Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
University College London, London, UK.
J Epidemiol Community Health. 2021 Jan;75(1):46-50. doi: 10.1136/jech-2020-214287. Epub 2020 Sep 9.
There is increasing interest in what evidence is needed to inform decisions about transporting interventions evaluated as effective to new settings. There has been less attention to how local decision-makers decide whether to implement such interventions immediately or subject to further evaluation. Using the example of school-based social and emotional learning, we consider this drawing on realist methods. We suggest decisions need to assess existing evaluations not merely in terms of whether the intervention was effective but also: how the intervention was implemented and what contextual factors affected this (drawing on process evaluation); and for whom the intervention was effective and through what mechanisms (drawing on mediation, moderation and qualitative comparative analyses from primary studies and/or systematic reviews). We contribute new insights to local needs assessments, suggesting that these should assess: the potential, capability, contribution and capacity present in the new setting for implementation; and whether similar 'aetiological mechanisms' underlie adverse outcomes locally as in previous evaluations. We recommend that where there is uncertainty concerning whether an intervention can feasibly be implemented this indicates the need for piloting of implementation. Where there is uncertainty concerning whether implementation of the intervention will trigger intended mechanisms, this suggests the need for a new effectiveness trial. Where there is uncertainty concerning whether intervention mechanisms, even if triggered, will generate the intended outcomes, this suggests that decision-makers may need to look to other types of intervention as being needed for their setting instead.
人们越来越关注需要哪些证据来为将已评估为有效的干预措施转移到新环境中的决策提供信息。但对于地方决策者如何决定立即实施这些干预措施还是进一步评估,关注较少。我们以基于学校的社会和情感学习为例,考虑使用现实主义方法来解决这个问题。我们认为,决策需要评估现有评估,不仅要考虑干预是否有效,还要考虑:干预是如何实施的,哪些环境因素影响了这一点(借鉴过程评估);干预对谁有效,通过什么机制(借鉴主要研究和/或系统评价中的中介、调节和定性比较分析)。我们为地方需求评估提供了新的见解,建议这些评估应评估:新环境中实施的潜在能力、贡献和能力;以及当地是否存在与以往评估中类似的“病因机制”导致不良结果。我们建议,如果干预措施在实施方面是否可行存在不确定性,则需要进行试点实施。如果对干预措施的实施是否会触发预期机制存在不确定性,则表明需要进行新的有效性试验。如果对干预机制是否会产生预期结果存在不确定性,即使触发了,这表明决策者可能需要考虑在其环境中使用其他类型的干预措施。
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