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Logistic, ethical, and political dimensions of stepped wedge trials: critical review and case studies

Overview of attention for article published in Trials, August 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (89th percentile)

Mentioned by

blogs
1 blog
policy
1 policy source
twitter
10 tweeters

Citations

dimensions_citation
49 Dimensions

Readers on

mendeley
134 Mendeley
citeulike
1 CiteULike
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Title
Logistic, ethical, and political dimensions of stepped wedge trials: critical review and case studies
Published in
Trials, August 2015
DOI 10.1186/s13063-015-0837-4
Pubmed ID
Authors

Audrey Prost, Ariella Binik, Ibrahim Abubakar, Anjana Roy, Manuela De Allegri, Christelle Mouchoux, Tobias Dreischulte, Helen Ayles, James J. Lewis, David Osrin

Abstract

Three arguments are usually invoked in favour of stepped wedge cluster randomised controlled trials: the logistic convenience of implementing an intervention in phases, the ethical benefit of providing the intervention to all clusters, and the potential to enhance the social acceptability of cluster randomised controlled trials. Are these alleged benefits real? We explored the logistic, ethical, and political dimensions of stepped wedge trials using case studies of six recent evaluations. We identified completed or ongoing stepped wedge evaluations using two systematic reviews. We then purposively selected six with a focus on public health in high, middle, and low-income settings. We interviewed their authors about the logistic, ethical, and social issues faced by their teams. Two authors reviewed interview transcripts, identified emerging issues through qualitative thematic analysis, reflected upon them in the context of the literature, and invited all participants to co-author the manuscript. Our analysis raises three main points. First, the phased implementation of interventions can alleviate problems linked to simultaneous roll-out, but also brings new challenges. Issues to consider include the feasibility of organising intervention activities according to a randomised sequence, estimating time lags in implementation and effects, and accommodating policy changes during the trial period. Second, stepped wedge trials, like parallel cluster trials, require equipoise: without it, randomising participants to a control condition, even for a short time, remains problematic. In stepped wedge trials, equipoise is likely to lie in the degree of effect, effectiveness in a specific operational milieu, and the balance of benefit and harm, including the social value of better evaluation. Third, the strongest arguments for a stepped wedge design are logistic and political rather than ethical. The design is advantageous when simultaneous roll-out is impractical and when it increases the acceptability of using counterfactuals. The logistic convenience of phased implementation is context-dependent, and may be vitiated by the additional requirements of phasing. The potential for stepped wedge trials to enhance the social acceptability of cluster randomised trials is real, but their ethical legitimacy still rests on demonstrating equipoise and its configuration for each research question and setting.

Twitter Demographics

The data shown below were collected from the profiles of 10 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 134 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
United States 1 <1%
Sweden 1 <1%
Brazil 1 <1%
Unknown 130 97%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 23 17%
Researcher 23 17%
Student > Master 21 16%
Student > Doctoral Student 13 10%
Student > Bachelor 8 6%
Other 30 22%
Unknown 16 12%
Readers by discipline Count As %
Medicine and Dentistry 49 37%
Social Sciences 16 12%
Nursing and Health Professions 9 7%
Mathematics 6 4%
Psychology 5 4%
Other 19 14%
Unknown 30 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 15. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 July 2019.
All research outputs
#1,278,727
of 15,462,543 outputs
Outputs from Trials
#449
of 4,079 outputs
Outputs of similar age
#24,771
of 240,184 outputs
Outputs of similar age from Trials
#1
of 1 outputs
Altmetric has tracked 15,462,543 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 91st percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,079 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 7.7. This one has done well, scoring higher than 88% of its peers.
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We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them