On May 12-17 2019, the IBTN held its first French Summer School, with IBTN co-lead Dr. Kim Lavoie as academic leader. In total, 26 participants, ranging from from Master’s students to new investigators, attended the Summer School. Montreal Behavioural Medicine Centre students Anda Dragomir (Ph.D. student), Claudia Gemme (Ph.D. student), Vincent Gosselin Boucher (Ph.D. student), Sara Labbé (Ph.D. student), Florent Larue (medical resident and Master’s student), and Li Anne Mercier (Ph.D. student) report on their experience.
The IBTN summer school week kicked off with a presentation of different models that can be used for the development of individual- and population-level interventions, as well as the importance of judiciously choosing a comparison group. Dr. Kim Lavoie’s presentation addressed the necessity of using a theoretical model as basis of any behavioural intervention and of evaluating the fidelity of the delivered intervention (with tools such as the CONSORT). A solid theoretical model should be the foundation of all methodological decisions made by investigators during the planning and delivery of the trial.
Such practices lead to a greater uniformity across trials, to a standardization of practices, and to an increased comparability and reproducibility of the results that are obtained, thereby facilitating peer reviewing. Ultimately, these practices increase the quality of behavioural trials. We have to stop believing that common sense is enough.
Moreover, it is essential to evaluate intervention fidelity, intervention provider fidelity, as well as participant fidelity, which are often overlooked in reporting. The importance of choosing adequate measures and methods of fidelity evaluation is major. Indeed, each step should be planned thoroughly prior to starting trials, and researchers have to ensure that they have effectively measured what they aimed to measure in the first place.
Dr. Angela Alberga, Ms. Annick Gauthier, patient-researcher, and Dr. Audrey L’Espérance presented on the fundamental principles of patient-oriented research. This type of research considers that chronic disease constitutes a full-time job in itself, and that patients are experts of their own health. The group discussed the needs related to the inclusion of patients and other stakeholders in research projects in order to create a sustainable partnership between investigators and patients in a healthcare and chronic disease management context.
Dr. Simon Bacon’s presentation covered the delivery and evaluation of pragmatic trials. Pragmatism cannot be conceptualised as a dichotomy: the pragmatism level of any trial is situated along a continuum. A trial that is more pragmatic would propose methods that are closer to real-life settings, thereby closer to actual efficacy, by reaching a balance between internal and external validity. The PRECIS-2 evaluation grid was presented as a tool to measure the level of pragmatism of various behavioural trials. This tool is helpful in situating where a trial stands on different scales (e.g.: recruitment, admissibility, etc.), and in recognizing its pragmatism level in comparison to natural conditions.
Tools such as PRISMA, used to standardize the conduct and reporting of meta-analyses and systematic reviews, were presented. Since a multiplicity of tools exists for the reporting of results, it is challenging to be explicit when recovering articles from databases for a meta-analysis. It is therefore important to describe precisely all interventions, using tools such as the PICO statement.
The importance of choosing adequate outcome measures was presented by Dr. Jean Bourbeau, MD. He discussed the steps leading to the selection of outcome measures for behaviour change interventions, and the variety of possible options. Dr. Justin Presseau closed the summer school week with a presentation on implementation science. It is problematic that 30 to 40% of patients do not receive the best evidence-based care. Dr. Presseau addressed a few avenues for reflection and several solutions while highlighting that the dissemination of research results should be planned from the beginning of the process. The implementation of research results is indispensable for the translation of trial results into healthcare provider practices. Proving that a behavioural intervention is efficient is not a sufficient condition to ensure its implementation.
Throughout the week, students worked in teams towards the elaboration of a fictive behavioural intervention protocol with the objective of presenting it to the larger group on the last day of the summer school. This exercise provided the opportunity for all participants to have a glimpse of the teamwork that leads to a grant proposal submission.
This experience allowed students to acknowledge the rise of health-related behavioral interventions, but also the lack of methodological rigor and homogeneity by researchers in the field when developing, conducting and reporting on trials. These limitations call for improvements on theoretical and practical levels. One of the take-home messages is the following: As researchers, it is important to adapt and improve our research practices according to new methods and technologies, for example by involving stakeholders from the beginning of the intervention development process.
The next IBTN Summer School will be held on May 24-30, 2020!