Archived: Beyond RCTs: why public health research must address the real issues

Many important questions in public health remain unanswered due to the research community’s preoccupation with randomised controlled trials (RCTs), a seminar has heard.

Professor Don Nutbeam, Professor of Public Health at the University of Sydney and former head of public health in the UK Department of Health, called for a more thoughtful view of what constitutes rigorous research to inform policy decisions.

Professor Don Nutbeam
Professor Don Nutbeam

“Many research questions in public health remain unanswered due to the insidious nature of the prevailing evaluation research paradigm. We are learning more and more about less and less,” he said.

“Policy makers have to make decisions based on what’s available to them at the time. We have to find the best way of corralling the best information with the highest possible level of rigour.”

Professor Nutbeam, who is also advisor to the Sax Institute, was a panellist at the Prevention Centre seminar ‘Physical activity for public health: in pursuit of rigorous evaluation in the real world’, co-organised by the Prevention Centre, the Prevention Research Collaboration and the Sax Institute.

Keynote speaker Dr David Ogilvie, leader of the MRC Epidemiology Unit’s physical activity and public health research program at the University of Cambridge, said there was not enough evidence about the most effective strategies to guide public health investment because it was difficult to obtain rigorous scientific results in complex real world settings.

Attention was often focused on evaluating certain types of intervention, because they were easier to research. But evidence concerning the larger questions of changing social or environmental influences on behaviour patterns was often missing, he said.

“There is an evaluative bias – attention has been focused on what’s easier to evaluate but that’s not necessarily what’s important,” he said.

What’s missing is evidence about true population level strategies – there is a lack of clear evidence for many things that seemed to be a good idea at the time.”

While rigour should be considered first, methodology should be tailored according to the research question, the panel agreed.

Our studies are trying to steer a course between the expectation that you have to do a randomised controlled trial, and studies that are so pragmatic and local that you cannot build generalisable inferences from them,” Dr Ogilvie said.