25 Years of Complex Intervention Trials: Reflections on Lived and Scientific Experiences

• Type of Material: Article
• Authors: Kelli Komro, Emory University
• Language: English
• Date: 2018-07-01
• Publisher: SAGE Publications (UK and US)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, The Author(s) 2017.
• Final Published Version (URL): http://dx.doi.org/10.1177/1049731517718939
• Title of Journal or Parent Work: Research on Social Work Practice
• ISSN: 1049-7315
• Volume: 28
• Issue: 5
• Start Page: 523
• End Page: 531
• Grant/Funding Information: The author received financial support for research summarized in this publication (NIH Award 5R01AA02069; NIH Award R01MD010241), and financial support from the Swedish Council for Working Life and Social Research, the Swedish Agency for Health Technology Assessment and Assessment of Social Services, the Public Health Agency of Sweden, and the National Board of Health and Welfare, to attend and present at the Stockholm Conference on Behavioral and Social Intervention Research, May 11–12, 2017.
• Keywords: DESIGN; complex intervention trials; LONG-TERM OUTCOMES; Social Sciences; HEART HEALTH-PROGRAM; commentary; Social Work; research design; URBAN YOUTH; CHILD; CHEROKEE NATION; FRAMEWORK; intervention design; ALCOHOL-USE PREVENTION; PROJECT NORTHLAND; RANDOMIZED CONTROLLED-TRIAL
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

For the past 25 years, I have led multiple group-randomized trials, each focused on a specific underserved population of youth and each one evaluated health effects of complex interventions designed to prevent high-risk behaviors. I share my reflections on issues of intervention and research design, as well as how research results fostered my evolution toward addressing fundamental social determinants of health and well-being. Reflections related to intervention design emphasize the importance of careful consideration of theory of causes and theory of change, theoretical comprehensiveness versus fundamental determinants of population health, how high to reach, and health in all policies. Flowing from these intervention design issues are reflections on implications for research design, including the importance of matching the unit of intervention to the unit of assignment, the emerging field of public health law research, and consideration of design options and design elements beyond and in combination with random assignment.