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EVIDENCE-BASED-HEALTH  November 2006

EVIDENCE-BASED-HEALTH November 2006

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Subject:

Re: Qualitative Research & implementation of complex interventions

From:

Frances Gardner <[log in to unmask]>

Reply-To:

Frances Gardner <[log in to unmask]>

Date:

Fri, 3 Nov 2006 15:32:39 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (107 lines)

Agree with Hilda Bastian's thoughtful comments, including that there's a fair 
amount of misrepresentation of EBP in the Grypdonck article.  Thus I wonder 
whether members of the list want to spend a long time (again) discussing these 
various straw men?  At least this article is not nearly as silly as the 
Canadian one the EBHC list recently discussed  which read more like something 
out of the famous Sokal hoax (fun to read if you dont know it 
http://www.physics.nyu.edu/faculty/sokal/ ).

Grypdonck makes a few good points about evaluating complex interventions, for 
example, that interpreting and applying the findings of Systematic Reviews is 
tricky if your not sure exactly what the intervention was and how it was 
implemented.  But why is this a criticism of EBP?  Complex issues like this 
are something that the whole framework of EBP and Cochrane encourages us to 
work on and solve.  Thus our group did a workshop at the Cochrane Meeting last 
week (Underhill, Montgomery et al, Oxford Implementation Index, abstract 
below) on a new tool to help reviewers index quality of implementation of 
complex interventions.  This surely is a rational solution to the (one or two) 
sensible problems Grypdonck raises.  

Dr Frances Gardner
Reader in Child and Family Psychology
Director of Graduate Studies in Evidence-Based Social Intervention
Department of Social Policy and Social Work
University of Oxford, 32 Wellington Sq, Oxford OX1 2ER, UK
tel 44 [0] 1865 270334/ 270325  fax 270324
e-mail: [log in to unmask]  web:     www.apsoc.ox.ac.uk 

-----------------------------
A new tool to incorporate implementation data into systematic reviews - 
applying the Oxford Implementation Index.

Kristen Underhill, Evan Mayo-Wilson, Frances Gardner, Don Operario and Paul 
Montgomery. 
Centre for Evidence-based Intervention, Department of Social Policy & Social 
Work, University of Oxford, Oxford, UK.
[log in to unmask]


Objectives: To disseminate, demonstrate, and discuss a new methodological tool 
that helps systematic reviewers integrate implementation data throughout the 
review process. At the end of the session, participants will be prepared to: 

identify variation in implementation across trials; 
use the index to extract implementation data from primary trials; 
evaluate implementation data for completeness and susceptibility to bias; 
use implementation data to inform decisions about analysing trials, 
investigating heterogeneity, and appraising the clinical relevance of results. 
Summary: Although the Cochrane Handbook for Systematic Reviews of 
Interventions and other guidelines help review authors assess methodological 
quality across trials, these instructions rarely ask review authors to analyse 
differences in implementation that make trials more or less comparable. These 
differences can arise in either trial arm, and they stem from variation in 
treatment design, delivery by trial staff, uptake by trial participants, and 
clinical context. Without systematically examining implementation data across 
trials, review authors may group incomparable treatments, combine trials that 
make dissimilar comparisons, overlook beneficial or harmful treatment 
components, or overstate the generalisability of a review's results. 

The goal of this workshop is to demonstrate the use of the Oxford 
Implementation Index, a methodological tool that helps systematic review 
authors extract, appraise, and use implementation data in reviews. The index 
was developed through a systematic literature search, piloting, and a modified 
Delphi panel of health and social care experts. Application of the index to 
Cochrane reviews in HIV prevention and psychosocial intervention will 
demonstrate that it is efficient and easy to use. Implementation data were 
integrated into these reviews for three purposes: deciding how to group trials 
for analysis, investigating heterogeneity arising from implementation 
differences, and critically appraising the clinical relevance of results.  
The index also identified implementation characteristics that were 
underreported, which review authors noted as sources of uncertainty. 
The workshop will include the following: 
Introduction to the causes/consequences of heterogeneity in implementation 
across primary trials; 
Presentation of the index as a way to address this heterogeneity; 
Demonstration of the index using two Cochrane reviews; 
Distribution of the index to workshop participants and solicitation of 
feedback; 
Group discussion addressing usability of the index and its applicability to 
other reviews. 



In message <[log in to unmask]> 
Marcus Tolentino Silva <[log in to unmask]> writes:
> Hi all,
> 
> Grypdonck say in article of QUALITATIVE HEALTH RESEARCH (Vol. 16 No. 10, 
December 2006 1371-1385) that Evidence-based health care "leads to flirting 
with the quantitative researchers who decide about publication in high-ranking 
journals and so can undermine the true nature of qualitative research".
> 
> http://qhr.sagepub.com/cgi/reprint/16/10/1371.pdf
> 
> I don´t know if this is true. Does anyone have any opinion?
> 
> Thanks!
> 
> Marcus Tolentino 
> Farmacêutico/Consultor Técnico 
> DECIT/SCTIE/MS

-- 
Dr Frances Gardner, Reader in Child and Family Psychology
Department of Social Policy & Social Work, Oxford University
32 Wellington Square, Oxford OX1 2ER, UK
tel:44-1865-270334  [log in to unmask]

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