论文标题

在仪器变量分析与移动干预的互动分析中界定当地平均治疗效果

Bounding the local average treatment effect in an instrumental variable analysis of engagement with a mobile intervention

论文作者

Spieker, Andrew J., Greevy, Robert A., Nelson, Lyndsay A., Mayberry, Lindsay S.

论文摘要

在随机试验中,局部平均治疗效果的估计通常需要在我们不愿排除未衡量的混杂的情况下称为排除限制的假设。在此假设下,将通过后随机变量来介导的任何益处。最近,人们对移动健康干预措施有兴趣提供医疗保健支持;这样的研究可以具有单向内容和/或双向内容,后者允许受试者以可以客观地测量主题特定级别(例如,接收响应的文本消息的比例),以一种可以客观测量的方式参与干预措施。因此,很有可能可以通过收到干预措施的内容来解释干预措施所带来的利益,并部分通过与之互动/回应。因此,当试图表征有条件的平均因果效应在随机后的参与度中,因此排除限制几乎肯定会违反。在本文中,我们提出了一种在概念上直观的灵敏度分析程序,从而引起了局部平均治疗效果的急剧界限。各种各样的仿真研究揭示了这种方法具有很好的有限样本行为,并在正确规范的灵敏度参数下恢复了局部平均治疗效果。我们将方法应用于评估2型糖尿病自我护理的文本消息传递干预措施的随机试验。

Estimation of local average treatment effects in randomized trials typically requires an assumption known as the exclusion restriction in cases where we are unwilling to rule out unmeasured confounding. Under this assumption, any benefit from treatment would be mediated through the post-randomization variable being conditioned upon, and would be directly attributable to neither the randomization itself nor its latent descendants. Recently, there has been interest in mobile health interventions to provide healthcare support; such studies can feature one-way content and/or two-way content, the latter of which allowing subjects to engage with the intervention in a way that can be objectively measured on a subject-specific level (e.g., proportion of text messages receiving a response). It is hence highly likely that a benefit achieved by the intervention could be explained in part by receipt of the intervention content and in part by engaging with/responding to it. When seeking to characterize average causal effects conditional on post-randomization engagement, the exclusion restriction is therefore all but surely violated. In this paper, we propose a conceptually intuitive sensitivity analysis procedure for this setting that gives rise to sharp bounds on local average treatment effects. A wide array of simulation studies reveal this approach to have very good finite-sample behavior and to recover local average treatment effects under correct specification of the sensitivity parameter. We apply our methodology to a randomized trial evaluating a text message-delivered intervention for Type 2 diabetes self-care.

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