More importantly, all randomised studies should report the level of attrition and compare drop-outs with the individuals that remain in the study to gauge whether there are systematic differences between these two groups – at least in terms of observable characteristics.

Another key challenge affecting the generalisability of RCTs is linked to behavioural changes that can influence treatment and control groups. These behavioural changes are known as Hawthorne and John Henry effects, with Hawthorne effects referring to behavioural changes in the treatment group while John Henry effects relate to behavioural changes in the control group. For example, individuals in the treatment group might positively change their behaviour for the duration of the study as they feel thankful for receiving treatment and as a response to being observed. The same behavioural changes might apply to members in the control group altering their behaviour positively or negatively.

A final technical challenge we need to understand is related to spill-over effects that can have adverse effects on the impact estimates obtained from a RCT.