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. 2006 Jan-Feb;13(1):16–23. doi: 10.1197/jamia.M1749

Table 1.

Threats to Internal Validity

1. Ambiguous temporal precedence: Lack of clarity about whether intervention occurred before outcome
2. Selection: Systematic differences over conditions in respondent characteristics that could also cause the observed effect
3. History: Events occurring concurrently with intervention could cause the observed effect
4. Maturation: Naturally occurring changes over time could be confused with a treatment effect
5. Regression: When units are selected for their extreme scores, they will often have less extreme subsequent scores, an occurrence that can be confused with an intervention effect
6. Attrition: Loss of respondents can produce artifactual effects if that loss is correlated with intervention
7. Testing: Exposure to a test can affect scores on subsequent exposures to that test
8. Instrumentation: The nature of a measurement may change over time or conditions
9. Interactive effects: The impact of an intervention may depend on the level of another intervention

Adapted from Shadish et al.4