Developing methods for understanding mechanism in complex interventions

公众通过媒体接触到无数关于复杂干预措施的功效的说法，如治疗抑郁症或其他精神健康和个人问题的心理疗法。卫生服务提供者面临越来越大的压力，要求他们增加提供咨询和心理治疗等干预措施。显然，有必要设计和实施受控临床试验，以测试这种干预措施是否有效。同样明显的是，需要开展研究项目，让人们了解干预措施是如何发挥作用的。了解治疗影响临床结果的机制有助于开发新的或改进现有的治疗方法。例如，如果一种治疗对临床结果有积极影响，而不是由于目标过程的变化，那么产生这种有益效果的机制可能被识别出来，推动它的治疗成分得到加强。同样，如果确定了一种治疗对临床结果产生负面影响的途径，则可以采取措施加以预防。拟议的研究将制定强有力和有效的统计方法，以评估复杂干预措施的运作机制。它还将帮助研究人员计划试验，以便他们不仅可以确定治疗是否有效，而且还可以确定治疗如何奏效。

The general public is exposed through the media to countless claims concerning the efficacy of complex interventions such as psychological therapies for the treatment of depression or other mental health and personal problems. Health service providers are under increasing pressure to increase the availability of interventions such as counselling and psychotherapy. There is clearly a need to design and implement controlled clinical trials to test whether such interventions work. It is equally clear that research projects need to be carried out that can inform on how the interventions work. Understanding the mechanism by which treatments affect clinical outcomes can help to develop new or improve existing treatments. For example if a treatment has a positive effect on a clinical outcome that is not due to changes in the processes targeted then the mechanism by which this beneficial effect arises can potentially be identified and the therapeutical component driving it enhanced. Similarly if a pathway is identified by which a treatment impacts negatively on a clinical outcome then steps might be undertaken to prevent it. The proposed research will develop robust and efficient statistical methods for evaluating the mechanisms by which complex interventions operate. It will also help researchers plan trials so that they can establish not only whether but also how treatments work.