Past exam of the mathematics course of the University of Cambridge / 2003 / iii / Paper 40 / 4 / a

Use individual stratified randomization within each prison, with concealed centrally generated permuted-block randomization and varying block sizes. Prison can affect both baseline risk and intervention delivery, so balancing assignments within prison protects against imbalance in that important covariate. Varying block sizes and allocation concealment prevent staff from predicting the next allocation and selecting participants accordingly. Prespecify how incomplete final blocks are treated. To enforce the overall 4000:4000 allocation exactly, coordinate the stratum totals centrally, allocating odd final places through a concealed random rule; exact half allocation within every prison is impossible if some prison totals are odd.

Individual randomization stratified by prison is preferable to randomizing only twenty whole prisons for this design. A cluster-randomized trial would have few independent units and could lose substantial precision through intraclass correlation. Sharing or selling the intervention can cause treatment contamination, so record it and retain an intention-to-treat analysis; substantial spillover might justify a separately powered cluster design rather than being ignored.