The appraisal of public health interventions: the use of theory

A. G. Threlfall, S. Meah, A. J. Fischer, R. Cookson, H. Rutter, M. P. Kelly

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND:
Public health decision-making is hampered by inappropriate adherence to underpowered randomized controlled trials (RCTs) which give inconclusive results and lead to decision-makers being loath to recommend interventions with strong theoretical and observational support.

METHODS:
We outline situations in which robust decisions about health interventions can be made without trial evidence. We present a new approach in which theory, causal models and past observations are given proper regard in the decision-making process. RESULTS: Using our approach, we provide examples where the use of causal theories and observations in areas, such as salt reduction, smoking cessation and gardening to improve mental health, is sufficient for deciding that such interventions are effective for improving health without needing the support of underpowered RCTs. Particularly where RCT evidence is inconclusive, our approach may provide similar aggregate health outcomes for society for vastly lower cost.

CONCLUSIONS:
When knowledge and theoretical understanding are unable sufficiently to reduce doubt about the direction of effect from an intervention, decisions should be made using evidence-based medicine approaches. There are, however, many cases where the combination of robust theory, causal understanding and observation are able to provide sufficient evidence of the direction of effect from an intervention that current practice should be altered.
LanguageEnglish
Pages166-171
Number of pages6
JournalJournal of Public Health
Volume37
Issue number1
DOIs
StatusPublished - 11 Jul 2014

Keywords

  • health services methods public health

Cite this

Threlfall, A. G., Meah, S., Fischer, A. J., Cookson, R., Rutter, H., & Kelly, M. P. (2014). The appraisal of public health interventions: the use of theory. Journal of Public Health, 37(1), 166-171. https://doi.org/10.1093/pubmed/fdu044

The appraisal of public health interventions: the use of theory. / Threlfall, A. G.; Meah, S.; Fischer, A. J.; Cookson, R.; Rutter, H.; Kelly, M. P.

In: Journal of Public Health, Vol. 37, No. 1, 11.07.2014, p. 166-171.

Research output: Contribution to journalArticle

Threlfall, AG, Meah, S, Fischer, AJ, Cookson, R, Rutter, H & Kelly, MP 2014, 'The appraisal of public health interventions: the use of theory', Journal of Public Health, vol. 37, no. 1, pp. 166-171. https://doi.org/10.1093/pubmed/fdu044
Threlfall, A. G. ; Meah, S. ; Fischer, A. J. ; Cookson, R. ; Rutter, H. ; Kelly, M. P. / The appraisal of public health interventions: the use of theory. In: Journal of Public Health. 2014 ; Vol. 37, No. 1. pp. 166-171.
@article{09e695300cd64a70a851b8a337080032,
title = "The appraisal of public health interventions: the use of theory",
abstract = "BACKGROUND: Public health decision-making is hampered by inappropriate adherence to underpowered randomized controlled trials (RCTs) which give inconclusive results and lead to decision-makers being loath to recommend interventions with strong theoretical and observational support. METHODS: We outline situations in which robust decisions about health interventions can be made without trial evidence. We present a new approach in which theory, causal models and past observations are given proper regard in the decision-making process. RESULTS: Using our approach, we provide examples where the use of causal theories and observations in areas, such as salt reduction, smoking cessation and gardening to improve mental health, is sufficient for deciding that such interventions are effective for improving health without needing the support of underpowered RCTs. Particularly where RCT evidence is inconclusive, our approach may provide similar aggregate health outcomes for society for vastly lower cost. CONCLUSIONS: When knowledge and theoretical understanding are unable sufficiently to reduce doubt about the direction of effect from an intervention, decisions should be made using evidence-based medicine approaches. There are, however, many cases where the combination of robust theory, causal understanding and observation are able to provide sufficient evidence of the direction of effect from an intervention that current practice should be altered.",
keywords = "health services methods public health",
author = "Threlfall, {A. G.} and S. Meah and Fischer, {A. J.} and R. Cookson and H. Rutter and Kelly, {M. P.}",
note = "Threlfall, Anthony G Meah, Soraya Fischer, Alastair J Cookson, Richard Rutter, Harry Kelly, Michael P eng England 2014/07/13 06:00 J Public Health (Oxf). 2015 Mar;37(1):166-71. doi: 10.1093/pubmed/fdu044. Epub 2014 Jul 11.",
year = "2014",
month = "7",
day = "11",
doi = "10.1093/pubmed/fdu044",
language = "English",
volume = "37",
pages = "166--171",
journal = "Journal of Public Health",
issn = "1741-3842",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - The appraisal of public health interventions: the use of theory

AU - Threlfall, A. G.

AU - Meah, S.

AU - Fischer, A. J.

AU - Cookson, R.

AU - Rutter, H.

AU - Kelly, M. P.

N1 - Threlfall, Anthony G Meah, Soraya Fischer, Alastair J Cookson, Richard Rutter, Harry Kelly, Michael P eng England 2014/07/13 06:00 J Public Health (Oxf). 2015 Mar;37(1):166-71. doi: 10.1093/pubmed/fdu044. Epub 2014 Jul 11.

PY - 2014/7/11

Y1 - 2014/7/11

N2 - BACKGROUND: Public health decision-making is hampered by inappropriate adherence to underpowered randomized controlled trials (RCTs) which give inconclusive results and lead to decision-makers being loath to recommend interventions with strong theoretical and observational support. METHODS: We outline situations in which robust decisions about health interventions can be made without trial evidence. We present a new approach in which theory, causal models and past observations are given proper regard in the decision-making process. RESULTS: Using our approach, we provide examples where the use of causal theories and observations in areas, such as salt reduction, smoking cessation and gardening to improve mental health, is sufficient for deciding that such interventions are effective for improving health without needing the support of underpowered RCTs. Particularly where RCT evidence is inconclusive, our approach may provide similar aggregate health outcomes for society for vastly lower cost. CONCLUSIONS: When knowledge and theoretical understanding are unable sufficiently to reduce doubt about the direction of effect from an intervention, decisions should be made using evidence-based medicine approaches. There are, however, many cases where the combination of robust theory, causal understanding and observation are able to provide sufficient evidence of the direction of effect from an intervention that current practice should be altered.

AB - BACKGROUND: Public health decision-making is hampered by inappropriate adherence to underpowered randomized controlled trials (RCTs) which give inconclusive results and lead to decision-makers being loath to recommend interventions with strong theoretical and observational support. METHODS: We outline situations in which robust decisions about health interventions can be made without trial evidence. We present a new approach in which theory, causal models and past observations are given proper regard in the decision-making process. RESULTS: Using our approach, we provide examples where the use of causal theories and observations in areas, such as salt reduction, smoking cessation and gardening to improve mental health, is sufficient for deciding that such interventions are effective for improving health without needing the support of underpowered RCTs. Particularly where RCT evidence is inconclusive, our approach may provide similar aggregate health outcomes for society for vastly lower cost. CONCLUSIONS: When knowledge and theoretical understanding are unable sufficiently to reduce doubt about the direction of effect from an intervention, decisions should be made using evidence-based medicine approaches. There are, however, many cases where the combination of robust theory, causal understanding and observation are able to provide sufficient evidence of the direction of effect from an intervention that current practice should be altered.

KW - health services methods public health

U2 - 10.1093/pubmed/fdu044

DO - 10.1093/pubmed/fdu044

M3 - Article

VL - 37

SP - 166

EP - 171

JO - Journal of Public Health

T2 - Journal of Public Health

JF - Journal of Public Health

SN - 1741-3842

IS - 1

ER -