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Krzyzanowski B, Manson SM, Eder MM, Kne L, Oldenburg N, Peterson K, Hirsch AT, Luepker RV, Duval S. Use of a Geographic Information System to create treatment groups for group-randomized community trials: The Minnesota Heart Health Program. Trials 2019; 20:185. [PMID: 30922358 PMCID: PMC6438016 DOI: 10.1186/s13063-019-3284-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background Group-randomized trials of communities often rely on the convenience of pre-existing administrative divisions, such as school district boundaries or census entities, to divide the study area into intervention and control sites. However, these boundaries may include substantial heterogeneity between regions, introducing unmeasured confounding variables. This challenge can be addressed by the creation of exchangeable intervention and control territories that are equally weighted by pertinent socio-demographic characteristics. The present study used territory design software as a novel approach to partitioning study areas for The Minnesota Heart Health Program’s “Ask about Aspirin” Initiative. Methods Twenty-four territories were created to be similar in terms of age, sex, and educational attainment, as factors known to modify aspirin use. To promote ease of intervention administration, the shape and spread of the territories were controlled. Means of the variables used in balancing the territories were assessed as well as other factors that were not used in the balancing process. Results The analysis demonstrated that demographic characteristics did not differ significantly between the intervention and control territories created by the territory design software. Conclusions The creation of exchangeable territories diminishes geographically based impact on outcomes following community interventions in group-randomized trials. The method used to identify comparable geographical units may be applied to a wide range of population-based health intervention trials. Trial registration National Institutes of Health (Clinical Trials.gov), Identifier: NCT02607917. Registered on 16 November 2015.
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Affiliation(s)
- Brittany Krzyzanowski
- Department of Geography, Environment & Society, University of Minnesota, Minneapolis, MN, USA
| | - Steven M Manson
- Department of Geography, Environment & Society, University of Minnesota, Minneapolis, MN, USA
| | - Milton Mickey Eder
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN,, USA
| | - Len Kne
- U-Spatial, Office of Vice President for Research, University of Minnesota, Minneapolis, MN, USA
| | - Niki Oldenburg
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Kevin Peterson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN,, USA
| | - Alan T Hirsch
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN,, USA
| | - Russell V Luepker
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN,, USA
| | - Sue Duval
- Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
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