Evidence-Based Public Health: Moving Beyond Randomized Trials

Victora, Cesar G.; Habicht, Jean-Pierre; Bryce, Jennifer

doi:10.2105/ajph.94.3.400

Cited by 1,056Advanced Causal Inference TechniquesEvaluation and Performance AssessmentStatistical Methods in Epidemiology

Evidence-Based Public Health: Moving Beyond Randomized Trials

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Victora, Cesar G., Habicht, Jean-Pierre, Bryce, Jennifer·2004·American Journal of Public Health

DOI 10.2105/ajph.94.3.400PMC PMC1448265

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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.

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RCTs are not always appropriate nor sufficient to address complex and multifaceted problems.
“For example, in several fields such as public health, RCTs are not always appropriate nor sufficient to address complex and multifaceted problems [3].”
From Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence (2017) · cites this paper as [3]

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Authors: Victora, C. G., Habicht, J.-P., & Bryce, J.
Affiliations: Universidade Federal de Pelotas (BR)
ORCID: Victora, Cesar G.
Habicht, Jean-Pierre
Venue: American Journal of Public Health
Publisher: American Public Health Association
Published: 2004-03
Volume: 94
Issue: 3
Pages: 400-405
ISSN: 0090-0036 (ISSN-L)
1541-0048
DOI: 10.2105/ajph.94.3.400
PMC: PMC1448265
OpenAlex: W1984963575
Cited by: 1,056
References: 28
Citations by year: 2026: 19 · 2025: 26 · 2024: 41 · 2023: 41 · 2022: 27 · 2021: 40 · 2020: 43 · 2019: 50 · 2018: 46 · 2017: 52 · 2016: 53 · 2015: 65 · 2014: 55 · 2013: 62 · 2012: 42
FWCI: 49.97
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Public Health (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Keywords: evidence-based public health, randomized controlled trials, observational studies, causal inference, effect modification, generalizability, internal validity, large-scale interventions, evaluation standards, public health intervention evaluation
MeSH terms: Decision Making, Humans, Reproducibility of Results, Epidemiologic Research Design, Public Health Practice, Causality, Effect Modifier, Epidemiologic, Randomized Controlled Trials as Topic, Evidence-Based Medicine

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Evidence-Based Public Health: Moving Beyond Randomized Trials

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