Healthcare costs have risen sharply, and policymaker concern about cost and inefficiency have contributed to an increased emphasis on evidence-based practices and, more specifically, on evidence-based practices that were developed from randomized controlled trials and quasi-experimental designs. As a result, practices that are supported by RCTs and QEDs have been widely adopted through policymaking and funding.
Research that relies on RCT and QED designs typically uses assessment instruments that have been developed for mainstream populations and do not account for differences in culture and context found across underserved populations. Thus it cannot be assumed that evidence-based practices will be effective in underserved communities.
Public health and other community-based researchers have cautioned policymakers and funding agencies against a simplistic acceptance of the superiority of RCTs. All research methods have limitations and must be interpreted cautiously and transparently, especially with diverse communities.
Providing and evaluating services for an underserved population does not mean working without documentation of evidence. It means that in cases where RCTs and QEDs are impractical or not culturally appropriate, other methods of documenting effectiveness can be used to provide evidence for longstanding community practices.