Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004 Mar;94(3):400-5.
doi: 10.2105/ajph.94.3.400.

Evidence-based public health: moving beyond randomized trials

Cesar G Victora  1 , Jean-Pierre Habicht, Jennifer Bryce
Affiliations

Evidence-based public health: moving beyond randomized trials

Cesar G Victora et al. Am J Public Health. 2004 Mar.

Abstract

Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other settings. However, causal chains in public health interventions are complex, making RCT results subject to effect modification in different populations. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility designs. For evaluating large-scale interventions, studies with plausibility designs are often the only feasible option and may provide valid evidence of impact. There is an urgent need to develop evaluation standards and protocols for use in circumstances where RCTs are not appropriate.

PubMed Disclaimer

Figures

FIGURE 1—
FIGURE 1—
Simplified impact model of how health worker training in nutrition counseling will lead to increased weight gain among young children in a developing country.
See this image and copyright information in PMC

Comment in

  • Moving beyond randomized controlled trials.
    Chaulk CP, Kazandjian VA. Chaulk CP, et al. Am J Public Health. 2004 Sep;94(9):1476. doi: 10.2105/ajph.94.9.1476. Am J Public Health. 2004. PMID: 15333296 Free PMC article. No abstract available.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Eriksson C. Learning and knowledge-production for public health: a review of approaches to evidence-based public health. Scand J Public Health. 2000;28:298–308. - PubMed
    1. Last JM, ed. A Dictionary of Epidemiology. 3rd ed. New York, NY: Oxford University Press; 1995.
    1. Moher DL, Schulz KF, Altman DG for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. Lancet. 2001;357:1191–1194. - PubMed
    1. Lambert SM, Markel H. Making history: Thomas Francis, Jr, MD, and the 1954 Salk Poliomyelitis Vaccine Field Trial. Arch Pediatr Adolesc Med. 2000;154:512–517. - PubMed
    1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–72. - PMC - PubMed

Publication types

LinkOut - more resources