More thoughts on the RCT question: a rejoinder to Forrester and Ritter
| Date | 15 June 2012 |
| DOI | https://doi.org/10.1108/17466661211238718 |
| Published date | 15 June 2012 |
| Pages | 153-158 |
| Author | Sarah Stewart‐Brown |
| Subject Matter | Education,Health & social care,Sociology |
More thoughts on the RCT question:
a rejoinder to Forrester and Ritter
Sarah Stewart-Brown
Abstract
Purpose – The paper’s purpose is to participate in a debate about the role of randomised controlled
trials in evaluation of preventive interventions for children.
Design/methodology/approach – The paper is a response to critiques on Stewart-Brown et al.
published in the Journal of Children’s Services, Vol. 6 No. 4, pp. 228–35.
Findings – Randomised controlled trials are likely to be at their best in the evaluation of interventions
that do not require the active engagement and personal development of participants. The latter may
depend on a series of interventions and events that potentiate each other over time. Randomised
controlled trials are likely to be least valuable in evaluating universal level interventions that aim to
change population norms. Because of the challenges involved in conducting RCTs in this setting they
cannot be relied upon to give accurate estimates of programme effectand therefore do not deserve the
privileged position that has been accorded them in the hierarchy of evidence.
Originality/value – This paper develops the argument that the privileged position of RCTs in the
evidence hierarchy of preventive services for children is undeserved.
Keywords Randomised controlled trials, Preventive services, Children (age groups),Parenting, Family,
Social interaction
Paper type Viewpoint
Introduction
Donald Forrester (2012) and Gary Ritter (2012) make some very valid points in their
responses to the paper ‘‘Should randomised controlled trials be the gold standard for
research on preventive interventions for children?’’ from myself and colleagues in the last-
but-one edition of this journal (Stewart-Brown et al., 2011).
I agree with much of what they say. In particular I agree with Forrester that the adoption of
polarised views, which of course is what debates tend to encourage, won’t take us ver y far
forward. This is an area of research in which there are many conundrums and few easy
answers, but it is often in the contemplation of paradox, bits of the jigsaw puzzle that simply
won’t fit together, that insight arises and new paradigms and mindsets can emerge.
That said, some of the comments they make do need addressing because, from a
UK-centric view, they are quite simply wrong.
Privileged position
The first of these is that, according to Ritter, RCTs do not occupy a privileged position in the
evidence hierarchy.I cannot speak for the USA, but in the UK they do. Every student of public
health, medicine and, increasingly, other health and social care disciplines in this country is
taught about the hierarchy of evidence, with good quality systematic reviews of RCTs at the
top, followed by individual RCTs, followed by good quality quasi-experimental studies.
DOI 10.1108/17466661211238718 VOL. 7 NO. 2 2012, pp. 153-158, QEmerald Group Publishing Limited, ISSN 1746-6660
j
JOURNAL OF CHILDREN’S SERVICES
j
PAGE 153
Sarah Stewart-Brown is a
Professor of Public Health
at Warwick Medical School,
University of Warwick,
Coventry, UK.
The author is grateful to
colleagues in the Family Links
trial team and to others who
have helped to develop her
ideas on this subject.
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