TY - JOUR
T1 - Step-wedge cluster-randomised community-based trials
T2 - An application to the study of the impact of community health insurance
AU - De Allegri, Manuela
AU - Pokhrel, Subhash
AU - Becher, Heiko
AU - Dong, Hengjin
AU - Mansmann, Ulrich
AU - Kouyaté, Bocar
AU - Kynast-Wolf, Gisela
AU - Gbangou, Adjima
AU - Sanon, Mamadou
AU - Bridges, John
AU - Sauerborn, Rainer
N1 - Funding Information:
This study is supported by the collaborative research grant SFB 544 of the German Science Foundation (DFG). The study sponsor had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the manuscript, and in the decision to submit it for publication.
PY - 2008/10/22
Y1 - 2008/10/22
N2 - Background: We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI) scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness. Our exclusive focus on the description and discussion of the methods is justified by the fact that the study relies on a methodology previously applied in the field of disease control, but never in the field of health financing. Methods: First, we clarify how clusters were defined both in respect of statistical considerations and of local geographical and socio-cultural concerns. Second, we illustrate how households within clusters were sampled. Third, we expound the data collection process and the survey instruments. Finally, we outline the statistical tools to be applied to estimate the impact of CHI. Conclusion: We discuss all design choices both in relation to methodological considerations and to specific ethical and organisational concerns faced in the field. On the basis of the appraisal of our experience, we postulate that conducting relatively sophisticated trials (such as our step-wedge cluster-randomised community-based trial) aimed at generating sound public health evidence, is both feasible and valuable also in low income settings. Our work shows that if accurately designed in conjunction with local health authorities, such trials have the potential to generate sound scientific evidence and do not hinder, but at times even facilitate, the implementation of complex health interventions such as CHI.
AB - Background: We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI) scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness. Our exclusive focus on the description and discussion of the methods is justified by the fact that the study relies on a methodology previously applied in the field of disease control, but never in the field of health financing. Methods: First, we clarify how clusters were defined both in respect of statistical considerations and of local geographical and socio-cultural concerns. Second, we illustrate how households within clusters were sampled. Third, we expound the data collection process and the survey instruments. Finally, we outline the statistical tools to be applied to estimate the impact of CHI. Conclusion: We discuss all design choices both in relation to methodological considerations and to specific ethical and organisational concerns faced in the field. On the basis of the appraisal of our experience, we postulate that conducting relatively sophisticated trials (such as our step-wedge cluster-randomised community-based trial) aimed at generating sound public health evidence, is both feasible and valuable also in low income settings. Our work shows that if accurately designed in conjunction with local health authorities, such trials have the potential to generate sound scientific evidence and do not hinder, but at times even facilitate, the implementation of complex health interventions such as CHI.
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U2 - 10.1186/1478-4505-6-10
DO - 10.1186/1478-4505-6-10
M3 - Article
C2 - 18945332
AN - SCOPUS:56449109372
SN - 1478-4505
VL - 6
JO - Health Research Policy and Systems
JF - Health Research Policy and Systems
M1 - 10
ER -