Are randomised controlled trials positivist? Reviewing the social science and philosophy literature to assess positivist tendencies of trials of social interventions in public health and health services

Bonell, C., Moore, G., Warren, E. and Moore, L. (2018) Are randomised controlled trials positivist? Reviewing the social science and philosophy literature to assess positivist tendencies of trials of social interventions in public health and health services. Trials, 19(1), 238. (doi:10.1186/s13063-018-2589-4) (PMID:29673378) (PMCID:PMC5907717)

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Abstract

Background: We have previously proposed that trials of social interventions can be done within a ‘realist’ research paradigm. Critics have countered that such trials are irredeemably positivist and asked us to explain our philosophical position. Methods: We set out to explore what is meant by positivism and whether trials adhere to its tenets (of necessity or in practice) via a narrative literature review of social science and philosophical discussions of positivism, and of the trials literature and three case studies of trials. Results: The philosophical literature described positivism as asserting: 1) the epistemic primacy of sensory information; 2) the requirement that theoretical terms equate with empirical terms; 3) the aim of developing universal laws; and 4) the unity of method between natural and social sciences. Regarding 1), it seems that rather than embodying the epistemic primacy of sensory data, RCTs of social interventions in health embrace an anti-positivist approach aiming to test hypotheses derived deductively from prior theory. Considering 2), while some RCTs of social interventions appear to limit theorization to concepts with empirical analogues, others examine interventions underpinned by theories engaging with mechanisms and contextual contingencies not all of which can be measured. Regarding 3), while some trialists and reviewers in the health field do limit their role to estimating statistical trends as a mechanistic form of generalization, this is not an inevitable feature of RCT-based research. Trials of social interventions can instead aim to generalize at the level of theory which specifies how mechanisms are contingent on context. In terms of 4), while RCTs are used to examine biomedical as well as social interventions in health, RCTs of social interventions are often distinctive in using qualitative analyses of data on participant accounts to examine questions of meaning and agency not pursued in the natural sciences. Conclusion: We conclude that the most appropriate paradigm for RCTs of social interventions is realism not positivism.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Moore, Professor Laurence
Authors: Bonell, C., Moore, G., Warren, E., and Moore, L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:Trials
Publisher:BioMed Central
ISSN:1745-6215
ISSN (Online):1745-6215
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Trials 19(1):238
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727661SPHSU Core Renewal: Complexity in Health Improvement Research ProgrammeLaurence MooreMedical Research Council (MRC)MC_UU_12017/14IHW - MRC/CSO SPHU