The use of segmented regression for evaluation of an interrupted time series study involving complex intervention: the C
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The use of segmented regression for evaluation of an interrupted time series study involving complex intervention: the CaPSAI project experience Ndema Habib1 · Petrus S. Steyn1 · Victoria Boydell2 · Joanna Paula Cordero1 · My Huong Nguyen1 · Soe Soe Thwin1 · Dela Nai3 · Donat Shamba4 · James Kiarie1 on behalf of the CaPSAI Project Team Received: 20 April 2020 / Revised: 15 September 2020 / Accepted: 9 October 2020 © The Author(s) 2020
Abstract An interrupted time series with a parallel control group (ITS-CG) design is a powerful quasi-experimental design commonly used to evaluate the effectiveness of an intervention, on accelerating uptake of useful public health products, and can be used in the presence of regularly collected data. This paper illustrates how a segmented Poisson model that utilizes general estimating equations (GEE) can be used for the ITS-CG study design to evaluate the effectiveness of a complex social accountability intervention on the level and rate of uptake of modern contraception. The intervention was gradually rolled-out over time to targeted intervention communities in Ghana and Tanzania, with control communities receiving standard of care, as per national guidelines. Two ITS GEE segmented regression models are proposed for evaluating of the uptake. The first, a two-segmented model, fits the data collected during pre-intervention and post-intervention excluding that collected during intervention roll-out. The second, a three-segmented model, fits all data including that collected during the roll-out. A much simpler difference-in-difference (DID) GEE Poisson regression model is also illustrated. Mathematical formulation of both ITSsegmented Poisson models and that of the DID Poisson model, interpretation and significance of resulting regression parameters, and accounting for different sources of variation and lags in intervention effect are respectively discussed. Strengths and limitations of these models are highlighted. Segmented ITS modelling remains valuable for studying the effect of intervention interruptions whether gradual changes, over time, in the level or trend in uptake of public health practices are attributed by the introduced intervention. Trial Registration: The Australian New Zealand Clinical Trials registry. Trial registration number: ACTRN12619000378123. Trial Registration date: 11-March-2019.
Membership of the CaPSAI Project Team is provided in the Acknowledgments. * Ndema Habib [email protected] Extended author information available on the last page of the article
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Vol.:(0123456789)
Health Services and Outcomes Research Methodology
Keywords Complex intervention · Quasi-experiment · Interrupted time series · Segmented regression · Community-driven intervention · Modern contraception uptake
1 Introduction Quasi-experimental designs are widely used in public health research studies in studying causal effect especially where randomization is neither feasible nor ethical (Shadish et al. 2002; Bonell et al. 2009). An interrupted time series with a control group (I
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