Evaluating Public Health Interventions

2. Stepping Up to Routine Public Health Evaluation With the Stepped Wedge Design

Bibliographic Data

ID11040256
AuthorsDonna Spiegelman (0000-0003-4006-4650, Donna Spiegelman is with the Departments of Epidemiology, Biostatistics, Nutrition, and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA (e-mail: ). Reprints can be ordered at by clicking the “Reprints” link., corresponding author)
Year2016
Volume106
Issue3
Pages453-457
Publication date2016-03-01
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2016.303068
PMID26885961
OpenAlexW2281196633
LanguageEN
Citations received4
References cited19

In a stepped wedge design (SWD), an intervention is rolled out in a staggered manner over time, in groups of experimental units, so that by the end, all units experience the intervention. For example, in the MaxART study, the date at which to offer universal antiretroviral therapy to otherwise ineligible clients is being randomly assigned in nine “steps” of four months duration so that after three years, all 14 facilities in northern and central Swaziland will be offering early treatment. In the common alternative, the cluster randomized trial (CRT), experimental units are randomly allocated on a single common start date to the interventions to be compared. Often, the SWD is more feasible than the CRT, both for practical and ethical reasons, but takes longer to complete. The SWD permits both within- and between- unit comparisons, while the CRT only allows between-unit comparisons. Thus, confounding bias with respect to time-invariant factors tends to be lower in an SWD than a CRT, but the SWD cannot as readily control for confounding by time-varying factors. SWDs have generally more statistical power than CRTs, especially as the intraunit correlation and the number of participants within unit increases. Software for both designs are available, although for a more limited set of SWD scenarios

Cluster randomised controlled trial · Confounding · CRTS · Intervention (counseling) · Psychological intervention · Public health · Public health interventions · Randomized controlled trial · Research design · Statistical power · Statistics · Unit (ring theory) · Advanced Causal Inference Techniques · Computer Science · Health Systems, Economic Evaluations, Quality of Life · HIV/AIDS Research and Interventions · Mathematics · Medicine · Nursing · Psychology

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