Are community health interventions evaluated appropriately? A review of six journals

J Clin Epidemiol. 1997 Feb;50(2):137-46. doi: 10.1016/s0895-4356(96)00338-1.


Objectives: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Medicine*
  • Evaluation Studies as Topic
  • Humans
  • Periodicals as Topic
  • Randomized Controlled Trials as Topic* / standards
  • Randomized Controlled Trials as Topic* / statistics & numerical data
  • Research Design / standards*