192 Chapter 6 THE CHALLENGE OF DATA LINKAGE Even when data to evaluate the natural experiment are available, a complex factor is creating the database that includes all information needed. Linking datasets has been emphasised as an important aspect to foster the evaluation of natural experiments [7]. Even though databanks with linked administrative datasets are increasingly becoming available for entire countries or regions, some regions lack reliable data. Large secondary databases provide excellent opportunities to evaluate natural experiments based on already collected data, as long as researchers are sufficiently aware of their potential. Training on secondary data as formal part of research education might increase the opportunities for natural experiments evaluation. In absence of databanks, datasets need to be linked on a one-by-one basis. Informed consents – especially those that have been signed years ago – are often not designed to accommodate the linkage of datasets for the retrospective evaluation of natural experiments. Existing ethical and regulatory frameworks for sharing and processing personal data are sometimes subject for debate, making the alignment of different stakeholders a main barrier to proceed. Researchers need support by their own institutions to create multidisciplinary teams in which persons from various backgrounds (e.g. legal officers, policymakers, practitioners, researchers) jointly facilitate the timely linkage of databases within ethical and regulatory frameworks. EMBRACING NATURAL EXPERIMENTS IN PUBLIC HEALTH Natural experiments provide unique opportunities to strengthen the evidence base. To increase their adoption in public health, it is essential to improve the understanding of studies based on natural experiments. Over the years, we have received disappointing reviewer comments when submitting evaluations of natural experiments to public health journals. Some of the misunderstanding may result from different ways of conceptualising natural experiments [5]. Given the tendency in some journals to consider scientific rigor and associated uncertainties as more important than implications for professional practice, as well as the strict criteria for the use of causal language solely allowed for RCTs [8], means that the continuum of evidence from associations to causal conclusions is being ignored. Interdisciplinary research can be one way to learn from methodologies used by researchers in other fields [9]. Training of public health professionals, non-academic stakeholders, funders, and policymakers to understand the value and specificities of natural experiments is likely needed to increase the use of these evaluation strategies. At last, we would like to draw attention to the career perspectives of researchers working on projects that capitalise on natural experiments. In a system where publications are still key to obtain new research funding and academic positions, evaluating small-scale interventions or conducting descriptive research might provide a more secure route to progress in academia [4]. This may pose a serious risk that the existing “evaluative bias” will
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