Naturalistic program evaluation strategies are gaining acceptance within the evaluation profession. They are especially useful in the examination of the transaction, or process, components of programs. One of their disadvantages is that they demand extensive quantities of evaluator time and effort which are difficult to arrange. Guba refers to evaluation conducted within the naturalistic paradigm (as distinct from the use of naturalistic techniques) as fourth-generation evaluation. This article describes an evaluation study in the health field that attempted to stay within the naturalistic paradigm while mitigating some of the drawbacks of the methodological process of naturalistic evaluation.