Should we embed randomized controlled trials within action research: arguing from a case study of telemonitoring

Area of Science:

• Health Services Research
• Clinical Trials Methodology
• Telehealth Evaluation

Background:

• Action research (AR) and randomized controlled trials (RCTs) are often viewed as incompatible research methodologies.
• This study explores the complementary potential of AR and RCTs in a telehealth context.
• A telemonitoring trial in New Zealand serves as a case study to illustrate this integration.

Purpose of the Study:

• To assess the effect of telemonitoring on patient outcomes and experiences.
• To demonstrate how action research principles can enhance randomized controlled trial design and conduct.
• To explore the integration of AR and RCTs in evaluating telehealth interventions.

Main Methods:

• A mixed-methods approach combining randomized controlled trial (RCT) and action research (AR) principles.
• Data collection involved observations, field notes, and discussions with patients, carers, healthcare professionals, and researchers.
• The study involved telemonitoring for heart failure, airways disease, and diabetes across urban and rural New Zealand settings.

Main Results:

• AR processes influenced the RCT by increasing sensitivity to clinical context and leading to design modifications.
• Co-design facilitated by AR improved the RCT's structure and technology procurement.
• The integration of AR and RCTs enhanced the evaluation of telehealth interventions.

Conclusions:

• Embedding RCTs within an AR framework can strengthen trial design and utility.
• AR characteristics can improve the evaluation of telehealth, maintaining or enhancing RCT quality.
• Research findings can be more effectively returned to practice through this integrated approach.