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QUASI EXPERIMENTAL

Department of Pharmacology and Toxicology


Gadjah Mada University

Nonrandom assignment in experiments

unethical
Impractical
Alasan:

Very expensive
Interest in intact groups

Perlu strategi/metode untuk mengantisipasi tidak


dapat dilakukannya random assignment.

Pendahuluan

Pada penelitian sosial

fenomena tidak
harus dibandingkan

tidak harus
ada kontrol

randomisasi sulit dilakukan

Pendahuluan:

Penelitian di laboratorium
pengamatan
pengamatan efek
efek tidak
tidak selalu
selalu harus
harus
dibandingkan
dibandingkan (preliminary)
(preliminary)
keterbatasan
keterbatasan scope
scope yang
yang diteliti
diteliti
randomisasi
randomisasi sulit
sulit dilakukan
dilakukan
aklimatisasi
aklimatisasi diasumsikan
diasumsikan telah
telah
mengendalikan
mengendalikan confounder
confounder

Randomisasi?
Randomisasi?
Blinding?
Blinding?
Inclusion
Inclusion criteria?
criteria?
Heterogeneity?
Heterogeneity?
Homogeneity?
Homogeneity?

External validity?
Ekstrapolasi?

Keterbatasan Quasi Experimental


Tidak dapat digunakan untuk menguji
hipotesis causal
Sulit untuk ekstrapolasi atau
generalisabilty
Tidak menggambarkan true value
Tidak dapat menyingkirkan confounder

Notasi
X
= treatment
O
= observasi
-------- = non randomised

Design quasi experimental yang tidak memungkinkan


causal inferences

1. One group
posttest only design

3. One group
pretest-posttest design

2. Posttest only design


with non-equivalent group

1. One group posttest only design


Design:

Tanpa pretest observation


Tanpa kelompok kontrol
Kapan dilakukan?

1. Pemberian pengobatan
2. Evaluasi hasil pendidikan
3. Environmental toxicology

2. Posttest only design with non-equivalent group

Design:

O
O

Tanpa pretest observation


Efek treatment vs. selection effect
non ekuivalen
Kapan dilakukan?
progress suatu treatment tidak bersamaan

Contoh:
X 12

X9

X6
X0

O
O

Mengamati hasil counseling 12 bulan, 9 bulan,


6 bulan, dan tanpa counseling

3. The One-Group Pretest-Posttest design

Design:

O1

O2

Pada satu kelompok


Disertai pretest observation
Apa kelemahannya ?

Contoh:
efek supervisi

The One-Group Pretest-Posttest design

O1

Kelemahan

History (kenaikan gaji, perubahan policy)


Regresi (produktivitas kerja)
Spurious
Efek maturasi (lebih skillful)

O2

1. The untreated control group design


with pretest & posttest

Design:

O1
O1

Masalah:

O2
O2

Selection maturation
Instrumentation
differential statistical regression
interaction of selection and history

Populasi-2

Proportion blood
pressure and /or lipid
lowering drug use
intervention

Proportion blood
pressure and / or lipid
lowering drug use

Populasi-1

Proportion blood pressure


and /or lipid lowering
drug use
No intervention
intervention

Proportion blood
pressure and /or lipid
lowering drug use

Atthobari, et al. Br. J. Clin. Pharm. 2003; 57(3):328-336

OUTCOME 1

O1

O1

treatment

control

Pretest

Posttest

O2
O2

Experiment

Atthobari, et al. Br. J. Clin. Pharm. 2004; 57(3):328-336

Control

O1

OUTCOME 2

O1

O2
O2

Terdapat pola selection-maturation interaction

treatment

control

Pretest

Posttest

Contoh: memberikan pendidikan ekstra pada anak yg. > pandai

O1

OUTCOME 3

O1

O2
O2

treatment
control

Pretest

Posttest

O1

OUTCOME 4

O1

O2
O2

control
treatment

Pretest

Posttest

Contoh: insentif extra untuk meningkatkan performance

O1

OUTCOME 5

O1

O2
O2

treatment

control

Pretest

Posttest

Contoh: intervensi pada paramedik vs. dokter

Threats to internal validity


1. history
2. maturation
3. testing
4. instrumentation
5. statistical regression
6. differential selection of participants
7. mortality
8. selection-maturation interaction

1. history

the occurrence of events that are


not part of the experimental
treatment but that occur during the
study and affect the dependent
variable

Peningkatan LLD pada pasien yang di screening


0.3

Cumulative incidence

Lipid Lowering Drugs (LLD)

0.2

0.1

History:
anothe
r study

Unscreened cohort
Screened aselect cohort
Screened enriched cohort

0.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Follow up (years)

Atthobari, et al. Br. J. Clin. Pharm. 2007, in press

2. maturation
the physical, intellectual, and
emotional changes that occur
naturally in a studys participants
over a period of time

Apakah training mampu meningkatkan clinical skilss


dokter baru?
90
80

Mean adherence

70
60
50
40
30
20
10
0
Pre

Post

Maturation threat:
Clinical Skills improves as physician naturally mature over the
year.
Can you conclude that the training was effective?

3. testing
refers to improved scores on a
posttest as a result of having
taken a pretest

Apakah training mempengaruhi kecepatan dokter


dalam menegakkan diagnosis?
14
12

Minutes (Mean)

10
8
6
4
2
0
pre

post

Testing threat:
If similar problems are used in the pretest and posttest, faster problem solving may be
due to familiarity with the diagnosis
Can we conclude that teaching the new technique improves diagnostic skill?

4. instrumentation
the unreliability or lack of consistency in
measuring instruments that can result in
an invalid assessment of performance

Apakah program KB menurunkan angka kelahiran bayi?


50
45

Reports of Rape

40
35
30
25
20
15
10
5
0
1

Month

Instrumentation threat:
Pada saat yang bersamaan, perekonomian sangat
memburuk, daya beli masyarakat rendah, kemampuan
ekonomi masyarakat rendah

5. statistical regression
the tendency of participants who score
highest on a test to score lower on a
second, similar test and vice versa

Test Scores (Mean)

Terapi obat X terhadap tekanan darah


100
90
80
70
60
50
40
30
20
10
0
Pre

Post

Regression threat:
Alat evaluasi post test tidak reliabel untuk mengukur penurunan
tekana darah, akibatnya terjadi regress to the mean
Can we conclude the drug X is effective?

6. differential selection of participants


the outcome when already formed
groups are compared raising the
possibility that the groups were different
before a study even begins

70

Tidak sembuh

Sembuh

60
50
%

40
30
20
10
0

Terapi A

Terapi B

Hasil berbeda lebih disebabkan oleh perbedaan


karakteristik pada 2 kelompok

7. mortality

the case in which participants drop out


of a study which changes the
characteristics of the groups and may
significantly affect the studys results

70

Tidak sembuh

Sembuh

60
50
%

40
30
20
10
0
Terapi A

Terapi B

Hasil berbeda karena angka drop out pada salah


satu kelompok lebih tinggi drpd kelompok yang lain

8. selection-maturation interaction
if already-formed groups are used in a
study, one group may profit more (or
less) from a treatment or have an initial
advantage because of maturation,
history, or testing factors

Proxy Pretest Design


N
N

O1
O1

O2
O2

pretest based on recollection or archived


data
useful when you werent able to get a
pretest but wanted to address gain

Contoh: Tujuan studi: mengetahui efek suatu


program terhadap peningkatan kepuasan
pasien di UGD

Program sudah berjalan


Kita bisa mendapatkan nilai post test,
tetapi tidak memiliki nilai pre test.
Kita perlu mencari proxy variable yang
kira-kira dapat digunakan untuk estimasi
pre test.
Sebagai contoh: gunakan nilai pretest
pasien di kamar bersalin sebagai proxy
pretest.

Separate Pre-Post Samples


N1
N1
N2
N2

O
X

O
O

Groups with the same subscript come from the


same context
here, N1 might be people who were in the
program at Agency 1 last year, with those in N2 at
Agency 2 last year
This is like having a proxy pretest on a different
group

Separate Pre-Post Samples

N
N

R1
R1
R2
R2

O
X

O
O

take random samples at two times of people at


two nonequivalent agencies
useful when we routinely measure with surveys
can assume that the pre and post samples are
equivalent but the two agencies may not be

Contoh: tujuan penelitian adalah meningkatkan


kepuasan pasien di 2 rumah sakit
Pasien berganti-ganti dari waktu ke waktu, kita
tidak bisa mengukur nilai pretest untuk pasien
yang sama.
Lakukan pengukuran kepuasan pada satu saat,
kemudian implementasikan program selama
kurun waktu tertentu.
Desain ini tidak cukup kuat, karena mengukur
orang yang berbeda
Oleh sebab itu yang dilihat hanya perubahan
antara sebelum program dan setelah program.

Double Pretest Design


N
N

O
O

O
O

O
O

strong in internal validity


helps address selection-maturation
how does this affect selection-testing?

Switching Replications
N
N

O
O

O
O

O
O

strong design for both internal and


external validity
strong against social threats to internal
validity
strong ethically