The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector , and on serological dengue virus infection and self-reported dengue cases .
One reason for doing r and omised controlled trials ( RCTs ) is that experiments can be convincing .
Early epidemiological experimenters , such as Jenner and the smallpox vaccine and Snow and his famous Broad Street pump h and le , already knew the answer they were demonstrating ; they used the experiments as knowledge translation devices to convince others .
More sophisticated modern experiments include cluster r and omised controlled trials ( C RCTs ) for experiments in the public health setting .
Those who are convinced by a trial and want to act , need to know how the trial relates to their own context , what contributed to success , and what might make it even more effective .
Community-led trials: Intervention co-design in a cluster randomised controlled trial
In conventional r and omised controlled trials ( RCTs ) , research ers design the interventions . In the Camino Verde trial , each intervention community design ed its own programmes to prevent dengue . Instead of fixed actions or menus of activities to choose from , the trial r and omised clusters to a participatory research protocol that began with sharing and discussing evidence from a local survey , going on to local authors hip of the action plan for vector control . Adding equitable stakeholder engagement to RCT infrastructure anchors the research culturally , making it more meaningful to stakeholders . Replicability in other conditions is straightforward , since all intervention clusters used the same engagement protocol to discuss and to mobilize for dengue prevention . The ethical codes associated with RCTs play out differently in community-led pragmatic trials , where communities essentially choose what they want to do . Several discussion groups in each intervention community produced multiple plans for prevention , recognising different time lines . Some chose fast turnarounds , like elimination of breeding sites , and some chose longer term actions like garbage disposal and improving water supplies . A big part of the skill set for community-led trials is being able to st and back and simply support communities in what they want to do and how they want to do it , something that does not come naturally to many vector control programs or to RCT research ers . Unexpected negative outcomes can come from the turbulence implicit in participatory research . One example was the  gender dynamic  in the Mexican arm of the Camino Verde trial . Strong involvement of women in dengue control activities seems to have discouraged men in setting s where activity in public spaces or outside of the home would ordinarily be considered a “ male competence”.Community-led trials address the tension between one-size-fits-all programme interventions and local needs . Whatever the conventional wisdom about how prevention works at a system level , programmes have to be perceived as locally relevant and they must engage stakeholders who make them work . Locally , each participating community has to know the intervention is relevant to them ; they have to want to do it . That happens much more easily if they design the programme themselves
The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector , and on serological dengue virus infection and self-reported dengue cases .
One reason for doing r and omised controlled trials ( RCTs ) is that experiments can be convincing .
Early epidemiological experimenters , such as Jenner and the smallpox vaccine and Snow and his famous Broad Street pump h and le , already knew the answer they were demonstrating ; they used the experiments as knowledge translation devices to convince others .
More sophisticated modern experiments include cluster r and omised controlled trials ( C RCTs ) for experiments in the public health setting .
Those who are convinced by a trial and want to act , need to know how the trial relates to their own context , what contributed to success , and what might make it even more effective .