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Challenges of implementing evidence-based programs.

More and more we hear that policy decisions should be based on strong evidence. The strength of evidence is based on the rigor of the research that goes into answering questions about whether a program can and does work in the field. No matter how strong the evidence is that supports a particular policy option or program, there is no guarantee that it will work in every community every time. The evidence that supports one program may be based on experiences in slightly different populations under different circumstances, and the evidence-based program that is implemented may not be identical to the programs that were studied. The last concern about evidence-based policymaking is that there are very few examples of well-tested policies and programs. Basing decisions on evidence is desirable but hard to do. Many evidence-based programs are broadly generalizable, but that does not mean they will work in a specific community now or in the future. For instance, a program for which there is sufficient evidence sup porting its use in an urban setting may not address issues that are relevant in a rural setting. This leads to a caution that policymakers should heed: before evidence-based programs are implemented in a community, it is important to first assess the community’s characteristics, such as demographic factors (eg, race, ethnicity, language, and sex) and the nature of the need. Findings from this assessment can then be used to tailor evidence-based programs to the community.