxicillin 3 g and broad spectrum antibiotics prescribed per 100 NHS treatment claims over a 1-year period; amoxicillin 3 g and broad spectrum antibiotics defined daily doses of antibiotics per 100 claims. Process measures include fidelity, knowledge, and confidence. Primary and secondary outcomes will be obtained using routine data. DISCUSSION This study provides the opportunity to robustly assess the effect of adding an in-practice training co-intervention to audit and feedback. Its behaviour change theory-informed content will allow replication of the different components and can inform future training interventions. TRIAL REGISTRATION ISRCTN, ISRCTN12345678 . Registered 18 June 2020.
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Affiliation(s)
- Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland.
| | | | | | - Jan Clarkson
- NHS Education for Scotland, Edinburgh, UK.,Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, Dundee, UK
| | | | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Linda Young
- NHS Education for Scotland, Edinburgh, UK.,Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, Dundee, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
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Relph S, Elstad M, Coker B, Vieira MC, Moitt N, Gutierrez WM, Khalil A, Sandall J, Copas A, Lawlor DA, Pasupathy D. Using electronic patient records to assess the effect of a complex antenatal intervention in a cluster randomised controlled trial-data management experience from the DESiGN Trial team. Trials 2021; 22:195. [PMID: 33685512 PMCID: PMC7941939 DOI: 10.1186/s13063-021-05141-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of electronic patient records for assessing outcomes in clinical trials is a methodological strategy intended to drive faster and more cost-efficient acquisition of results. The aim of this manuscript was to outline the data collection and management considerations of a maternity and perinatal clinical trial using data from electronic patient records, exemplifying the DESiGN Trial as a case study. METHODS The DESiGN Trial is a cluster randomised control trial assessing the effect of a complex intervention versus standard care for identifying small for gestational age foetuses. Data on maternal/perinatal characteristics and outcomes including infants admitted to neonatal care, parameters from foetal ultrasound and details of hospital activity for health-economic evaluation were collected at two time points from four types of electronic patient records held in 22 different electronic record systems at the 13 research clusters. Data were pseudonymised on site using a bespoke Microsoft Excel macro and securely transferred to the central data store. Data quality checks were undertaken. Rules for data harmonisation of the raw data were developed and a data dictionary produced, along with rules and assumptions for data linkage of the datasets. The dictionary included descriptions of the rationale and assumptions for data harmonisation and quality checks. RESULTS Data were collected on 182,052 babies from 178,350 pregnancies in 165,397 unique women. Data availability and completeness varied across research sites; each of eight variables which were key to calculation of the primary outcome were completely missing in median 3 (range 1-4) clusters at the time of the first data download. This improved by the second data download following clarification of instructions to the research sites (each of the eight key variables were completely missing in median 1 (range 0-1) cluster at the second time point). Common data management challenges were harmonising a single variable from multiple sources and categorising free-text data, solutions were developed for this trial. CONCLUSIONS Conduct of clinical trials which use electronic patient records for the assessment of outcomes can be time and cost-effective but still requires appropriate time and resources to maximise data quality. A difficulty for pregnancy and perinatal research in the UK is the wide variety of different systems used to collect patient data across maternity units. In this manuscript, we describe how we managed this and provide a detailed data dictionary covering the harmonisation of variable names and values that will be helpful for other researchers working with these data. TRIAL REGISTRATION Primary registry and trial identifying number: ISRCTN 67698474 . Registered on 02/11/16.
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Affiliation(s)
- Sophie Relph
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Maria Elstad
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, 4th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Bolaji Coker
- Division of Health and Social Care Research, King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK
| | - Matias C Vieira
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.,Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, 101 Alexander Fleming St, Cidade Universitaria, Campinas, SP, Brazil
| | - Natalie Moitt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Walter Muruet Gutierrez
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.,Molecular & Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew Copas
- Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Deborah A Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, BS8 2BL, UK.,Bristol NIHR Biomedical Research Centre, Bristol, BS8 2BL, UK.,MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BL, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.,Speciality of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Hutting N, Oswald W, Nijhuis-van der Sanden MWG, Filart M, Raaijmakers T, Bieleman HJ, Staal JB, Heerkens YF. The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the 'WORK TO BE DONE' cluster randomised controlled trial. BMC Musculoskelet Disord 2020; 21:360. [PMID: 32513153 PMCID: PMC7281957 DOI: 10.1186/s12891-020-03375-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient's work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health. METHODS/DESIGN This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients' care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients. DISCUSSION The trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism. TRIAL REGISTRATION Netherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518.
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Affiliation(s)
- Nathan Hutting
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - Wiebke Oswald
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
- School of Allied Health, Physical Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Monique Filart
- School of Health, Physical Therapy, Saxion University of Applied Sciences, Enschede, The Netherlands
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | | | - Hendrik J Bieleman
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical centre, Nijmegen, The Netherlands
- School of Allied Health, Musculoskeletal Research Group, HAN University of Applied Sciences, Key factors in Physiotherapy and Allied Health Research Group, Nijmegen, The Netherlands
| | - Yvonne F Heerkens
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
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Anders KL, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Andari B, Jewell NP, Dufault SM, Ryan PA, Tanamas SK, Rancès E, O'Neill SL, Simmons CP, Utarini A. Update to the AWED (Applying Wolbachia to Eliminate Dengue) trial study protocol: a cluster randomised controlled trial in Yogyakarta, Indonesia. Trials 2020; 21:429. [PMID: 32450914 PMCID: PMC7249400 DOI: 10.1186/s13063-020-04367-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Yogyakarta, Indonesia, with the aim of measuring the efficacy of Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting. Enrolment began in January 2018 and is ongoing. The original study protocol was published in April 2018. Here, we describe amendments that have been made to the study protocol since commencement of the trial. METHODS The key protocol amendments are (1) a revised study duration with planned end of participant enrolment in August 2020, (2) the addition of new secondary objectives (i) to estimate serotype-specific efficacy of the Wolbachia intervention and (ii) to compare Ae. aegypti abundance in intervention versus untreated clusters, (3) an additional exposure classification for the per-protocol analysis where the Wolbachia exposure index is calculated using only the cluster-level Wolbachia prevalence in the participant's cluster of residence, (4) power re-estimation using a multinomial sampling method that better accounts for randomness in sampling, and (5) the addition of two trial stopping rules to address the potential for persistently low rates of virologically confirmed dengue case enrolment and Wolbachia contamination into untreated clusters. Additional minor changes to the protocol are also described. DISCUSSION The findings from this study will provide the first experimental evidence for the efficacy of Wolbachia in reducing dengue incidence. Enrolment in the trial will conclude this year (2020) and results will be reported shortly thereafter. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT03055585. Registered on 14 February 2017. Last updated 22 March 2020.
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Affiliation(s)
- Katherine L Anders
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia.
| | - Citra Indriani
- Department of Biostatistics, Epidemiology and Population Health and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Riris Andono Ahmad
- Department of Biostatistics, Epidemiology and Population Health and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Warsito Tantowijoyo
- World Mosquito Program, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Eggi Arguni
- Department of Pediatrics and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Bekti Andari
- Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Nicholas P Jewell
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Suzanne M Dufault
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, 94720-7360, CA, USA
| | - Peter A Ryan
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Stephanie K Tanamas
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Edwige Rancès
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Scott L O'Neill
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Cameron P Simmons
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Adi Utarini
- Department of Health Policy and Management, and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
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Kombe MM, Zulu JM, Michelo C, Sandøy IF. Community perspectives on randomisation and fairness in a cluster randomised controlled trial in Zambia. BMC Med Ethics 2019; 20:99. [PMID: 31864351 PMCID: PMC6925446 DOI: 10.1186/s12910-019-0421-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One important ethical issue in randomised controlled trials (RCTs) is randomisation. Relatively little is known about how participating individuals and communities understand and perceive central aspects of randomisation such as equality, fairness, transparency and accountability in community-based trials. The aim of this study was to understand and explore study communities' perspectives of the randomisation process in a cluster RCT in rural Zambia studying the effectiveness of different support packages for adolescent girls on early childbearing. METHODS In this explorative study, in-depth semi-structured interviews were carried out in 2018 with 14 individuals who took part in the randomisation process of the Research Initiative to Support the Empowerment of Girls (RISE) project in 2016 and two traditional leaders. Two of the districts where the trial is implemented were purposively selected. Interviews were audio recorded and fully transcribed. Data were analysed by coding and describing emergent themes. RESULTS The understanding of the randomisation process varied. Some respondents understood that randomisation was conducted for research purposes, but most of them did not. They had trouble distinguishing research and aid. Generally, respondents perceived the randomisation process as transparent and fair. However, people thought that there should not have been a "lottery" because they wanted all schools to receive equal or balanced benefits of the interventions. CONCLUSIONS Randomisation was misunderstood by most respondents. Perceived procedural fairness was easier to realize than substantive fairness. Researchers working on Cluster Randomised Controlled Trials (CRCTs) should consider carefully how to explain randomisation.
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Affiliation(s)
- Maureen Mupeta Kombe
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, University of Zambia, Ridgeway Campus, P.O Box 50110, Lusaka, Zambia
| | - Ingvild F. Sandøy
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Davies MJ, Kristunas CA, Alshreef A, Dixon S, Eborall H, Glab A, Huddlestone L, Hudson N, Khunti K, Martin G, Northern A, Patterson M, Pritchard R, Schreder S, Stribling B, Turner J, Gray LJ. The impact of an intervention to increase uptake to structured self-management education for people with type 2 diabetes mellitus in primary care (the embedding package), compared to usual care, on glycaemic control: study protocol for a mixed methods study incorporating a wait-list cluster randomised controlled trial. BMC Fam Pract 2019; 20:152. [PMID: 31699046 PMCID: PMC6839094 DOI: 10.1186/s12875-019-1038-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approximately 425 million people globally have diabetes, with ~ 90% of these having Type 2 Diabetes Mellitus (T2DM). This is a condition that leads to a poor quality of life and increased risk of serious health complications. Structured self-management education (SSME) has been shown to be effective in improving glycaemic control and patient related outcome measures and to be cost-effective. However, despite the demonstrated benefits, attendance at SSME remains low. An intervention has been developed to embed SSME called the 'Embedding Package'. The intervention aims to address barriers and enhance enablers to uptake of SSME at patient, healthcare professional and organisational levels. It comprises a marketing strategy, user friendly and effective referral pathways, new roles to champion SSME and a toolkit of resources. METHODS A mixed methods study incorporating a wait-list cluster randomised trial and ethnographic study, including 66 UK general practices, will be conducted with two intervention start times (at 0 and 9 months), each followed by an active delivery phase. At 18 months, the intervention will cease to be actively delivered and a 12 month observational follow-up phase will begin. The intervention, the Embedding Package, aims to increase SSME uptake and subsequent improvements in health outcomes, through a clear marketing strategy, user friendly and effective referral pathways, a local clinical champion and an 'Embedder' and a toolkit of resources for patients, healthcare professionals and other key stakeholders. The primary aim is, through increasing uptake to and attendance at SSME, to reduce HbA1c in people with T2DM compared with usual care. Secondary objectives include: assessing whether there is an increase in referral to and uptake of SSME and improvements in biomedical and psychosocial outcomes; an assessment of the sustainability of the Embedding Package; contextualising the process of implementation, sustainability of change and the 'fit' of the Embedding Package; and an assessment of the cost-effectiveness of the Embedding Package. DISCUSSION This study will assess the effectiveness, cost-effectiveness and sustainability of the Embedding Package, an intervention which aims to improve biomedical and psychosocial outcomes of people with T2DM, through increased referral to and uptake of SSME. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number ISRCTN23474120. Assigned 05/04/2018. The study was prospectively registered. On submission of this manuscript practice recruitment is complete, participant recruitment is ongoing and expected to be completed by the end of 2019.
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Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline A Kristunas
- Diabetes Research Centre, University of Leicester, Leicester, UK.,Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre , University Road, Leicester, LE1 7RH, UK
| | - Abualbishr Alshreef
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Eborall
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre , University Road, Leicester, LE1 7RH, UK
| | - Agnieszka Glab
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lisa Huddlestone
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre , University Road, Leicester, LE1 7RH, UK
| | - Nicky Hudson
- Centre for Reproduction Research, School of Applied Social Science, De Montfort University, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mike Patterson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rebecca Pritchard
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bernie Stribling
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jessica Turner
- Centre for Reproduction Research, School of Applied Social Science, De Montfort University, Leicester, UK
| | - Laura J Gray
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre , University Road, Leicester, LE1 7RH, UK.
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Hodgkinson A, Abbott J, Hurley MA, Lowe N, Qualter P. An educational intervention to prevent overweight in pre-school years: a cluster randomised trial with a focus on disadvantaged families. BMC Public Health 2019; 19:1430. [PMID: 31675942 PMCID: PMC6824038 DOI: 10.1186/s12889-019-7595-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children. METHODS A pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years' Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child). At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over 2 years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up. RESULTS Five pairs of Early Years' Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families). At the cluster level, improvement in Centre policies and practices was similar for both groups (p = 0.830). At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p = 0.002; change difference 0.49; 95% CI 0.17 to 0.80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p = 0.582) were similar in both groups. CONCLUSIONS The Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years' staff can implement the Healthy Heroes programme. TRIAL REGISTRATION ISRCTN22620137 Registered 21st December 2016.
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Affiliation(s)
- Alison Hodgkinson
- School of Psychology, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Janice Abbott
- School of Psychology, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
| | - Margaret A Hurley
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Nicola Lowe
- School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Pamela Qualter
- Institute of Education, University of Manchester, Manchester, M13 9PL, UK
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MacPherson P, Webb EL, Variava E, Lala SG, Milovanovic M, Ratsela A, Lebina L, Kinghorn A, Martinson NA. Intensified household contact tracing, prevention and treatment support versus enhanced standard of care for contacts of tuberculosis cases in South Africa: study protocol for a household cluster-randomised trial. BMC Infect Dis 2019; 19:839. [PMID: 31606032 PMCID: PMC6790042 DOI: 10.1186/s12879-019-4502-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Household contact tracing of index TB cases has been advocated as a key part of TB control for many years, but has not been widely implemented in many low-resource setting because of the current dearth of high quality evidence for effectiveness. Innovative strategies for earlier, more effective treatment are particularly important in contexts with hyper-endemic levels of HIV, where levels of TB infection remain extremely high. METHODS We present the design of a household cluster-randomised controlled trial of interventions aimed at improving TB-free survival and reducing childhood prevalence of Mycobacterium tuberculosis infection among household contacts of index TB cases diagnosed in two provinces of South Africa. Households of index TB cases will be randomly allocated in a 1:1 ratio to receive either an intensified home screening and linkage for TB and HIV intervention, or enhanced standard of care. The primary outcome will compare between groups the TB-free survival of household contacts over 15 months. All participants, or their next-of-kin, will provide written informed consent to participate. DISCUSSION Evidence from randomised trials is required to identify cost-effective approaches to TB case-finding that can be applied at scale in sub-Saharan Africa. TRIAL REGISTRATION ISRCTN16006202 (01/02/2017: retrospectively registered) and NHREC4399 (11/04/2016: prospectively registered). Protocol version: 4.0 (date: 18th January 2018).
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Affiliation(s)
- Peter MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi. .,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Klerksdorp, South Africa.,Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Sanjay G Lala
- Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa.,Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, and University of the Witwatersrand, Soweto, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Andrew Ratsela
- Department of Medicine, Polokwane and Mankweng Hospitals, University of Limpopo, Polokwane, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
| | - Neil A Martinson
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Klerksdorp, South Africa.,Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa
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40
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Copas AJ, Hooper R. Cluster randomised trials with different numbers of measurements at baseline and endline: Sample size and optimal allocation. Clin Trials 2019; 17:69-76. [PMID: 31580144 DOI: 10.1177/1740774519873888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS Published methods for sample size calculation for cluster randomised trials with baseline data are inflexible and primarily assume an equal amount of data collected at baseline and endline, that is, before and after the intervention has been implemented in some clusters. We extend these methods to any amount of baseline and endline data. We explain how to explore sample size for a trial if some baseline data from the trial clusters have already been collected as part of a separate study. Where such data aren't available, we show how to choose the proportion of data collection devoted to the baseline within the trial, when a particular cluster size or range of cluster sizes is proposed. METHODS We provide a design effect given the cluster size and correlation parameters, assuming different participants are assessed at baseline and endline in the same clusters. We show how to produce plots to identify the impact of varying the amount of baseline data accounting for the inevitable uncertainty in the cluster autocorrelation. We illustrate the methodology using an example trial. RESULTS Baseline data provide more power, or allow a greater reduction in trial size, with greater values of the cluster size, intracluster correlation and cluster autocorrelation. CONCLUSION Investigators should think carefully before collecting baseline data in a cluster randomised trial if this is at the expense of endline data. In some scenarios, this will increase the sample size required to achieve given power and precision.
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Affiliation(s)
- Andrew J Copas
- Institute for Clinical Trials Methodology, MRC Clinical Trials Unit at University College London, London, UK
| | - Richard Hooper
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Thysen SM, Jensen AKG, Rodrigues A, Borges IDS, Aaby P, Benn C, Fisker A. Can earlier BCG vaccination reduce early infant mortality? Study protocol for a cluster randomised trial in Guinea-Bissau. BMJ Open 2019; 9:e025724. [PMID: 31551370 PMCID: PMC6773322 DOI: 10.1136/bmjopen-2018-025724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The BCG vaccine is designed to protect against tuberculosis, but the vaccine may have broader effects. In 2014, the Strategic Advisory Group of Experts on Immunization reviewed the literature on non-specific effects of BCG, and concluded that the evidence was consistent with beneficial non-specific effects and requested further randomised trials. METHODS AND ANALYSES Within the Bandim Health Project's urban and rural health and demographic surveillance systems, we will conduct a cluster-randomised trial in six suburban districts and 55 rural villages. Infants are enrolled at a home visit before 72 hours of life. In intervention clusters, children are vaccinated with BCG and oral polio vaccine (OPV). In control clusters, the caregivers are informed about vaccination opportunities. Using Cox-proportional hazards models, we will test whether BCG and OPV provided at a single home visit can reduce early infant mortality up to 60 days.The trial was initiated with a pilot study in Biombo region in June 2015. The trial was scaled up to full study including Oio and Cacheu regions in July 2016. The trial was expanded to include the urban study area in July 2017. ETHICS AND DISSEMINATION BCG vaccination is delayed in many low-income settings. WHO-recommended home visits are resource demanding and vaccines are not part of the recommendation. Utilising the home visits to provide BCG and OPV may provide countries with a further incentive to introduce a single home visit. In countries, where home visits are already in place, vaccines can easily be added to reduce early infant mortality. The trial is approved by the Guinean Ethical Committee (Reference number: 0016/CNES/INASA/2015) and the Danish Ethics Committee has given its consultative approval. The results of the trial will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02504203; Pre-results.
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Affiliation(s)
- Sanne M Thysen
- OPEN, University of Southern Denmark, Odense, Denmark
- Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark
- Bandim Health Project, Bandim Health Project, Bissau, Guinea-Bissau
| | | | | | | | - Peter Aaby
- Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark
- Bandim Health Project, Bandim Health Project, Bissau, Guinea-Bissau
| | - Christine Benn
- OPEN, University of Southern Denmark, Odense, Denmark
- Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark
- Bandim Health Project, Bandim Health Project, Bissau, Guinea-Bissau
| | - Ane Fisker
- OPEN, University of Southern Denmark, Odense, Denmark
- Research Center of Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark
- Bandim Health Project, Bandim Health Project, Bissau, Guinea-Bissau
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Alhassan RK, Nketiah-Amponsah E, Ayanore MA, Afaya A, Salia SM, Milipaak J, Ansah EK, Owusu-Agyei S. Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: a cluster randomised trial. BMC Public Health 2019; 19:791. [PMID: 31226977 PMCID: PMC6588841 DOI: 10.1186/s12889-019-7180-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background Ghana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana. Methods This study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up. Results Intervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures. Conclusion Community engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies. Electronic supplementary material The online version of this article (10.1186/s12889-019-7180-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences Ho, PMB 31, Volta, Region Ho, Ghana.
| | | | - Martin Amogre Ayanore
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Solomon Mohammed Salia
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Japiong Milipaak
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Korkor Ansah
- Institute of Health Research (IHR), University of Health and Allied Sciences, Ho, Ghana
| | - Seth Owusu-Agyei
- Institute of Health Research (IHR), University of Health and Allied Sciences, Ho, Ghana
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Meiksin R, Allen E, Crichton J, Morgan GS, Barter C, Elbourne D, Hunt K, Melendez-Torres GJ, Morris S, Reyes HLMN, Sturgess J, Taylor B, Young H, Campbell R, Bonell C. Protocol for pilot cluster RCT of project respect: a school-based intervention to prevent dating and relationship violence and address health inequalities among young people. Pilot Feasibility Stud 2019; 5:13. [PMID: 30693093 PMCID: PMC6341537 DOI: 10.1186/s40814-019-0391-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/03/2019] [Indexed: 03/12/2023] Open
Abstract
Background Dating and relationship violence (DRV)—intimate partner violence during adolescence—encompasses physical, sexual and emotional abuse. DRV is associated with a range of adverse health outcomes including injuries, sexually transmitted infections, adolescent pregnancy and mental health issues. Experiencing DRV also predicts both victimisation and perpetration of partner violence in adulthood. Prevention targeting early adolescence is important because this is when dating behaviours begin, behavioural norms become established and DRV starts to manifest. Despite high rates of DRV victimisation in England, from 22 to 48% among girls and 12 to 27% among boys ages 14–17 who report intimate relationships, no RCTs of DRV prevention programmes have taken place in the UK. Informed by two school-based interventions that have shown promising results in RCTs in the USA—Safe Dates and Shifting Boundaries—Project Respect aims to optimise and pilot a DRV prevention programme for secondary schools in England. Methods Design: optimisation and pilot cluster RCT. Trial will include a process evaluation and assess the feasibility of conducting a phase III RCT with embedded economic evaluation. Cognitive interviewing will inform survey development. Participants: optimisation involves four schools and pilot RCT involves six (four intervention, two control). All are secondary schools in England. Baseline surveys conducted with students in years 8 and 9 (ages 12–14). Follow-up surveys conducted with the same cohort, 16 months post-baseline. Optimisation sessions to inform intervention and research methods will involve consultations with stakeholders, including young people. Intervention: school staff training, including guidance on reviewing school policies and addressing ‘hotspots’ for DRV and gender-based harassment; information for parents; informing students of a help-seeking app; and a classroom curriculum for students in years 9 and 10, including a student-led campaign. Primary outcome: the primary outcome of the pilot RCT will be whether progression to a phase III RCT is justified. Testing within the pilot will also determine which of two existing scales is optimal for assessing DRV victimisation and perpetration in a phase III RCT. Discussion This will be the first RCT of an intervention to prevent DRV in the UK. If findings indicate feasibility and acceptability, we will undertake planning for a phase III RCT of effectiveness. Trial registration ISRCTN, ISRCTN 65324176. Registered 8 June 2017. Electronic supplementary material The online version of this article (10.1186/s40814-019-0391-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Meiksin
- 1London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Elizabeth Allen
- 1London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Crichton
- 2University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Gemma S Morgan
- 2University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Christine Barter
- 3University of Central Lancashire, Preston, Lancashire PR1 2HE UK
| | - Diana Elbourne
- 1London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Kate Hunt
- 4University of Stirling, Stirling, FK9 4LA UK
| | | | - Steve Morris
- 6University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | | | - Joanna Sturgess
- 1London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Bruce Taylor
- 8NORC at the University of Chicago, 4350 East West Highway, Room 733, Bethesda, MD 20814 USA
| | - Honor Young
- 5Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Rona Campbell
- 2University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Chris Bonell
- 1London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Kristunas CA, Hemming K, Eborall H, Eldridge S, Gray LJ. The current use of feasibility studies in the assessment of feasibility for stepped-wedge cluster randomised trials: a systematic review. BMC Med Res Methodol 2019; 19:12. [PMID: 30630416 PMCID: PMC6327386 DOI: 10.1186/s12874-019-0658-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/02/2019] [Indexed: 11/12/2022] Open
Abstract
Background Stepped-wedge cluster randomised trials (SW-CRTs) are a pragmatic trial design, providing an unprecedented opportunity to increase the robustness of evidence underpinning implementation and quality improvement interventions. Given the complexity of the SW-CRT, the likelihood of trials not delivering on their objectives will be mitigated if a feasibility study precedes the definitive trial. It is not currently known if feasibility studies are being conducted for SW-CRTs nor what the objectives of these studies are. Methods Searches were conducted of several databases to identify published feasibility studies which were designed to inform a future SW-CRT. For each eligible study, data were extracted on the characteristics of and rationale for the feasibility study; the process for determining progression to the main trial; how the feasibility study informed the main trial; and whether the main trial went ahead. A narrative synthesis and descriptive analysis are presented. Results Eleven feasibility studies were identified, which included eight completed study reports and three protocols. Three studies used a stepped-wedge design and these were the only studies to be randomised. Studies were predominantly of a mixed-methods design. Only one study assessed specific features related to the feasibility of using a SW-CRT and one investigated the time taken to complete the study procedures. The other studies were mostly assessing the feasibility and acceptability of the intervention. Conclusion Published feasibility studies for SW-CRTs are scarce and those that are being reported do not investigate issues specific to the complexities of the trial design. When conducting feasibility studies in advance of a definitive SW-CRT, researchers should consider assessing the feasibility of study procedures, particularly those specific to the SW-CRT design, and ensure that the findings are published for the benefit of other researchers. Electronic supplementary material The online version of this article (10.1186/s12874-019-0658-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Grischott T. The Shiny Balancer - software and imbalance criteria for optimally balanced treatment allocation in small RCTs and cRCTs. BMC Med Res Methodol 2018; 18:108. [PMID: 30326827 PMCID: PMC6192202 DOI: 10.1186/s12874-018-0551-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/27/2018] [Indexed: 12/04/2022] Open
Abstract
Background In randomised controlled trials with only few randomisation units, treatment allocation may be challenging if balanced distributions of many covariates or baseline outcome measures are desired across all treatment groups. Both traditional approaches, stratified randomisation and allocation by minimisation, have their own limitations. A third method for achieving balance consists of randomly choosing from a preselected list of sufficiently balanced allocations. As with minimisation, this method requires that heterogeneity between treatment groups is measured by specified imbalance metrics. Although certain imbalance measures are more commonly used than others, to the author's knowledge there is no generally accepted “gold standard”, neither for categorical and even less so for continuous variables. Methods An intuitive and easily accessible web-based software tool was developed which allows for balancing multiple variables of different types and using various imbalance metrics. Different metrics were compared in a simulation study. Results Using simulated data, it could be shown that for categorical variables, χ2-based imbalance measures seem to be viable alternatives to the established “quadratic imbalance” metric. For continuous variables, using the area between the empirical cumulative distribution functions or the largest difference in the three pairs of quartiles is recommended to measure imbalance. Another imbalance metric suggested in the literature for continuous variables, the (symmetrised) Kullback-Leibler divergence, should be used with caution. Conclusion The Shiny Balancer offers the possibility to visually explore the balancing properties of several well established or newly suggested imbalance metrics, and its use is particularly advocated in clinical studies with few randomisation units, as it is typically the case in cluster randomised trials. Electronic supplementary material The online version of this article (10.1186/s12874-018-0551-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland.
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Kufa T, Fielding KL, Hippner P, Kielmann K, Vassall A, Churchyard GJ, Grant AD, Charalambous S. An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial. Contemp Clin Trials 2018; 72:43-52. [PMID: 30053431 DOI: 10.1016/j.cct.2018.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the effect of an intervention to optimize TB/HIV integration on patient outcomes. METHODS Cluster randomised control trial at 18 primary care clinics in South Africa. The intervention was placement of a nurse (TB/HIV integration officer) to facilitate provision of integrated TB/HIV services, and a lay health worker (TB screening officer) to facilitate TB screening for 24 months. Primary outcomes were i) incidence of hospitalisation/death among individuals newly diagnosed with HIV, ii) incidence of hospitalisation/death among individuals newly diagnosed with TB and iii) proportion of HIV-positive individuals newly diagnosed with TB who were retained in HIV care 12 months after enrolment. RESULTS Of 3328 individuals enrolled, 3024 were in the HIV cohort, 731 in TB cohort and 427 in TB-HIV cohort. For the HIV cohort, the hospitalisation/death rate was 12.5 per 100 person-years (py) (182/1459py) in the intervention arm vs. 10.4/100py (147/1408 py) in the control arms respectively (Relative Risk (RR) 1.17 [95% CI 0.92-1.49]).For the TB cohort, hospitalisation/ death rate was 17.1/100 py (67/ 392py) vs. 11.1 /100py (32/289py) in intervention and control arms respectively (RR 1.37 [95% CI 0.78-2.43]). For the TB-HIV cohort, retention in care at 12 months was 63.0% (213/338) and 55.9% (143/256) in intervention and control arms (RR 1.11 [95% 0.89-1.38]). CONCLUSIONS The intervention as implemented failed to improve patient outcomes beyond levels at control clinics. Effective strategies are needed to achieve better TB/HIV service integration and improve TB and HIV outcomes in primary care clinics. TRIAL REGISTRATION South African Register of Clinical Trials (registration number DOH-27-1011-3846).
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Affiliation(s)
- T Kufa
- The Aurum Institute, Johannesburg, South Africa; The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.
| | - K L Fielding
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - P Hippner
- The Aurum Institute, Johannesburg, South Africa
| | - K Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - A Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - G J Churchyard
- The Aurum Institute, Johannesburg, South Africa; The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - A D Grant
- The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa; The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Gondwe T, Robberstad B, Mukaka M, Lange S, Blomberg B, Phiri K. Delivery strategies for malaria chemoprevention with monthly dihydroartemisinin-piperaquine for the post-discharge management of severe anaemia in children aged less than 5 years old in Malawi: a protocol for a cluster randomized trial. BMC Pediatr 2018; 18:238. [PMID: 30029620 PMCID: PMC6057552 DOI: 10.1186/s12887-018-1199-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children initially hospitalized with severe anaemia in Africa are at high risk of readmission or death within 6 months after discharge. No intervention strategy specifically protects children during the post-discharge period. Recent evidence from Malawi shows that 3 months of post-discharge malaria chemoprevention (PMC) with monthly treatment with artemether-lumefantrine in children with severe malarial anaemia prevented 31% of deaths and readmissions. While a confirmatory multi-centre trial for PMC with dihydroartemisinin-piperaquine is on going in Kenya and Uganda, there is a need to design and evaluate an effective delivery strategy for this promising intervention. METHODS This is a cluster-randomized trial with 5 arms, each representing a unique PMC delivery strategy. Convalescent children aged less than 5 years and weighing more than 5 kg admitted with severe anaemia and clinically stable are included. All eligible children will receive dihydroartemisinin-piperaquine at 2, 6 and 10 weeks after discharge either: 1) in the community without an SMS reminder; 2) in the community with an SMS reminder; 3) in the community with a community health worker reminder; 4) at the hospital with an SMS reminder; or 5) at the hospital without an SMS reminder. For community-based strategies (1, 2 and 3), mothers will be given all the PMC doses at the time of discharge while for hospital-based strategies (4 and 5) mothers will be required to visit the hospital each month. Each arm will consist of 25 clusters with an average of 3 children per cluster giving approximately 75 children and will be followed up for 15 weeks. The primary outcome measure is uptake of complete courses of PMC drugs. DISCUSSION The proposed study will help to identify the most effective, cost-effective, acceptable and feasible strategy for delivering malaria chemoprevention for post-discharge management of severe anaemia in under-five children in the Malawian context. This information is important for policy decision in the quest for new strategies for malaria control in children in similar contexts. TRIAL REGISTRATION ClinicalTrials.gov: NCT02721420 . Protocol registered on 29 March 2016.The study was not retrospectively registered but there was a delay between date of submission and the date it first became available on the registry.
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Affiliation(s)
- Thandile Gondwe
- College of Medicine, University of Malawi, Private Bag, 360 Blantyre, Malawi
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Siri Lange
- Chr. Michelsen Institute, Jekteviksbakken 31, 5006 Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Christiesgt. 13, 5020 Bergen, Norway
| | - Bjørn Blomberg
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kamija Phiri
- College of Medicine, University of Malawi, Private Bag, 360 Blantyre, Malawi
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Ponsford R, Allen E, Campbell R, Elbourne D, Hadley A, Lohan M, Melendez-Torres GJ, Mercer CH, Morris S, Young H, Bonell C. Study protocol for the optimisation, feasibility testing and pilot cluster randomised trial of Positive Choices: a school-based social marketing intervention to promote sexual health, prevent unintended teenage pregnancies and address health inequalities in England. Pilot Feasibility Stud 2018; 4:102. [PMID: 29850026 PMCID: PMC5964886 DOI: 10.1186/s40814-018-0279-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Since the introduction of the Teenage Pregnancy Strategy (TPS), England’s under-18 conception rate has fallen by 55%, but a continued focus on prevention is needed to maintain and accelerate progress. The teenage birth rate remains higher in the UK than comparable Western European countries. Previous trials indicate that school-based social marketing interventions are a promising approach to addressing teenage pregnancy and improving sexual health. Such interventions are yet to be trialled in the UK. This study aims to optimise and establish the feasibility and acceptability of one such intervention: Positive Choices. Methods Design: Optimisation, feasibility testing and pilot cluster randomised trial. Interventions: The Positive Choices intervention comprises a student needs survey, a student/staff led School Health Promotion Council (SHPC), a classroom curriculum for year nine students covering social and emotional skills and sex education, student-led social marketing activities, parent information and a review of school sexual health services. Systematic optimisation of Positive Choices will be carried out with the National Children’s Bureau Sex Education Forum (NCB SEF), one state secondary school in England and other youth and policy stakeholders. Feasibility testing will involve the same state secondary school and will assess progression criteria to advance to the pilot cluster RCT. Pilot cluster RCT with integral process evaluation will involve six different state secondary schools (four interventions and two controls) and will assess the feasibility and utility of progressing to a full effectiveness trial. The following outcome measures will be trialled as part of the pilot:Self-reported pregnancy and unintended pregnancy (initiation of pregnancy for boys) and sexually transmitted infections, Age of sexual debut, number of sexual partners, use of contraception at first and last sex and non-volitional sex Educational attainment
The feasibility of linking administrative data on births and termination to self-report survey data to measure our primary outcome (unintended teenage pregnancy) will also be tested. Discussion This will be the first UK-based pilot trial of a school-wide social marketing intervention to reduce unintended teenage pregnancy and improve sexual health. If this study indicates feasibility and acceptability of the optimised Positive Choices intervention in English secondary schools, plans will be initiated for a phase III trial and economic evaluation of the intervention. Trial registration ISRCTN registry (ISCTN12524938. Registered 03/07/2017). Electronic supplementary material The online version of this article (10.1186/s40814-018-0279-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruth Ponsford
- 1London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Elizabeth Allen
- 2London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Rona Campbell
- 3University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Diana Elbourne
- 2London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Alison Hadley
- 4University of Bedfordshire, University Square, Luton, LU1 3JU UK
| | - Maria Lohan
- 5Queens University Belfast, University Road, Belfast, BT7 1NN UK
| | | | | | - Steve Morris
- 8University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Honor Young
- 6Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Chris Bonell
- 1London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Maxwell AE, Parker RA, Drever J, Rudd A, Dennis MS, Weir CJ, Al-Shahi Salman R. Promoting Recruitment using Information Management Efficiently (PRIME): a stepped-wedge, cluster randomised trial of a complex recruitment intervention embedded within the REstart or Stop Antithrombotics Randomised Trial. Trials 2017; 18:623. [PMID: 29282142 PMCID: PMC5745698 DOI: 10.1186/s13063-017-2355-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background Few interventions are proven to increase recruitment in clinical trials. Recruitment to RESTART, a randomised controlled trial of secondary prevention after stroke due to intracerebral haemorrhage, has been slower than expected. Therefore, we sought to investigate an intervention to boost recruitment to RESTART. Methods/design We conducted a stepped-wedge, cluster randomised trial of a complex intervention to increase recruitment, embedded within the RESTART trial. The primary objective was to investigate if the PRIME complex intervention (a recruitment co-ordinator who conducts a recruitment review, provides access to bespoke stroke audit data exports, and conducts a follow-up review after 6 months) increases the recruitment rate to RESTART. We included 72 hospital sites located in England, Wales, or Scotland that were active in RESTART in June 2015. All sites began in the control state and were allocated using block randomisation stratified by hospital location (Scotland versus England/Wales) to start the complex intervention in one of 12 different months. The primary outcome was the number of patients randomised into RESTART per month per site. We quantified the effect of the complex intervention on the primary outcome using a negative binomial, mixed model adjusting for site, December/January months, site location, and background time trends in recruitment rate. Results We recruited and randomised 72 sites and recorded their monthly recruitment to RESTART over 24 months (March 2015 to February 2017 inclusive), providing 1728 site-months of observations for the primary analysis. The adjusted rate ratio for the number of patients randomised per month after allocation to the PRIME complex intervention versus control time before allocation to the PRIME complex intervention was 1.06 (95% confidence interval 0.55 to 2.03, p = 0.87). Although two thirds of respondents to the 6-month follow-up questionnaire agreed that the audit reports were useful, only six patients were reported to have been randomised using the audit reports. Respondents frequently reported resource and time pressures as being key barriers to running the audit reports. Conclusion The PRIME complex intervention did not significantly improve the recruitment rate to RESTART. Further research is needed to establish if PRIME might be beneficial at an earlier stage in a prevention trial or for prevention dilemmas that arise more often in clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2355-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy E Maxwell
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit and Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jonathan Drever
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Anthony Rudd
- St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Martin S Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit and Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Atkins S, Ojajärvi U, Talola N, Viljamaa M, Nevalainen J, Uitti J. Impact of improved recording of work-relatedness in primary care visits at occupational health services on sickness absences: study protocol for a randomised controlled trial. Trials 2017; 18:352. [PMID: 28747193 PMCID: PMC5530531 DOI: 10.1186/s13063-017-2076-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/30/2017] [Indexed: 11/25/2022] Open
Abstract
Background Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year. Methods/design A pragmatic trial will be conducted using patient electronic registers and registers of the central pensions agency in Finland. Twenty-two occupational health centres will be randomised to intervention and control groups. Intervention units will receive training to improve recording of work ability illnesses in the primary care setting and improved follow-up procedures. The intervention impact will be assessed through examining rates of sickness absence across intervention and control clinics as well as before and after the intervention. Discussion The trial will develop knowledge of the intervention potential of primary care for preventing work disability pensions and sickness absence. The use of routine patient registers and pensions registers to assess the outcomes of a randomised controlled trial will bring forward trial methodology, particularly when using register-based data. If successful, the intervention will improve the quality of occupational health care primary care and contribute to reducing work disability. Trial registration ISRCTN Registry reference number ISRCTN45728263. Registered on 18 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2076-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salla Atkins
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | | | - Nina Talola
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | | | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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