Exploratory randomized controlled trial evaluating the impact of a waiting list control design
Open accessAbstract
BACKGROUND: Employing waiting list control designs in psychological and behavioral intervention research may artificially inflate intervention effect estimates. This exploratory randomized controlled trial tested this proposition in a study employing a brief intervention for problem drinkers, one domain of research in which waiting list control designs are used. METHODS: All participants (N = 185) were provided with brief personalized feedback intervention materials after being randomly allocated either to be told that they were in the intervention condition and that this was the intervention or to be told that they were in the waiting list control condition and that they would receive access to the intervention in four weeks with this information provided in the meantime. RESULTS: A total of 157 participants (85%) were followed-up after 4 weeks. Between-group differences were found in one of four outcomes (proportion within safe drinking guidelines). An interaction was identified between experimental manipulation and stage of change at study entry such that participant change was arrested among those more ready to change and told they were on the waiting list. CONCLUSIONS: Trials with waiting list control conditions may overestimate treatment effects, though the extent of any such bias appears likely to vary between study populations. Arguably they should only be used where this threat to valid inference has been carefully assessed.
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The literature reports growing concerns over the use of waitlist style control groups in psychotherapy research, as the outcomes of the interventions may be over-estimated with this type of control.
“The literature reports growing concerns over the use of waitlist style control groups in psychotherapy research, as the outcomes of the interventions may be over-estimated with this type of control.64”
From Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. (2023) · cites this paper as [64]
Intervention outcomes should be interpreted with caution because of the potential for overestimation of effect sizes when a waitlist comparison group is used in behavior change research.
“Intervention outcomes should also be interpreted with caution because of the potential for overestimation of effect sizes when a waitlist comparison group is used in behavior change research [106].”
From Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial (2023) · cites this paper as [106]
Previous research suggests that waitlist participants' expectations of receiving support at a later time could hinder the self-driven behavior change that they might otherwise have made during the same period.
“previous research suggests that waitlist participants’ expectations of receiving support at a later time could hinder the self-driven behavior change that they might otherwise have made during the same period [106].”
From Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial (2023) · cites this paper as [106]
Waitlist designs may overestimate intervention effects.
“it has been noted that such designs may overestimate intervention effects [84].”
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“While there are ethical advantages to a waitlist design because it allows for the provision of care to research participants who are seeking help whilst permitting a non-intervention evaluation, specially in a non-clinical population as ours, it has been noted that such designs may overestimate intervention effects [8…”
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- Authors
- Cunningham, J. A., Kypri, K., & McCambridge, J.
- Affiliations
- Australian National University (AU)
- University of Newcastle Australia (AU)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Cunningham, John A
- Venue
- BMC Medical Research Methodology
- Published
- 2013-12
- Volume
- 13
- Issue
- 1
- Pages
- 150-150
- ISSN
- 1471-2288 (ISSN-L)
- PMC
- PMC4029562
- OpenAlex
- W2132268984
- Cited by
- 321
- References
- 40
- Citations by year
- 2026: 18 · 2025: 29 · 2024: 35 · 2023: 41 · 2022: 42 · 2021: 37 · 2020: 33 · 2019: 28 · 2018: 15 · 2017: 17 · 2016: 11 · 2015: 5 · 2014: 10
- FWCI
- 7.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Research Methodology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Wellcome Trust (WT086516MA)
- Medical Research Council
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- overestimation of treatment effects, brief intervention, problem drinking, personalized feedback, stages of change, alcohol consumption, drinking guidelines
- MeSH terms
- Adult, Alcohol Drinking, Behavior Therapy, Female, Humans, Male, Middle Aged, Research Design, Waiting Lists, Bias, Alcohol-Related Disorders
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