Randomized Control Trials, while considered the “gold standard” of research, are exceedingly difficult to employ for prevention efforts, especially in those focused on real-world implementation. Randomization is unfeasible, if not impossible, in almost any community-level prevention effort. Time-scale is often a challenge as well, as trials are often limited to months, while prevention is more relevant over the course of years. Two alternative research models were emphasized. Several experts, including Dr. Marrero, spoke about the value of Community-Based Participatory Research, in which the community leads the process of defining research questions, goals, interventions, and more. Additionally, Dr. Bloch spoke about the need for “realistic evaluation approaches,” which aim to measure real-world efficacy and impact, to gain more credibility in the world of research regarding prevention and social interventions.
Additionally, the traditional research paradigm often leads to a critical gap between academia and real-world-implementation for prevention efforts. Collaboration among academics, entrepreneurs, and program specialists or community organizers are rare, underfunded, and unlikely to garner much interest or prestige for either party involved. Finally, research tends to look at aggregates, but for prevention research in individuals, there may be just as much, or more, to learn by examining the outliers. Dr. Polonsky drew attention to the Look AHEAD trial, which in aggregate was deemed to be an ineffective intervention. Yet Dr. Polonsky noted that a small subset of participants saw substantial and sustained weight loss. He emphasized the need to examine what, exactly, sets apart these super-performers, as well as those in other interventions.