From: Making trials matter: pragmatic and explanatory trials and the problem of applicability
 | Explanatory attitude | Pragmatic attitude |
---|---|---|
Question | Efficacy: can the intervention work? | Effectiveness: does the intervention work when used in normal practice? |
Setting | Well resourced, 'ideal' setting | Normal practice |
Participants | Highly selected; poorly adherent participants and those with conditions which might dilute the effect are often excluded | Little or no selection beyond the clinical indication of interest |
Intervention | Strictly enforced and adherence is monitored closely | Applied flexibly as it would be in normal practice |
Outcomes | Often short-term surrogates, or process measures | Directly relevant to participants, funders, communities and healthcare practitioners |
Relevance to practice | Indirect: little effort is made to match the design of the trial to the decision making needs of those in the usual setting in which the intervention will be implemented | Direct: the trial is designed to meet the needs of those making decisions about treatment options in the setting in which the intervention will be implemented |