Are community health interventions evaluated appropriately? A review of six journals.
OBJECTIVE
To determine if Randomized Controlled Trial (RCT) methodology was used appropriately in community health, we: (1) determined the proportion of non-randomized studies that should have been RCTs, and (2) assessed the quality of the RCTs.


METHODS
The 1992 issues of six community health journals were manually searched. Intervention studies were analyzed. Studies that did not use randomization were analyzed for feasibility and practicality of RCT methods; RCTs were analyzed for quality using a checklist. RCTs were compared with community health RCTs from The New England Journal of Medicine. The proportion of studies meeting each criterion was determined.


RESULTS
Fourteen percent of 603 studies were interventions and 4% were RCTs. Of those not using randomization, 42% should have. Mean RCT scores were significantly lower for the community health journals than for The New England Journal of Medicine. Many criteria important to quality scored poorly.


CONCLUSIONS
RCTs are underused and lack methodologic rigor in community health. Conclusions regarding the effectiveness of interventions are therefore suspect.
Smith
P J
PJ
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Moffatt
M E
ME
Gelskey
S C
SC
Hudson
S
S
Kaita
K
K
D003154:Community Medicine; D005069:Evaluation Studies as Topic; D006801:Humans; D016239:MEDLINE; D010506:Periodicals as Topic; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000706:statistics & numerical data; D012107:Research Design / Q000592:standards*