Pub Date : 2022-02-21DOI: 10.1177/26320843211061288
P. Blanche, B. Zareini, P. Rasmussen
The Cox model is one of the most used statistical models in medical research. It models the hazard rate of an event and its association with covariates through hazard ratios. In the simple setting without competing risks nor time-dependent covariates, there exists a one-to-one mathematical connection between the hazard rate and the risk of experiencing the event within any given time period (e.g., 5 years). This makes it possible to conclude that a covariate associated with a hazard ratio above one is associated with a higher risk of event. Although it is becoming widely known that this connection is lost in the presence of competing risks, it seems that fewer users of the Cox model are aware that this connection is also lost when using time-dependent covariates. In other words, it seems still widely unknown that, when using a time-dependent Cox model, a hazard ratio estimated above one does not necessarily mean that there is a higher risk. Hence, this note aims to clarify why this is not the case with a detailed pedagogical example.
{"title":"A hazard ratio above one does not necessarily mean higher risk, when using a time-dependent cox model","authors":"P. Blanche, B. Zareini, P. Rasmussen","doi":"10.1177/26320843211061288","DOIUrl":"https://doi.org/10.1177/26320843211061288","url":null,"abstract":"The Cox model is one of the most used statistical models in medical research. It models the hazard rate of an event and its association with covariates through hazard ratios. In the simple setting without competing risks nor time-dependent covariates, there exists a one-to-one mathematical connection between the hazard rate and the risk of experiencing the event within any given time period (e.g., 5 years). This makes it possible to conclude that a covariate associated with a hazard ratio above one is associated with a higher risk of event. Although it is becoming widely known that this connection is lost in the presence of competing risks, it seems that fewer users of the Cox model are aware that this connection is also lost when using time-dependent covariates. In other words, it seems still widely unknown that, when using a time-dependent Cox model, a hazard ratio estimated above one does not necessarily mean that there is a higher risk. Hence, this note aims to clarify why this is not the case with a detailed pedagogical example.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"42 - 48"},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48457296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-02DOI: 10.1177/26320843211061297
NR Agni, C. Fairhurst, C. McDaid, M. Reed, D. Torgerson
Background Randomised controlled trials (RCTs) often struggle with various aspects of participant recruitment, including engaging clinicians to recruit effectively, and subsequently fail to reach their target sample size. Studies evaluating interventions to improve recruitment aimed specifically at recruiters to the trial are limited in number. The RCTs embedded into the World Hip Trauma Evaluation (WHiTE) cohort study use Trainee Principal Investigators (TPIs) to help manage and drive recruitment at trial sites. No formalised training or support is provided by central trials units to the TPIs. Additionally, trial recruiters receive a generic automated email confirming randomisation to the trial with no other communication to influence or incentivise their behaviour to further recruit. The primary aim of this factorial trial was to evaluate the effectiveness of an educational intervention to TPIs and a positive reinforcement intervention via an email (digital) nudge on increasing recruitment. Secondary aims included feasibility of implementing the interventions and surveying TPIs on the educational package quality of content, delivery and ongoing support. Design This was a multicentre, open, cluster, 2x2 factorial RCT embedded in the WHiTE 8 COPAL RCT, in which research sites were randomised 1:1:1:1 to receive the enhanced TPI package, the digital nudge intervention, both, or neither. Results 1215 patients were recruited to the WHiTE 8 COPAL trial across 20 sites during the SWAT between August 2018 and March 2019. There was a statistically significant interaction between the interventions (IRR 2.09, 95% CI 1.64 to 2.68, p < 0.001). There was a statistically significant benefit on recruitment (IRR 1.23 95% 1.09 to 1.40, p=0.001) from utilizing an enhanced TPI education intervention. The digital nudge intervention had no significant impact on recruitment (IRR 0.89 95% CI 0.79 to 1.01, p=0.07). Within enhanced TPI package sites, the digital nudge had a beneficial effect, while in the standard practice TPI sites it had a detrimental effect. Feasibility analysis showed the median time to site digital nudge and enhanced TPI set up were one day and 17 days, respectively. 353 digital nudges were created taking an average of 12 min to construct, log the activity and then disseminate to recruiters. Median induction time for enhanced TPI was 32 min and 100% of the groups were extremely satisfied with the induction content, delivery and ongoing support. Discussion An education and support programme targeted at surgical TPIs involving a digital education package, 1:1 telephone induction and subsequent support package was effective in increasing recruitment in the first 6 months of trial commencement. There was no evidence for the effectiveness of the digital nudge intervention in isolation, although our results show that when combined with an education programme, it leads to enhanced effectiveness of that programme.
随机对照试验(RCTs)在招募参与者方面经常遇到困难，包括让临床医生有效招募参与者，结果无法达到目标样本量。研究评估干预措施，以改善招聘，专门针对招聘人员的试验数量有限。纳入世界髋关节创伤评估(WHiTE)队列研究的随机对照试验使用受训首席调查员(tpi)来帮助管理和推动试验地点的招募。中央试验单位没有向tpi提供正式的培训或支持。此外，试验招聘人员会收到一封通用的自动电子邮件，确认试验的随机化，而没有其他通信来影响或激励他们进一步招聘的行为。本析因试验的主要目的是评估教育干预对tpi的有效性，以及通过电子邮件(数字)推动增加招聘的积极强化干预。次要目标包括实施干预措施的可行性，以及调查教育包的内容质量、交付和持续支持的tpi。这是一项嵌入WHiTE 8 COPAL RCT的多中心、开放、集群、2x2因子RCT，研究地点按1:1:1:1随机分组，分别接受增强TPI包、数字助推干预、两者都接受或两者都不接受。在2018年8月至2019年3月的SWAT期间，在20个地点招募了1215名患者参加WHiTE 8 COPAL试验。干预措施之间存在显著的交互作用(IRR 2.09, 95% CI 1.64 ~ 2.68, p < 0.001)。利用增强的TPI教育干预在招募方面有统计学上显著的益处(IRR 1.23 95% 1.09至1.40,p=0.001)。数字助推干预对招募没有显著影响(IRR 0.89 95% CI 0.79至1.01,p=0.07)。在增强的TPI包站点中，数字助推具有有益的效果，而在标准实践TPI站点中，它具有有害的影响。可行性分析显示，数字助推和增强TPI设置的中位时间分别为1天和17天。创建了353个数字推送，平均花费12分钟来构建、记录活动，然后传播给招聘人员。增强TPI的中位诱导时间为32分钟，100%的组对诱导内容、方式和持续支持都非常满意。针对外科tpi的教育和支持计划包括数字教育包、1:1电话诱导和随后的支持包，在试验开始的前6个月有效地增加了招聘。没有证据表明数字助推干预单独有效，尽管我们的研究结果表明，当与教育计划相结合时，它会提高该计划的有效性。
{"title":"EnTraP: A factorial randomised controlled trial embedded within world hip trauma evaluation eight COPAL investigating the effect of an enhanced trainee principal investigator package and digital nudge on recruitment rates","authors":"NR Agni, C. Fairhurst, C. McDaid, M. Reed, D. Torgerson","doi":"10.1177/26320843211061297","DOIUrl":"https://doi.org/10.1177/26320843211061297","url":null,"abstract":"Background Randomised controlled trials (RCTs) often struggle with various aspects of participant recruitment, including engaging clinicians to recruit effectively, and subsequently fail to reach their target sample size. Studies evaluating interventions to improve recruitment aimed specifically at recruiters to the trial are limited in number. The RCTs embedded into the World Hip Trauma Evaluation (WHiTE) cohort study use Trainee Principal Investigators (TPIs) to help manage and drive recruitment at trial sites. No formalised training or support is provided by central trials units to the TPIs. Additionally, trial recruiters receive a generic automated email confirming randomisation to the trial with no other communication to influence or incentivise their behaviour to further recruit. The primary aim of this factorial trial was to evaluate the effectiveness of an educational intervention to TPIs and a positive reinforcement intervention via an email (digital) nudge on increasing recruitment. Secondary aims included feasibility of implementing the interventions and surveying TPIs on the educational package quality of content, delivery and ongoing support. Design This was a multicentre, open, cluster, 2x2 factorial RCT embedded in the WHiTE 8 COPAL RCT, in which research sites were randomised 1:1:1:1 to receive the enhanced TPI package, the digital nudge intervention, both, or neither. Results 1215 patients were recruited to the WHiTE 8 COPAL trial across 20 sites during the SWAT between August 2018 and March 2019. There was a statistically significant interaction between the interventions (IRR 2.09, 95% CI 1.64 to 2.68, p < 0.001). There was a statistically significant benefit on recruitment (IRR 1.23 95% 1.09 to 1.40, p=0.001) from utilizing an enhanced TPI education intervention. The digital nudge intervention had no significant impact on recruitment (IRR 0.89 95% CI 0.79 to 1.01, p=0.07). Within enhanced TPI package sites, the digital nudge had a beneficial effect, while in the standard practice TPI sites it had a detrimental effect. Feasibility analysis showed the median time to site digital nudge and enhanced TPI set up were one day and 17 days, respectively. 353 digital nudges were created taking an average of 12 min to construct, log the activity and then disseminate to recruiters. Median induction time for enhanced TPI was 32 min and 100% of the groups were extremely satisfied with the induction content, delivery and ongoing support. Discussion An education and support programme targeted at surgical TPIs involving a digital education package, 1:1 telephone induction and subsequent support package was effective in increasing recruitment in the first 6 months of trial commencement. There was no evidence for the effectiveness of the digital nudge intervention in isolation, although our results show that when combined with an education programme, it leads to enhanced effectiveness of that programme.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"33 - 41"},"PeriodicalIF":0.0,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41425644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1177/26320843221077720
{"title":"Editorial","authors":"","doi":"10.1177/26320843221077720","DOIUrl":"https://doi.org/10.1177/26320843221077720","url":null,"abstract":"","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"1 - 1"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41847170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1177/26320843211061302
K. Jamie, A. Rathbone
This paper examines the place of theory in qualitative medical research. While theory’s place in research planning and data analysis has been well-established, the contribution of theory during qualitative data collection tends to be overlooked. Yet, data collection is not an asocial or apolitical process and requires reflection and analysis in and of itself. Therefore, drawing on an exemplar case study research project which focused on patients’ use of medicines, the paper argues that engaging with theory to think reflexively, throughout a project but particularly during the process of data collection can ensure the rigour and trustworthiness of qualitative data. In this case study, we draw on sociologist Erving Goffman’s theoretical framework of the dramaturgical metaphor to address the multiplicity of roles that healthcare practitioners undertaking qualitative research have to occupy and navigate. Rather than painting researchers out of their research through a naïve search for ‘objectivity’, reflexivity that is scaffolded by theory, offers a way through which researchers’ biases and subjectivities can be made explicit and their data analysis transparent. In making this argument, we encourage medical researchers to engage with, and be attuned to, theoretical perspectives outwith their own discipline.
{"title":"Using theory and reflexivity to preserve methodological rigour of data collection in qualitative research","authors":"K. Jamie, A. Rathbone","doi":"10.1177/26320843211061302","DOIUrl":"https://doi.org/10.1177/26320843211061302","url":null,"abstract":"This paper examines the place of theory in qualitative medical research. While theory’s place in research planning and data analysis has been well-established, the contribution of theory during qualitative data collection tends to be overlooked. Yet, data collection is not an asocial or apolitical process and requires reflection and analysis in and of itself. Therefore, drawing on an exemplar case study research project which focused on patients’ use of medicines, the paper argues that engaging with theory to think reflexively, throughout a project but particularly during the process of data collection can ensure the rigour and trustworthiness of qualitative data. In this case study, we draw on sociologist Erving Goffman’s theoretical framework of the dramaturgical metaphor to address the multiplicity of roles that healthcare practitioners undertaking qualitative research have to occupy and navigate. Rather than painting researchers out of their research through a naïve search for ‘objectivity’, reflexivity that is scaffolded by theory, offers a way through which researchers’ biases and subjectivities can be made explicit and their data analysis transparent. In making this argument, we encourage medical researchers to engage with, and be attuned to, theoretical perspectives outwith their own discipline.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"11 - 21"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44611570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1177/26320843211069530
Sophie M C Green, Erin Raine, L. Hall, M. Collinson, Ellen Mason, K. Gillies, D. French, Y. K. Bartlett, S. Hartley, R. Foy, A. Farrin, Samuel G Smith
Background: Returning a trial questionnaire is a behaviour affected by a range of psychological and contextual factors. Previously tested Short Message Service (SMS) messages to prompt questionnaire return have not addressed these factors, and have not been characterised by established taxonomies of behaviour change techniques (BCTs). Purpose: We aimed to develop acceptable theory-based SMS messages, with fidelity to four BCTs, to support participant understanding of the consequences of not returning trial questionnaires. Methods and Results: We initially developed 32 messages. Ten behaviour change experts assessed message fidelity to the intended BCT (Study 1a). All messages had appropriate fidelity to the intended BCT (mean ratings = 6.8/10 [SD = 0.6) to 7.5/10 [SD = 0.3]). Study 1b, a focus group with five patient representatives, recommended removing the BCT ‘comparative imagining of future outcomes’ (4 messages), two further messages be removed, and amendments to five messages. In Study 1c, 60 breast cancer survivors rated all remaining 26 messages as acceptable (mean = 3.8/5 [SD = 1.2] to 4.3/5 [SD = 0.8]). Twelve behaviour change experts rated the fidelity of the 26 messages to intended BCTs (Study 1d); all messages had appropriate fidelity (mean ratings = 6.1/10 [SD = 2.4] to 6.9/10 [SD = 1.4]). Conclusions: In these studies, we developed 26 SMS messages that were acceptable to the intended recipients and had sufficient fidelity to the intended BCTs. This approach could be taken to design interventions supporting behaviours needed for the successful delivery of clinical trials. The messages are available to research teams who can evaluate them in Studies within Trials.
{"title":"Developing theory-based text messages to support retention in clinical trials: A mixed methods approach","authors":"Sophie M C Green, Erin Raine, L. Hall, M. Collinson, Ellen Mason, K. Gillies, D. French, Y. K. Bartlett, S. Hartley, R. Foy, A. Farrin, Samuel G Smith","doi":"10.1177/26320843211069530","DOIUrl":"https://doi.org/10.1177/26320843211069530","url":null,"abstract":"Background: Returning a trial questionnaire is a behaviour affected by a range of psychological and contextual factors. Previously tested Short Message Service (SMS) messages to prompt questionnaire return have not addressed these factors, and have not been characterised by established taxonomies of behaviour change techniques (BCTs). Purpose: We aimed to develop acceptable theory-based SMS messages, with fidelity to four BCTs, to support participant understanding of the consequences of not returning trial questionnaires. Methods and Results: We initially developed 32 messages. Ten behaviour change experts assessed message fidelity to the intended BCT (Study 1a). All messages had appropriate fidelity to the intended BCT (mean ratings = 6.8/10 [SD = 0.6) to 7.5/10 [SD = 0.3]). Study 1b, a focus group with five patient representatives, recommended removing the BCT ‘comparative imagining of future outcomes’ (4 messages), two further messages be removed, and amendments to five messages. In Study 1c, 60 breast cancer survivors rated all remaining 26 messages as acceptable (mean = 3.8/5 [SD = 1.2] to 4.3/5 [SD = 0.8]). Twelve behaviour change experts rated the fidelity of the 26 messages to intended BCTs (Study 1d); all messages had appropriate fidelity (mean ratings = 6.1/10 [SD = 2.4] to 6.9/10 [SD = 1.4]). Conclusions: In these studies, we developed 26 SMS messages that were acceptable to the intended recipients and had sufficient fidelity to the intended BCTs. This approach could be taken to design interventions supporting behaviours needed for the successful delivery of clinical trials. The messages are available to research teams who can evaluate them in Studies within Trials.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"22 - 31"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48737416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-23DOI: 10.1177/26320843211061294
Ni Wayan Septarini, S. Burns, B. Maycock
Introduction The prevalence of sexually transmitted infections (STIs) among MSM (men who have sex with men) and transgender women (waria) in Bali is of significant public health concern. According to the 2015 Integrated Biological and Behavioural Survey (IBBS), HIV prevalence among MSM in Denpasar (the capital city of Bali) was 36% – the highest prevalence in this population reported nationally. In addition, 26% of MSM and 25% of waria in Indonesia were living with HIV in 2015. There is limited research examining the attitudes, behaviours and experiences of MSM in Indonesia, and specifically in Bali. This study will develop a model to help understand the social-cultural context, attitudes, behaviours, and experiences to inform interventions to increase safe sex practices amongst Indonesian MSM and waria who live in Bali. Methods and analysis The community-engaged research (CEnR) study, employing a sequential mixed-methods approach, will engage MSM and waria community throughout all five phases. The first two phases will include partnership building and exploratory research (focus group discussions/FGDs). Phase three will include the administration of a survey (n = 374 Indonesian MSM and waria). Phases four and five include explanatory (in-depth interviews) and dissemination phases, respectively. Multivariate analysis will be employed for the quantitative data (the survey) and thematic analysis will be used to analyse the qualitative data (FGDs and in-depth interviews). Discussion The findings of this CEnR will inform culturally congruent interventions for organisation working with MSM and transgender to promote safer sexual health practice and improve general well-being of this community.
{"title":"THE CABE PROJECT: Developing a model to conceptualise the sexual attitudes, behaviours, and experiences of men who have sex with men and Waria in Bali, Indonesia: Protocol for a mixed-methods design within a community-engaged research study","authors":"Ni Wayan Septarini, S. Burns, B. Maycock","doi":"10.1177/26320843211061294","DOIUrl":"https://doi.org/10.1177/26320843211061294","url":null,"abstract":"Introduction The prevalence of sexually transmitted infections (STIs) among MSM (men who have sex with men) and transgender women (waria) in Bali is of significant public health concern. According to the 2015 Integrated Biological and Behavioural Survey (IBBS), HIV prevalence among MSM in Denpasar (the capital city of Bali) was 36% – the highest prevalence in this population reported nationally. In addition, 26% of MSM and 25% of waria in Indonesia were living with HIV in 2015. There is limited research examining the attitudes, behaviours and experiences of MSM in Indonesia, and specifically in Bali. This study will develop a model to help understand the social-cultural context, attitudes, behaviours, and experiences to inform interventions to increase safe sex practices amongst Indonesian MSM and waria who live in Bali. Methods and analysis The community-engaged research (CEnR) study, employing a sequential mixed-methods approach, will engage MSM and waria community throughout all five phases. The first two phases will include partnership building and exploratory research (focus group discussions/FGDs). Phase three will include the administration of a survey (n = 374 Indonesian MSM and waria). Phases four and five include explanatory (in-depth interviews) and dissemination phases, respectively. Multivariate analysis will be employed for the quantitative data (the survey) and thematic analysis will be used to analyse the qualitative data (FGDs and in-depth interviews). Discussion The findings of this CEnR will inform culturally congruent interventions for organisation working with MSM and transgender to promote safer sexual health practice and improve general well-being of this community.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"3 1","pages":"2 - 10"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47837849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01Epub Date: 2021-11-20DOI: 10.1177/26320843211061292
Qingzhao Yu, Mandi Yu, Joe Zou, Xiaocheng Wu, Scarlett L Gomez, Bin Li
Background: Third-variable effect refers to the effect from a third-variable that explains an observed relationship between an exposure and an outcome. Depending on whether there is a causal relationship from the exposure to the third variable, the third-variable is called a mediator or a confounder. The multilevel mediation analysis is used to differentiate third-variable effects from data of hierarchical structures.
Data collection and analysis: We developed a multilevel mediation analysis method to deal with time-to-event outcomes and implemented the method in the mlma R package. With the method, third-variable effects from different levels of data can be estimated. The method uses multilevel additive models that allow for transformations of variables to take into account potential nonlinear relationships among variables in the mediation analysis. We apply the proposed method to explore the racial/ethnic disparities in survival among patients diagnosed with breast cancer in California between 2006 and 2017, using both individual risk factors and census tract level environmental factors. The individual risk factors are collected by cancer registries and the census tract level factors are collected by the Public Health Alliance of Southern California in partnership with the Virginia Commonwealth University's Center on Society and Health. The National Cancer Institute work group linked variables at the census tract level with each patient and performed the analysis for this study.
Results: We found that the racial disparity in survival were mostly explained at the census tract level and partially explained at the individual level. The associations among variables were depicted. Conclusion: The multilevel mediation analysis method can be used to differentiate mediation/confounding effects for factors originated from different levels. The method is implemented in the R package mlma.
{"title":"Multilevel mediation analysis on time-to-event outcomes: Exploring racial/ethnic disparities in breast cancer survival in California.","authors":"Qingzhao Yu, Mandi Yu, Joe Zou, Xiaocheng Wu, Scarlett L Gomez, Bin Li","doi":"10.1177/26320843211061292","DOIUrl":"10.1177/26320843211061292","url":null,"abstract":"<p><strong>Background: </strong>Third-variable effect refers to the effect from a third-variable that explains an observed relationship between an exposure and an outcome. Depending on whether there is a causal relationship from the exposure to the third variable, the third-variable is called a mediator or a confounder. The multilevel mediation analysis is used to differentiate third-variable effects from data of hierarchical structures.</p><p><strong>Data collection and analysis: </strong>We developed a multilevel mediation analysis method to deal with time-to-event outcomes and implemented the method in the <i>mlma</i> R package. With the method, third-variable effects from different levels of data can be estimated. The method uses multilevel additive models that allow for transformations of variables to take into account potential nonlinear relationships among variables in the mediation analysis. We apply the proposed method to explore the racial/ethnic disparities in survival among patients diagnosed with breast cancer in California between 2006 and 2017, using both individual risk factors and census tract level environmental factors. The individual risk factors are collected by cancer registries and the census tract level factors are collected by the Public Health Alliance of Southern California in partnership with the Virginia Commonwealth University's Center on Society and Health. The National Cancer Institute work group linked variables at the census tract level with each patient and performed the analysis for this study.</p><p><strong>Results: </strong>We found that the racial disparity in survival were mostly explained at the census tract level and partially explained at the individual level. The associations among variables were depicted. Conclusion: The multilevel mediation analysis method can be used to differentiate mediation/confounding effects for factors originated from different levels. The method is implemented in the R package <i>mlma</i>.</p>","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"2 4","pages":"157-167"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9232182/pdf/nihms-1761271.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40400610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/26320843211061298
Nicoline Toresen Lokdam, Marianne Riksheim Stavseth, A. Bukten
Objectives This paper demonstrates how to investigate the external validity of a study sample by triangulating survey and registry data, using data from the Norwegian Offender Mental Health and Addiction (NorMA) Study as a case. Methods We use survey data from the NorMA study (n = 1495), including the NorMA cohort (n = 733), and data from the Norwegian Prison Registry on all people imprisoned on 1 September 2013 (n = 3386). Triangulation was performed by (1) comparing the NorMA cohort to those lost to follow-up (n = 762), using survey data from the NorMA study. Secondly, we compared the NorMA cohort to the one-day population, using data from the Norwegian Prison Registry. We also stratified the one-day sample by possession of a Norwegian personal identification number (PIN). Results We found differences in birthplace, imprisonment and drug use between the NorMA cohort, lost to follow-up and the one-day population. Twenty-three percent of the one-day population did not have a Norwegian PIN. The NorMA cohort was more similar to those with a Norwegian PIN in the one-day population. Our triangulation demonstrates that 56–62% of the Norwegian prison population had an indication of drug use before imprisonment. Conclusions The NorMA cohort was overall representative of the one-day prison population holding a Norwegian PIN and less representative of prisoners without a Norwegian PIN. Using this method provides tangible inputs on the strengths and limitations of a study sample and can be a feasible method to investigate the external validity of survey data.
{"title":"Exploring the external validity of survey data with triangulation: A case study from the Norwegian Offender Mental Health and Addiction (NorMA) Study","authors":"Nicoline Toresen Lokdam, Marianne Riksheim Stavseth, A. Bukten","doi":"10.1177/26320843211061298","DOIUrl":"https://doi.org/10.1177/26320843211061298","url":null,"abstract":"Objectives This paper demonstrates how to investigate the external validity of a study sample by triangulating survey and registry data, using data from the Norwegian Offender Mental Health and Addiction (NorMA) Study as a case. Methods We use survey data from the NorMA study (n = 1495), including the NorMA cohort (n = 733), and data from the Norwegian Prison Registry on all people imprisoned on 1 September 2013 (n = 3386). Triangulation was performed by (1) comparing the NorMA cohort to those lost to follow-up (n = 762), using survey data from the NorMA study. Secondly, we compared the NorMA cohort to the one-day population, using data from the Norwegian Prison Registry. We also stratified the one-day sample by possession of a Norwegian personal identification number (PIN). Results We found differences in birthplace, imprisonment and drug use between the NorMA cohort, lost to follow-up and the one-day population. Twenty-three percent of the one-day population did not have a Norwegian PIN. The NorMA cohort was more similar to those with a Norwegian PIN in the one-day population. Our triangulation demonstrates that 56–62% of the Norwegian prison population had an indication of drug use before imprisonment. Conclusions The NorMA cohort was overall representative of the one-day prison population holding a Norwegian PIN and less representative of prisoners without a Norwegian PIN. Using this method provides tangible inputs on the strengths and limitations of a study sample and can be a feasible method to investigate the external validity of survey data.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"2 1","pages":"140 - 147"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42709376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/26320843211061301
S. Parkin, J. Neale, Emmert Roberts, Eileen Brobbin, A. Bowen, L. Hermann, Georges-Jacques Dwyer, Richard Turner, J. Henderson, L. Kuester, Rebecca McDonald, P. Radcliffe, D. Robson, S. Craft, J. Strang, N. Metrebian
In March 2020, the ‘Everyone In’ initiative was introduced by the UK government as a public health response to COVID-19. This initiative sought to temporarily accommodate people experiencing rough sleeping in hotels in all local authority areas throughout England. In London, ‘Everyone In’ involved the procurement of vacant accommodation in over 100 hotels and temporarily re-housed approximately 2000 individuals. A rapid qualitative study was undertaken within two hotels to explore experiences of the initiative from the perspective of people accommodated in the hotels. This article describes how standard qualitative methods were adapted and implemented to complete the study whilst meeting COVID-19 social distancing guidelines. The research involved a longitudinal design of a two-stage qualitative interview that sought to capture residents’ experience of ‘Everyone In’ at two points in time (while in the hotel and when residents had left the hotel). Adapted qualitative methods were employed by a team of 13 researchers. These adaptations included socially distanced leaflet dropping, telephone-based participant recruitment, a remote, multistage, longitudinal qualitative telephone interviewing and rapid framework analysis. 35 hotel residents were recruited into the study (two subsequently withdrew participation). A total of 299 (of a possible 330) short interviews were completed by 33 participants (26 male and 7 female) as part of the multi-stage, longitudinal design of the study. This study indicates that adapted qualitative research methods employed during a pandemic can be successfully applied to obtain insights and experiences (of individuals and groups) otherwise difficult to reach and/or complex to understand.
{"title":"Conducting rapid qualitative research amongst people with experience of rough sleeping in London during the COVID-19 pandemic","authors":"S. Parkin, J. Neale, Emmert Roberts, Eileen Brobbin, A. Bowen, L. Hermann, Georges-Jacques Dwyer, Richard Turner, J. Henderson, L. Kuester, Rebecca McDonald, P. Radcliffe, D. Robson, S. Craft, J. Strang, N. Metrebian","doi":"10.1177/26320843211061301","DOIUrl":"https://doi.org/10.1177/26320843211061301","url":null,"abstract":"In March 2020, the ‘Everyone In’ initiative was introduced by the UK government as a public health response to COVID-19. This initiative sought to temporarily accommodate people experiencing rough sleeping in hotels in all local authority areas throughout England. In London, ‘Everyone In’ involved the procurement of vacant accommodation in over 100 hotels and temporarily re-housed approximately 2000 individuals. A rapid qualitative study was undertaken within two hotels to explore experiences of the initiative from the perspective of people accommodated in the hotels. This article describes how standard qualitative methods were adapted and implemented to complete the study whilst meeting COVID-19 social distancing guidelines. The research involved a longitudinal design of a two-stage qualitative interview that sought to capture residents’ experience of ‘Everyone In’ at two points in time (while in the hotel and when residents had left the hotel). Adapted qualitative methods were employed by a team of 13 researchers. These adaptations included socially distanced leaflet dropping, telephone-based participant recruitment, a remote, multistage, longitudinal qualitative telephone interviewing and rapid framework analysis. 35 hotel residents were recruited into the study (two subsequently withdrew participation). A total of 299 (of a possible 330) short interviews were completed by 33 participants (26 male and 7 female) as part of the multi-stage, longitudinal design of the study. This study indicates that adapted qualitative research methods employed during a pandemic can be successfully applied to obtain insights and experiences (of individuals and groups) otherwise difficult to reach and/or complex to understand.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"2 1","pages":"124 - 139"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47305529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/26320843211061306
Landon Gibson, Frederick M. Zimmerman
Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this assumption is often done either by graphical examination or by statistical tests in the pre-treatment period. They result in a binary conclusion about the validity of the assumption. Purpose. This paper proposes a sensitivity analysis that quantifies the departure from parallel trends necessary to meaningfully change the estimated treatment effect. Results. Sensitivity analyses have an advantage over traditional parallel trends tests: they use all available data and thereby work even if only one pre-period is available, and they quantify the strength of unobserved confounder(s) required to change the conclusions of a study. Conclusions. We apply the sensitivity analysis metrics developed by Cinelli and Hazlett (2020) and illustrate them on two studies.
{"title":"Measuring the sensitivity of difference-in-difference estimates to the parallel trends assumption","authors":"Landon Gibson, Frederick M. Zimmerman","doi":"10.1177/26320843211061306","DOIUrl":"https://doi.org/10.1177/26320843211061306","url":null,"abstract":"Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this assumption is often done either by graphical examination or by statistical tests in the pre-treatment period. They result in a binary conclusion about the validity of the assumption. Purpose. This paper proposes a sensitivity analysis that quantifies the departure from parallel trends necessary to meaningfully change the estimated treatment effect. Results. Sensitivity analyses have an advantage over traditional parallel trends tests: they use all available data and thereby work even if only one pre-period is available, and they quantify the strength of unobserved confounder(s) required to change the conclusions of a study. Conclusions. We apply the sensitivity analysis metrics developed by Cinelli and Hazlett (2020) and illustrate them on two studies.","PeriodicalId":74683,"journal":{"name":"Research methods in medicine & health sciences","volume":"2 1","pages":"148 - 156"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45506610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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