The RE-AIM framework developed by Glasgow et al. (1999) It has five evaluation components.
- Reach: the proportion of people in a given population who participate in a program and their characteristics. For example, an organization’s outreach to stakeholders can be indirect, intentional, or direct. Reach is the number of program participants divided by the size of the target population.
- Effectiveness: positive and negative program outcomes. These are typically measured as the proportion of participants experiencing particular positive and negative program outcomes. In addition to clinical patient outcomes, other types of outcomes include (i) behavioral outcomes for participants (e.g., smoking cessation, eating patterns, physical activity), (ii) outcomes for staff delivering an intervention (approaching patients, providing directions and counseling, making follow-up calls), and (iii) outcomes for payers and purchasers supporting the intervention (uptake of an intervention, policy change). Quality of life, such as patient functioning, mental health, and consumer satisfaction, should also be considered.
- Adoption: percentage of potential settings (e.g. organizations) and staff that have agreed to participate in the program. You could think of this as organizational acceptance. Adoption is often assessed through direct observation or structured interviews or surveys.
- Implementation: the extent to which the program was implemented as planned and at what cost. Implementation can be assessed at the individual and organizational levels. At the individual level, participant follow-up or “adherence” can be measured; at the organizational level, the proportion of staff members who implement the program as planned can be measured.
- Maintenance: maintenance of primary outcomes (>6 months) for individuals; sustainability of implemented programs for organizations. For individuals, relapse or discontinuation is a challenge and should be assessed; at the organizational level, the extent to which a health promotion practice or policy becomes routine and part of an organization’s everyday culture and norms should be measured.
Below is a summary of the five dimensions in tabular form.
Each of the five dimensions mentioned above is represented on a scale from 0 to 1 (or 0% to 100%). Part of the reason for the name is that the impact of an intervention is a function of its reach and effectiveness (Impact = Reach × Effectiveness) as described in Abrams et al. (1996). Besides, Effectiveness = Implementation × EfficiencyAn intervention may be effective, but it is only effective if it is easily translated into the real world. However, interventions can have a large impact in short-term research settings, but may not be sustainable. The “AIM” component aims to more fully characterize the public health impact of an intervention based on organizational factors. RE-AIM has been used to evaluate a variety of interventions, such as:
A key question is whether RE-AIM can be used not only for individual interventions, but also for multifaceted interventions that target a range of different stakeholders (e.g., providers, educators, others). An article by Sweet and others, 2014 Note that RE-AIM could be applied to a multifaceted intervention in one of three ways:
- Specific focus of the activity. Under this approach, each activity undertaken would be assessed based on the RE-AIM dimension it addressed. “For example, awareness-raising strategies would focus on reach or adoption, physical activity promotion strategies could be used to improve effectiveness and maintenance, and provider training strategies could be identified as methods to improve adoption and implementation of evidence-based guidelines.”
- Additive approachIn this methodology, information would be collected from all initiatives and then combined to inform each RE-AIM dimension. For example, reach could be assessed based on all activities (e.g., mailings, website visits, participant enrollment). This approach allows for a good grasp of overall impact, but not how a specific activity moved the needle on a given RE-AIM dimension.
- Hybrid approachIn this approach, researchers pragmatically decide which strategies merit more in-depth RE-AIM evaluation and which are best evaluated using one or two RE-AIM dimensions. The decision is often determined “pragmatically” based on stakeholder perspectives. Swett et al. argue that this approach “can accelerate the integration of research, policy, and practice…[and] It will also reduce the burden on participants and partner organisations…”
He Sweet al. 2014 The article applies the multifaceted RE-AIM framework to the SCI Canada Actionwhich was an initiative whose mission was to “develop and mobilize strategies to inform, teach, and enable people living with SCI to initiate and maintain a physically active lifestyle.” The specific metrics used as part of their application of RE-AIM to SCI Action Canada’s intervention are shown below.
You can read more about how they implemented this approach in the full paper. here.
