BMJ  2004;328:282-285 (31 January), doi:10.1136/bmj.328.7434.282

Education and debate

Evaluating the health effects of social interventions

¹ MRC Social and Public Health Sciences Unit, Glasgow, G12 8RZ, ² Nursing and Midwifery School, University of Glasgow, Glasgow, ³ Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, ⁴ Easterhouse Money Advice Centre, Easterhouse, Glasgow, ⁵ School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Glasgow

Is no evidence better than any evidence when controlled studies are unethical?

The first 150 words of the full text of this article appear below.

Rigorous evidence on the health effects of social interventions is scarce^{1 2} despite calls for more evidence from randomised studies.³ One reason for the lack of such experimental research on social interventions may be the perception among researchers, policymakers, and others that randomised designs belong to the biomedical world and that their application to social interventions is both unethical and simplistic.⁴ Applying experimental designs to social interventions may be problematic but is not always impossible and is a desirable alternative to uncontrolled experimentation.³ However, even when randomised designs have been used to evaluate social interventions, opportunities to incorporate health measures have often been missed.⁵ For example, income supplementation is thought to be a key part of reducing health inequalities,⁶ but rigorous evidence to support this is lacking because most randomised controlled trials of income supplementation have not included health measures.⁵ Current moves to increase uptake of benefits offer new opportunities to . . . [Full text of this article]

Aims of study

The intervention

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Outcomes

Study design

Design 1: randomisation of the intervention
Design 2: randomising to waiting list
Design 3: non-randomised controlled trial
Design 4: uncontrolled study

Discussion

Randomisation
Generating evidence for healthy public policy

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Rapid Responses:

Read all Rapid Responses

Improving Access and improving health - social intervention does work. The case for "simplistic" evidence!

Stephen Ferguson
bmj.com, 30 Jan 2004 [Full text]

Attendance Allowance

Robert A Billings
bmj.com, 4 Feb 2004 [Full text]

RCT may not be the 'gold standard'

Trisha Greenhalgh, et al.
bmj.com, 11 Feb 2004 [Full text]

Re: Attendance Allowance

Robert Hoskins, et al.
bmj.com, 12 Feb 2004 [Full text]

Evaluation of social interventions should reflect their complexity

Suzanne Moffatt, et al.
bmj.com, 17 Feb 2004 [Full text]

Re: RCT may not be the 'gold standard'

Vicki J Strange, et al.
bmj.com, 18 Feb 2004 [Full text]

An opportunity to broaden the "Gold Standard" debate?

Aidan P. O'Hora
bmj.com, 19 Feb 2004 [Full text]

Evaluating the health effects of social interventions: studying the Torbay Financial Assessments and Benefits Team

Suzanne Richards, et al.
bmj.com, 5 Mar 2004 [Full text]

Authors Response

Hilary Thomson, et al.
bmj.com, 10 Mar 2004 [Full text]

Re: RCT may not be the 'gold standard'

Robert T Mathie
bmj.com, 6 Apr 2004 [Full text]