Marchand Erica, Stice Eric, Rohde Paul, Becker Carolyn Black
Oregon Research Institute, Eugene, 97403, United States.
Behav Res Ther. 2011 Jan;49(1):32-41. doi: 10.1016/j.brat.2010.10.008. Epub 2010 Nov 2.
Efficacy trials test whether interventions work under optimal, highly controlled conditions whereas effectiveness trials test whether interventions work with typical clients and providers in real-world settings. Researchers, providers, and funding bodies have called for more effectiveness trials to understand whether interventions produce effects under ecologically valid conditions, which factors predict program effectiveness, and what strategies are needed to successfully implement programs in practice settings. The transition from efficacy to effectiveness with preventive interventions involves unique considerations, some of which are not shared by treatment research. The purpose of this article is to discuss conceptual and methodological issues that arise when making the transition from efficacy to effectiveness research in primary, secondary, and tertiary prevention, drawing on the experiences of two complimentary research groups as well as the existing literature. We address (a) program of research, (b) intervention design and conceptualization, (c) participant selection and characteristics, (d) providers, (e) context, (f) measurement and methodology, (g) outcomes, (h) cost, and (i) sustainability. We present examples of research in eating disorder prevention that demonstrate the progression from efficacy to effectiveness trials.
疗效试验检验干预措施在最优、高度可控条件下是否有效，而效果试验检验干预措施在现实环境中与典型的服务对象及提供者配合时是否有效。研究人员、提供者和资助机构呼吁开展更多效果试验，以了解干预措施在生态有效条件下是否产生效果、哪些因素可预测项目效果，以及在实际环境中成功实施项目需要哪些策略。预防性干预措施从疗效向效果的转变涉及独特的考量因素，其中一些是治疗研究中所没有的。本文旨在借鉴两个互补研究小组的经验以及现有文献，讨论在一级、二级和三级预防中从疗效研究向效果研究转变时出现的概念和方法问题。我们探讨了以下方面：（a）研究项目；（b）干预设计与概念化；（c）参与者选择与特征；（d）提供者；（e）背景；（f）测量与方法；（g）结果；（h）成本；（i）可持续性。我们列举了饮食失调预防研究的实例，展示了从疗效试验到效果试验的进展。
