There is nothing like having real data when you are learning a new computer programme. Similarly, having a real research problem to grapple with can help in finding out how useful is a book like this. This book demonstrates the wealth of methodological expertise within the sexual health field. It sets out to explore philosophical, ethical, and methodological issues about randomized trials of sexual health interventions, beginning with a debate about the appropriateness of randomization in this field. The outcome is a foregone conclusion. Susan Kippax's anti-trial opinion had been described as recklessly arrogant in Iain Chalmers foreword and her arguments knocked down one by one in the first chapter, before she even had a chance to state them. Nevertheless, her chapter should be read by pro trialists because it helps to understand the concerns, not just of academics but perhaps of potential study participants.
The next part of the book is the how to do it section, with a series of methodological chapters about issues surrounding cluster trials, development of complex interventions, and different types of randomization and outcome measures. These chapters, written by trialists, tended to use case studies of their own trials to illustrate their point. This is an advantage in many waysan insight into how successful investigators chose their clusters, or behavioural or process outcomes, for example. Unfortunately, the same trials were promoted in different chapters, suggesting that these were the only well-conducted trials in existence. Perhaps they are but I would have appreciated a more critical approach such as that used in the chapters on biological, behavioural, and psychological outcome measures and randomization methods.
The final section covers a range of issues related to the generalizability and implementation of trial results. A single chapter covering generalizability, cost-effectiveness, computer modelling, translation of research into practice, and sustainability diminished the importance of these issues and would have been better split up into more manageable sections. The case study here was the Mwanza trial, which ran out of steam halfway through translating policy into practice. Here, a contribution from an expert in programme management could have introduced a more objective analysis of this area.
A major strength of the book is its international scope. The sexual health interventions in Tanzania and Uganda are some of the best conducted complex interventions in any subject area in the world. There are areas that could have been dealt with in greater detail. In particular a specific chapter on ethical issues would have given a more coherent picture. Further consideration of surrogate markers and the relationship between behavioural and biological outcomes would also be valuable.
The book did help me write my grant proposal. It should now become required reading for those planning or seeking funding for complex sexual health interventions.