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Table 1 Three exemplar trials of school-based health interventions

From: 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

Child Development Program (CDP) RCT [21, 22, 38, 39]
Timing: 1982–89
Setting and sample: three elementary schools in the intervention group and three elementary schools in the control group, in northern California.
Intervention: this aimed to “encourage pro-social behaviour by providing children with several types of experience which serve to engender a sense of community and a climate of mutual respect and concern in the classroom and school” [22] (p.149). Activities included cooperative learning, and involvement of children in rule setting, discussions and helping activities.
Outcome evaluation: this reported positive intervention effects on interview-assessed cognitive problem-solving and conflict resolution skills, increased questionnaire-reported peer acceptance, reduced loneliness and anxiety and increased observer-rated prosocial behaviours. There were no effects on questionnaire-reported measures of self-esteem, liking of school, perceived social competence or popularity.
Process evaluation: observations indicated that intervention classrooms were more likely to use strategies promoted by the intervention, particular where teachers were rated as of high competence.
Rationale for including as an example: this RCT is quite old and did not employ any qualitative research despite focusing on a social intervention. It is therefore a good case study to assess whether in practice some trials might be positivist in approach.
A Stop Smoking in Schools Trial (ASSIST) RCT [27, 31, 32]
Timing: 2001–4
Setting and sample: Twenty-nine secondary schools allocated to intervention and 30 to be controls in western England and south-east Wales.
Intervention: Secondary school-based peer education outside classrooms focused on smoking prevention.
Outcome evaluation: This reported a reduction in the prevalence of smoking in the past week overall and among those who had smoked at baseline.
Process evaluation: Quantitative and qualitative research found that teachers generally supported the intervention despite concerns about some aspects such as the possibility that students might nominate some individuals as peer educators who teachers did not see as good representatives of the school. The evaluation found that peer educators themselves tended to focus messages on information more than persuasion and primarily targeted non-smoking friends.
Rationale for including as an example: This was a trial led by one of the authors of this paper (Initials withheld for blind-reviewing) which though not explicitly realist or anti-positivist in orientation, nonetheless focused on questions of how, for whom and under what circumstances the intervention worked. It therefore offers a promising case study to assess whether or not in practice a modern trial of a social intervention has positivist tendencies.
Initiating change locally in bullying and aggression through the school environment (INCLUSIVE) RCT [24, 46, 60]
Timing: 2014–17
Setting and sample: 20 secondary schools in the intervention group and 20 secondary schools in the control group, all in south-eastern England.
Intervention: a whole-school intervention to reduce bullying, aggression via training staff in restorative practice, provision of local data and a facilitator to enable local needs-led decisions involving staff and students and a social and emotional learning curriculum.
Outcome evaluation: this evaluated effects on student questionnaire-reported bullying and aggression (primary outcomes) plus secondary outcomes including student substance use, mental and sexual health and quality of life as well as staff attendance, quality of life and burnout.
Process evaluation: ongoing quantitative and qualitative research on intervention implementation, reach, acceptability and mechanisms, and how these varied by context.
Rationale for including as an example: this was a trial involving some of the authors of this paper (initials withheld for blind-reviewing) and was explicitly realist and anti-positivist in orientation. It is therefore a good case study to assess whether trials can avoid the various tenets of positivism or whether this is unavoidable.