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To the Editor: In his Commentary, Dr Berwick¹ identified the widespread use and acceptance of RCTs and in general classic experimental design as " . . . inadequate tools for studying complex, unstable, nonlinear social change" that reveal "little about mechanisms or about factors that affect generalizability." More than 20 years ago, the field of program evaluation identified that its major purpose was to examine the theory or conceptual basis of the program.² Comprehensive evaluations address the theory by carefully defining the components of the program and their relationships, and then examining the implementation of these components and how they mediate outcomes.³

This theory-based perspective is independent of the experimental design and should be part of every comprehensive evaluation if the funding is sufficient. Berwick does not sufficiently distinguish between program theory and experimental design.¹ I believe that most evaluators consider that the theory-based approach should be used regardless of the type of design . . . [Full Text of this Article]

Leonard Bickman, PhD
leonard.bickman@vanderbilt.edu
Center for Evaluation and Program Improvement
Vanderbilt University
Nashville, Tennessee

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