Community-based health intervention trials: An overview of methodological issues
Community-based health intervention trials: An overview of methodological issues
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DOI：
10.1093/epirev/24.1.72
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发表时间：
2002-01-01
影响因子：
5.5
通讯作者：
King, AC
中科院分区：
文献类型：
--
作者：
Atienza, AA;King, AC
过去几十年来，在社区范围内实施的卫生干预措施在公共卫生和流行病学研究中得到越来越多的应用。随着以社区为基础的干预有望成为一种提高卫生项目效益的可普适性的手段，为卫生政策制定者提供超出以个人为基础的临床试验获得的信息，并以具有成本效益的方式改善健康(1)，研究人员已经向前迈进，使许多社区接触到大规模的卫生干预。社区卫生干预试验的出现代表着卫生研究从主要关注个人调查转向关注更大的社区群体调查。这种强调以社区为重点的干预措施给研究人员带来了独特的方法论挑战。在本文中，我们概述了与更传统的、基于个体的临床干预试验相比，与社区干预试验有关的主要方法学问题。尽管以社区为基础的研究与以个人为基础的研究的界限并不总是容易区分(2)，但以个人为基础的临床试验的成熟文献可以作为与相对较新的以社区为基础的健康试验进行比较的有用点。我们在这里关注的方法学问题包括随机化、统计效力、队列与横断面评估、长期趋势、结果测量以及方法学设计中概念化的作用。此外，还讨论了科学方法论与其他实际问题（如经济和社会政治问题）之间的平衡。
Health interventions applied on a community-wide basis have come into increasing use in public health and epidemiologic research over the past several decades. With the promise of community-based interventions as a means of increasing the generalizability of health program benefits, providing information to health policy-makers beyond that obtained by individual-based clinical trials, and improving health in a cost-effective manner (1), researchers have forged ahead to expose numerous communities to large-scale health interventions. The emergence of community health intervention trials represents a shift in health research from investigations that focus primarily on the individual to those that focus on larger community groups. This emphasis on interventions focusing on communities has created distinct methodological challenges for researchers.In this paper, we provide an overview of major methodological issues pertaining to community-based intervention trials as compared with the more traditional, individualbased clinical intervention trials. Although the boundaries distinguishing community-based research from individualbased research are not always easily discernable (2), the well-established literature on individual-based clinical trials can stand as a useful point of comparison against the relatively recent development of community-based health trials. The methodological issues we focus on here include randomization, statistical power, cohort versus cross-sectional assessments, secular trends, outcome measurement, and the role of conceptualization in methodological design. Furthermore, the balance between scientific methodology and other practical issues (eg, economic and sociopolitical issues) is discussed.