from EXPLORE showed that childhood sexual abuse was highly associated with HIV risk-taking behavior and infection among men who have sex with men who participated in the study.
Even when RCTs are impractical, their basic principles can be extended to other research. Suppose one wants to evaluate the effectiveness of a community-based training program designed to help LGBT high school dropouts transition to employment. Researchers clearly cannot establish credible estimates of a “treatment” (completion of the program) by comparing subsequent employment rates of program participants with those of nonparticipants. After all, youths with high motivation are more likely to stay with the program than youths with low motivation. Researchers might, however, credibly estimate the impact of the program by comparing employment rates of youths in neighborhoods where the program was made available (the “treatment” group) with those of youths in otherwise comparable neighborhoods that had no training program (the “control” group). Such credible program evaluations are important for understanding the treatment effects of social programs, and can be conducted even when the “treatment” choice (the neighborhood choice for the employment program) is not randomly assigned as in a proper RCT.
CDC’s Diffusion of Effective Behavioral Interventions (DEBI) program is an example of how RCTs are being used to determine the most effective of two or more community-level or population-specific interventions. DEBI is a national-level strategy to provide high-quality training and ongoing technical assistance to state and community HIV/sexually transmitted infection (STI) program staff for selected evidence-based prevention interventions that focus on HIV, other STIs, and viral hepatitis. Initiated in 1999, the program includes evidence-based behavioral interventions identified in the 2009 Compendium of Evidence-Based HIV Prevention Interventions, which were evaluated through a series of efficacy reviews, many of which involved RCTs (CDC, 2009). Development of a model for adapting evidence-based prevention interventions to groups not initially studied was initiated in 2004 (McKleroy et al., 2006). This effort supported increased funding for adapting and culturally tailoring evidence-based prevention interventions initially designed for gay men for use with other affected population groups.
Implementation of the DEBI program has been critically reviewed in the context of dissemination and technology transfer. Dworkin and colleagues (2008) emphasize the importance of adaptation and dissemination as a participatory process and conclude that additional strategies are needed to ensure that the experience and assistance of community stakeholders are effectively represented.
The view of RCTs as the gold standard for measuring an intervention’s impact extends across many diverse fields of human inquiry, such as educa-