Evaluation design III Flashcards
Quasi-experimental designs
Can be used when random assignment is not possible
Less internal val than “true” exps
Still provide moderate amount of support for causal inferences
Quasi-experimental designs research
Sharma et al. (2021)
Sharma et al. (2021)
BackgroundAccredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy.
MethodsWe conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem-solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables.
ResultsWe analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p<0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of 12years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12years of experience.
ConclusionsThe P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India
Controlled before and after study design
see notes
Controlled before and after study design research
Goga et al. (2020)
Goga et al. (2020)
Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding.
Design Quasi-experimental controlled before-after study. Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa.
Participants All HWs providing infant feeding counselling in selected facilities were invited.
Interventions Three 1-2 hours, on-site workshops over 3-6 weeks. Primary outcome measures Knowledge (22 binary questions), attitude (21 questions-5-point Likert Scale) and confidence (19 questions-3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level.
Results In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August-December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups.
Conclusion A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs’ knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.
types of controlled conditions in quasi-exp design
Control group in quasi-exp study may receive diff intervention, selected components of intervention being tested/something that mimics time and attention paid to Ps (i.e. placebo)
Or use wait-list control, which means control Ps receive nothing during study period but will eventually receive intervention some time after study period
the cycling demo towns programme
1st phase: Oct 2005-Oct 2008
All towns funded at approx. £6 per head per year, matched by local authority
All towns ‘medium-sized’; larger ones focused effort on part of popn
○ Exeter one of towns
Infrastructure changes - painting cycling lanes
Campaigns
Ride as groups
Media coverage
Signage
surveys
Secondary analysis of Sport England’s Active People Survey (2005/5 and 2007/8)
Sport and active recreation
○ APS1 (2005/6) n = 1000 per LA (local authority)
○ APS2 (2007/8) n = 500 per LA
○ Phone; random digit dialling; representative sample
○ Didn’t necessary take part in campaign
- Intervention designed to affect whole popn level not just those P in intervention - should have sufficient reach to affect all of local authority
see notes
Left: at baseline 10-12% cycled at least once per month - equality at baseline - more variation in demonstration compared to other authorities - due to larger sample size - increase in cycling prevalence in 2008 with demonstration group - smaller change in non intervention - error bars don’t overlap - there is effect of intervention
Right: higher standard of cycling - lower prevalence - 2.5% - increases more in demo towns than non demo towns - bigger error bars -overlap - diffs not sig - less of change than if cycled less freq
Matched analysis
Possibility of confounders, e.g. age, gender
CDTs matched with comparison areas using National Statistics 2001 Area Classification
Closest stat neighbour on demographics
see notes
Closer r’ship in before and after with just once a month - closer r’ship with matched groups
Error bars overlap - just by chance
Matched analysis research
Rose and van der Laan (2009)
Rose and van der Laan (2009)
Matched case-control study designs are commonly implemented in the field of public health. While matching is intended to eliminate confounding, the main potential benefit of matching in case-control studies is a gain in efficiency. Methods for analyzing matched case-control studies have focused on utilizing conditional logistic regression models that provide conditional and not causal estimates of the odds ratio. This article investigates the use of case-control weighted targeted maximum likelihood estimation to obtain marginal causal effects in matched case-control study designs. We compare the use of case-control weighted targeted maximum likelihood estimation in matched and unmatched designs in an effort to explore which design yields the most information about the marginal causal effect. The procedures require knowledge of certain prevalence probabilities and were previously described byvan der Laan (2008). In many practical situations where a causal effect is the parameter of interest, researchers may be better served using an unmatched design.
Changes in cycling between 2006-2009: ICM matched analysis (n=c.9,000)
Mean time spent cycling 1.23h-1.25h
% cycling in past year: 24.3%-27.7%
New to cycling: 1.8%-2.8%
○ Only people who respond may already cycle already
Cycled in last 7 days: 41.7%-49.4%
No sig change: mean days in last week; mean time in last week; % ride to work; days cycled to work
Changes in cycling between 2006-2009: ICM matched analysis (n=c.9,000) research
Sustrans and Davis (2019)
Sustrans and Davis (2019)
intervention typologies:
§ City and town wide interventions
§ Building or improving routes or networks
§ Social marketing including marketing of infrastructure
§ Workplace and other institution based interventions
§ Interpersonal interventions
§ School based interventions
We distinguish city and town wide interventions from the other intervention typologies by virtue of the fact of the approach applied being usually a combination of measures. These combinations typically include measures included in the other typological clusters. The other groups of identified typologies tend, in the research literature and in the practicality of delivery, to be relatively more localised.
Overall, the review concludes that there is strong evidence for the positive impact of interventions to increase active travel. This in turn increases levels of physical activity 13 15 . Of the different intervention typologies the evidence was strongest (in terms of volume and robustness) for city or town-wide interventions. Each of the other intervention types reported some increases in walking and or cycling.
Quasi-experimental statistical methods
Diff-in-Diff analysis: method involves comparing changes before and after the programme for indvs in programme and control
Regression analysis: attempts to address problem of confounding by controlling for diff at baseline
Quasi-experimental statistical methods research
Nygaard et al. (2020)
Nygaard et al. (2020)
Often an intervention is applied in an area (e.g. community, municipality) without it being an experiment and without a control group, this can be categorized as a natural experiment. Such a situation offers the opportunity to exploit exposure contrasts between areas regarding the specific intervention for evaluation. In the present study, we will employ the difference-in-difference approach to evaluate the natural experiment (the structural intervention) comparing measures of health and social factors retrieved from registers in the two social housing areas before and after the intervention. A ‘natural experiment’ study comparing individual and aggregated level differences in register-based information on health and social variables across time including the entire study period is included in the research project. The population includes all residents with an address in the study area and the control area at any point during the years 2015-2025 (∼3,000 residents in each area). All residents are linked to the Danish social and health registers by the unique personal identification number, which makes it possible to follow all permanent and former residents over time. Hereby we plan to study if the structural changes (the structural intervention, the ‘natural experiment’) give rise to differences in health (such as use of general practitioner, hospitalizations, use of selected medications) and social factors (e.g. divorces, income levels, unemployment) compared to the control area. The control area is representing a similar social housing area in the same municipality, which will not undergo structural changes until 2023. Findings will be evaluated drawing upon knowledge gained from the entire study from surveys and qualitative interviews as well experiences from the interventions. In this presentation, we wish to discuss how best to include the knowledge based on other methodologies in the register-based analyses
advantages of controlled before and after design
Provides some assurance that outcomes actually results of programme
Most practical option for conducting outcome evals in community interventions
By using preexisting/self-selecting groups, such as indvs already enrolled in programme, it avoids additional steps required with random assignment to study conditions
Overcomes ethical concerns involved in withholding/delaying treatment/substituting less effective treatment for one group of study Ps
disadvantages of controlled before and after design
Can demand more time and resources
Requires access to at least 2 similar groups
Without randomisation, study groups may differ in imp ways that account for some of groups diffs in outcomes after intervention
Selection bias