Plus-Deltas

• viewable at http://bit.ly/PDResponses

On review papers -- Plus: Appreciated the effort and result of the synthesis work.

• example: Providing a student a learning opportunity to write a review and present at a workshop. / Good effort. / synthesis of mixed results for primary intervention methods / Very comprehensive rapid review / Thorough coverage of the various interventions studied. I'm sure this was helpful for those who did not have the opportunity to review the papers provided in advance of the workshop. / Point form synthesis of results/finding / Good to see an overview on this topic / Comprehensive and very quick review. A number of unanswered questions remain, / Interesting topic generated good questions. / broad review / Given the vast amount of literature I appreciate that conducting a thorough review on this area is a challenge and this review briefly touched on some interesting areas. / I appreciated her attempt to summarize a very broad area in a short period of time. / Comprehensiveness

Delta: Provided questions/suggestions useful for revising the draft papers. Began to raise issues of kinds that became clear in the Six Principles/Questions responses (see below).

On keynotes: The Deltas show how much the audience was stimulated. The issues raised in the deltas could form a checklist to test whether any research agenda emerging from the workshop is dealing with difficult & cutting edge issues.

• examples: John I -- Would people agree to choose randomizations? pilot/vignette studies to evaluate feasibility of the approach? / Minimising selection bias for self-selected interventions. / Complex analysis methods alluded to, but need for new or different computational methods seemed to be dismissed or brushed aside. These methods need development before the clever data collection methods can be implemented, or co-developed. / how to integrate the study design with variables that could be effective but don't fit with experimental model (because difficult to change, not equipoise, and not individualizable) / The point about subversion - if solid observational evidence is seen as a prerequisite before moving to intervention (ethics etc), then could we only intervene on exposures that are not the main concern of the main cohort study? Or are we thinking about re-thinking the order in which we need to generate evidence, and essentially blur the line between observation and intervention? / / "what about variations in the ""exposome"" -- should these not also be candidates for assessing their effect sizes, i.e. beyond individualistic (reductionist) interventions / / given difference in errors in variables you noted between genotype and exposome, how much needs to be invested in properly characterizing the exposome -- looks to me to be seriously underestimated" /
• Clare R -- What's the state of ethical analysis around the changes to informed consent with this new design? / Just clarification of concept that all cohort are participants are effectively 'the' control group with the possibility that they might become the intervention group. / how do you address the idea of contamination among "controls". If only the intervention group is aware, what steps do you need to go to ensure there is a non-exposed group for comparison? / "would like to have heard more from latter part of presentation when time constraints /Rights and responsibilities balance very interesting / Appreciate ths focus on taking patient issues and concerns into account when designing trials. Natural experiments were not touched upon. Cohorts and the evaluation of natural experiments seems a good fit. I would also help to better address population health interventions. / Not sure whether the cmRCT paradigm would work equally well in cohorts of healthy people (as opposed with patients where there is much higher interest to uptake the experimental intervention especially if the disease is serious and incapacitating, healthy people may not see an equally convincing, apparent benefit by adopting an intervention to which they are randomized). May need to pilot this. /

On creativity session as a whole: Delta: "The objective of the activities could be more clear from the outset (what are we trying to achieve? what are we supposed to get out of each exercise?)" PT's response: Next time plan to remind participants of the framing not just verbally but with visual aid

Workshop aims: 1. formulate new approaches to health intervention research & 2. maximize investment of participants in further development and implementation This session: stimulate fresh thinking & foster connections conducive of #1 and #2.

_believing & doubting_: PT: Next time plan to sequence it: write, discuss with neighbor, share (&discuss) with table

dialogue hour: The power of compelling stories in affecting change. / I appreciated the opportunity to share ideas in the breakout group using the playing cards to stimulate thematic discussions rather than people just popping off. / I really liked how it was well organized / Opportunity to consider the purpose of OHS in broader societal context. / Great conversation and useful exchange of ideas. It was an effective way to generate dialogue. / Using the playing cards to organize our discussion. / THE DIALOGUE/CARD PART WAS VERY GOOD, MANY INTERESTING IDEAS CAME FORTH / Liked that all had the chance to contribute / People got into the swing of the turn-taking dialogue and the discussion evolved & felt worthwhile. / Liked the free writing; allowed me to think thru a half-formed issue / I appreciated the innovative approaches. It seems that an effort has been made to appeal to all types of adult learning. / "Free writing for 5 mins was excellent........ Really worked for me.... And the group I think.... / Check in and dialogue process was really good too / Did not have time to do 4 &5 sadly / Will definitely use ! / the opportunity in the first group discussion to hear the various perspectives and backgrounds / "- free writing / - group discussion and range of topics in conversation" / Organization, enthusiasm, and the creation of a safe environment for sharing ideas. / Small group discussions offer an opportunity for deeper exploration of themes raised in the presentations. The techniques provided some structure to ensure a degree of fairness for everyone who wants to speak. / I found the one hour dialogue were interesting. The different methods used for the development of the discussion was quite helpful in the development of constructive discussions. / Group session with cards. I think the free writing did help people engage / Great opportunity to share perspectives and to help form a share mental model./

PT: Suggestion 1: Given that there are scribes and the assumption that organizers (&volunteers?) will work afterwards to synthesize what has been raised, perhaps the breakout groups could use the dialogue hour process again, primed by, say, 20 minutes reviewing the delta suggestions from the keynotes, the six PQs, and the organizers' agenda for the morning. Suggestion 2: Because people were engaged when freewriting and in small group dialogue (than in the plenary format of the panel), continue to invite people to formulate in writing their contribution to an ideal research agenda [in wordprocessor or on paper before submitted to http://bit.ly/SixPQs] then share in pairs (with someone you don't know) and discuss/explain/interrogate (and perhaps revise & resubmit). (This will help participants in their ongoing work, even if they are not involved with the workshop's project afterwards.)

Six Principles or Questions

• viewable at http://bit.ly/SixPQShare

In a time-constrained first pass, the categories below were discerned by PT. Some participants had most points in one category (e.g., Objectives or Methods) and some had a mix. (Conjecture from PT: for a research agenda to enlist the participants in this workshop, it would need to make room for development in each category and for cross-challenges among them.)

• Knowledge
  • e.g., "Starting point must be full understanding of existing evidence"
• Infrastructure
  • "Build upon or leverage existing infrastructure which includes cohorts" / "Encourage collaboration across sectors and disciplines to help garner the infrastructure and support needed for large nested RCT cohorts."
• Objectives
  • "Address a significant health issue"
• Methods & conceptualization
  • "Can built environment and other contextual variables be creatively translated into experiments (as J.I. wondered)? (What exemplars are there to learn from?)"
• Audience/motivation
  • "Practitioners and policy makers (decision makers) should be involved in setting priorities" / "An honest account of the formation of OHS (and how it has not included an intervention arm) would help clarify what needs to be done to get an intervention agenda adopted and funded."
• Participants
  • "Can intervention studies be a way to empower cohort study particiants? (Passivity -> actvity)"
• Multi-dimensionality
  • "Encourage collaboration across sectors and disciplines to help garner the infrastructure and support needed for large nested RCT cohorts."
• Social health
  • "Equity concerns and impact should be built into any intervention study designs - e.g. differential impact of interventions."
• Scale
  • (pilot community projects not at scale to have power)