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预防干预研究的荟萃分析问题

Meta-analytical issues for prevention intervention research.

作者信息

Tobler N

机构信息

School of Social Welfare, State University of New York at Albany 12222, USA.

出版信息

NIDA Res Monogr. 1994;142:342-403.

PMID:9243541
Abstract

Lack of systematic methods for comparing diversified programs has limited the use of research results. Drug prevention intervention research has a history of mixed or marginal results, a situation that leads to the supposition that programs do not work. Meta-analytical methods have successfully resolved problems of conflicting results and are a cost-effective method for building a knowledge base. Using both qualitative and quantitative methods, meta-analysis applies all of the scientific rigor of primary research to the integration of this research. Quantitative synthesis is accomplished by computing an effect size, which, unlike significance test, allows comparisons across studies having varied sample sizes. One advantage for drug prevention intervention research, which seldom shows statistically significant results, is the powerful findings produced when small positive effect sizes are consistent across many studies. Generalizability is possible through meta-analytic aggregation, as a large body of studies contain all the exigencies of real-world research. Troublesome areas that can distort conclusions are presented to alert readers of literature reviews so they are able to interpret meta-analytic reviews accurately. Specific problematic issues are introduced, such as preexisting differences, combining efficacy and implementation studies, and the use of the weighted effect size with a group of studies that has a large range in sample sizes. Meta-analytic procedures are illustrated by comparing the results of 114 experimental and quasi-experimental school-based adolescent drug prevention programs with a selected subset of 56 higher quality experimentally evaluated programs.

摘要

缺乏用于比较多样化项目的系统方法限制了研究结果的应用。药物预防干预研究一直以来结果参差不齐或成效有限,这种情况导致人们认为这些项目不起作用。元分析方法成功解决了结果相互矛盾的问题,是构建知识库的一种经济有效的方法。元分析同时运用定性和定量方法,将所有原始研究的科学严谨性应用于这些研究的整合。定量综合是通过计算效应量来完成的,与显著性检验不同,效应量允许对样本量不同的研究进行比较。对于很少显示出统计学显著结果的药物预防干预研究来说,一个优势是当许多研究中的小的正效应量一致时会产生有力的结果。通过元分析汇总可以实现可推广性,因为大量研究包含了现实世界研究的所有紧急情况。文中指出了可能扭曲结论的棘手领域,以提醒文献综述的读者,使他们能够准确解释元分析综述。文中还介绍了具体的问题,如预先存在的差异、将疗效研究与实施研究相结合,以及在一组样本量范围很大的研究中使用加权效应量。通过比较114个以学校为基础的青少年药物预防实验项目和准实验项目的结果与56个经过实验评估的高质量项目的选定子集,来说明元分析程序。

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