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Myth: Evidence-based healthcare treatments are automatically transferable to specific situations

Myth: Evidence-based healthcare treatments are automatically transferable to specific situations

Photographer:Fotograaf: Joey Roberts

Myth busters

How to decide which treatment, prevention programme or health policy to choose? For many doctors and policymakers the answer seems simple. You look at high-quality scientific studies and take the intervention that has proven to be the most effective. “This has its origins in medicine”, says Tamara Schloemer, researcher at the Department of International Health. “But when it comes to more complex healthcare interventions, there are many factors that may influence their effectiveness. Every experiment has its own design and participants – it’s been run in a very specific context. People’s belief in evidence-based interventions sometimes makes them forget they are not automatically transferable.”

One example is a substance-abuse programme for high schoolers in the US. “The trial data showed it was very effective, so it was recommended by the US Department of Health and Human Services and the National Institute on Drug Abuse. But when it was implemented in high schools in the real world, the programme did more harm than good. The target group – youngsters with a high risk of becoming substance abusers – took less part in the social activities and bonded more with other high-risk peers. Exactly the opposite of what they wanted to achieve.”

How does such a thing happen? In this case, as in many, the answer is unknown. “Very little research has been done on the question of why an intervention is successful or unsuccessful in a specific context. Most researchers mention transferability in a few sentences at the end of their study. But they don’t give you any clues as to how you could make it transferable or which elements you may have to be careful with when implementing the intervention, whereas this information could be very helpful”, Schloemer says. “There can be many reasons why something that works well in one context doesn’t work at all in another. The people may differ in terms of age, socioeconomic status, attitudes towards the topic. Take mandatory vaccinations for children. In some countries that might lead to protests and demonstrations, in others people will accept it without question. Some people will respond well to an information campaign, others to fines if they don’t vaccinate their children. You also have to take the environment into account: how is the healthcare system organised and financed? Will parents have to pay for the vaccinations themselves or will their insurance cover it? Are health workers able to perform the vaccinations or is extra knowledge necessary?”

Schloemer is calling on decision makers not only to analyse these factors after an intervention has been implemented, but also to take them into account beforehand. To make this easier she and her colleague Peter Schröder-Bäck have designed a model which can help people decide what criteria are important. “Of course you can never know all the factors; you can only be sure if it works after you’ve evaluated the intervention in a specific context. But hopefully this will help people to make more precise predictions and decide which elements to take into account to improve their chances of success.”

Mythbusters is a series in which academics shoot down popular myths on complex topics

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