Using baseline target moderation to guide decisions on adapting prevention programs
Using baseline target moderation to guide decisions on adapting prevention programs
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DOI：
10.1017/s0954579419001044
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发表时间：
2019-12-01
影响因子：
3.3
通讯作者：
Howe, George W.
中科院分区：
文献类型：
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作者：
Howe, George W.
预防科学的先驱Tom Dishion是最早认识到使干预措施适应个别家庭需要的重要性的人之一。为了实现这一目标，我们建议使用预防试验来评估基线目标调节中介（BTMM），其中预防干预效果是通过特定目标的改变来介导的，并且所产生的效果在目标的基线水平上是不同的。本文讨论了在最近的试验中发现的四种形式的BTMM，包括代偿性、愈富愈富、交叉效应和差异医源性效应。基于诊断条件的预防阈值、中点目标和近端风险或保护机制，提出了一种评估有意义的预防效果的策略。本文描述了利用这些阈值的BTMM分析结果来估计干预风险降低或增加的指标的方法，因为它们在基线目标水平上变化，并提出了潜在的切割点，用于识别由于弱或潜在的医源性计划效应而从计划适应中受益的亚组。模拟数据用于说明四种形式BTMM效应的曲线，以及当未经治疗的对照组结果也在基线目标水平上变化时，对适应变化的影响。
Tom Dishion, a pioneer in prevention science, was one of the first to recognize the importance of adapting interventions to the needs of individual families. Building towards this goal, we suggest that prevention trials be used to assess baseline target moderated mediation (BTMM), where preventive intervention effects are mediated through change in specific targets, and the resulting effect varies across baseline levels of the target. Four forms of BTMM found in recent trials are discussed including compensatory, rich-get-richer, crossover, and differential iatrogenic effects. A strategy for evaluating meaningful preventive effects is presented based on preventive thresholds for diagnostic conditions, midpoint targets and proximal risk or protective mechanisms. Methods are described for using the results from BTMM analyses of these thresholds to estimate indices of intervention risk reduction or increase as they vary over baseline target levels, and potential cut points are presented for identifying subgroups that would benefit from program adaptation because of weak or potentially iatrogenic program effects. Simulated data are used to illustrate curves for the four forms of BTMM effects and how implications for adaptation change when untreated control group outcomes also vary over baseline target levels.