Participation in light of anticipating benefits: how can it blurry findings?

What is it about?

How somebody chooses to adhere to a specific therapy or program depends largely on anticipated results or paybacks. Our paper was motivated by Moving to Opportunity (MTO) for Fair Housing program study conducted by the US Department of Housing and Urban Development, in which volunteer low-income families were randomized to receive (or not receive) subsidized rental vouchers to move out of public housing. As in most randomized trials, adherence was not perfect; participants (predominantly single mothers) who were eligible to move decided to move or remain in their public housing appartment. The effect of moving on mental health and behavior problems of the children of the study participants showed a stark contrast depending on the gender of the child and the family vulnerabilities. Motivated by seemingly contradictory results from the MTO, we assess, tease out and break-down the results based on these parents willingness to move to demonstrate how the pernicious bias resulting from participants' decision to adhere to a study protocol can cloud the results and lead to their misinterpretation.

Featured Image

Why is it important?

When a treatment has a heterogeneous effect and participants have the option to choose treatment options perceived as being of greatest benefit to them, the intent-to-treat analysis may lead to spurious results and erroneous interpretations.

Perspectives