Frequently Asked Questions
The Basics (FAQs page 1)
Question: What is RE-AIM?
Answer: RE-AIM is an acronym that consists of five
elements, or dimensions, that relate to health behavior
interventions:
• Reach the target population
• Effectiveness or efficacy
• Adoption by target settings, institutions, and
staff
• Implementation - consistency and costs of
delivery of intervention
• Maintenance of intervention effects in
individuals and settings over time
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Question: How do you define each element?
Answer: Reach - The absolute number,
proportion, and representativeness of individuals who participate
in a given initiative, intervention or program.
Representativeness refers to whether participants have
characteristics that reflect the target population's
characteristics. For example, if your intent is to increase
physical activity in sedentary people between the ages of 35 and
70, you wouldn't test your program on triathletes.
Effectiveness/Efficacy - The impact of an
intervention on important outcomes. This includes potential
negative effects, quality of life, and economic outcomes.
Adoption - The absolute number, proportion, and
representativeness of settings and staff who are willing to
initiate a program or approve a policy.
Implementation - At the setting level,
implementation refers to how closely staff members follow the
program that the developers provide. This includes consistency of
delivery as intended and the time and cost of the program.
Maintenance - At the setting level, the extent
to which a program or policy becomes part of the routine
organizational practices and policies.
At the individual level, maintenance refers to the long-term
effects of a program on outcomes after 6 or more months after the
most recent intervention contact.
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Question: How do the
RE-AIM elements relate to planning?
Answer: As you design, plan, or evaluate an
intervention, there are questions that you should ask yourself.
| • |
Reach the target
population |
| • |
Effectiveness or efficacy |
| • |
Adoption by target, institutions, or
clinicians |
| • |
Implementation - consistency and costs
of delivery of intervention |
| • |
Maintenance of intervention effects in
individuals and settings over time |
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Question: Which
RE-AIM element is the most important? (Isn't Reach really
the bottom line in what you are trying to accomplish?)
Answer: Some have argued that Reach is the most
important criteria, but we think that all five RE-AIM dimensions
are equally important. An intervention with high Reach, but little
or no Efficacy will have limited impact. Similarly, even if an
intervention has high Reach and impressive Efficacy, if no
organizations will Adopt the intervention, or if only a handful of
experts can successfully Implement the program, it will have
limited real-world impact.
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Question: Why isn't cost
one of the RE-AIM dimensions - is it so important to adoption and
other issues?
Answer: We agree that cost is often one of the
key factors in determining how widely Adopted an intervention will
be. However, we view cost, or cost-effectiveness and cost-benefit,
as one of the factors that influences several RE-AIM dimensions in
addition to Adoption; for example, cost is usually related to
intensiveness of intervention which is often related (positively)
to Effectiveness and (negatively) to Implementation.
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Question: How is
RE-AIM different from other evaluation approaches?
Answer: RE-AIM draws upon previous work in
several areas including diffusion of innovations, multi-level
models, and Precede-Proceed. The primary ways that it is different
is that it a) is intended specifically to facilitate translation of
research to practice, b) it places equal emphasis on internal and
external validity issues and emphasizes representativeness, and c)
it provides specific and standard ways of measuring key factors
involved in evaluating potential for public health impact and
widespread application.
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Question: How is
the RE-AIM definition of Implementation different from concepts
such as intervention delivery, receipt of intervention, or
implementation fidelity?
Answer: In the RE-AIM framework, Implementation
is closely related to the above issues. However, it has a greater
focus on the intervention setting level and on the staff delivering
the program and what they do, rather than on what the individual
participant who receives a program does. Both are important, but
RE-AIM places emphasis on the potential implications for delivering
intervention in applied settings, and on assessing Implementation
for different components of the program and across diverse
intervention staff. In addition, implementing RE-AIM is also
concerned with cost and with adaptations that are made to the
program or policy.
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Question: Is RE-AIM
used to design programs, or just to evaluate them?
Answer: Both. Although used more commonly at
present to report results or compare interventions, it is also
useful as a planning tool and as a method to review intervention
studies.
These articles provide examples of reporting results:
Evaluating Initial Reach and Robustness of a
Practical Randomized Trial of Smoking Reduction.
Glasgow RE, Estabrooks PA, Marcus AC, Smith TL, Gaglio B,
Levinson AH, Tong S.
Health Psychol 2008 Nov 27(6):78-788.
Implementation,
generalization, and long-term results of the "Choosing Well"
diabetes self-management intervention.
Glasgow, R.E., Toobert, D.J., Hampson, S.E., & Strycker,
L.A.
(2002). Pt Educ Couns, 48(2):
115-122.
Tailored Behavioral Support for Smoking Reduction:
Development and Pilot Results of an Innovative
Intervention.
Levinson AH, Glasgow RE, Gaglio B, Smith TL, Cahoon J, Marcus AC.
Health Educ Res 2008 Apr;23(2):335-46.
The following articles discuss using RE-AIM for planning:
Beginning with the Application in Mind: Designing
and Planning Health Behavior Change Interventions to Enhance
Dissemination.
Klesges, L.M., Estabrooks, P.A., Glasgow, R.E., Dzewaltowski, D.A.
Ann Behav Med 2005;29:66S-75S.
RE-AIM for Program Planning and Evaluation: Overview and Recent
Developments.
Glasgow, R.E., Toobert, D.J.
Center for Health Aging: Model Health Programs for
Communities/National Council on Aging (NCOA), 2007.
These articles provide examples of using RE-AIM to evaluate
evidence and review the literature:
Promoting
smoking abstinence in pregnant and postpartum patients: A
comparison of 2 approaches.
Lando, H.A., Valanis, B.G., Lichtenstein, E.L., et al. (2001).
American Journal of Managed Care, 7, 685-693.
Reporting of
Validity from School Health Promotion Studies Published in 12
Leading Journals
Estabrooks, P.A., Dzewaltowski, D.A., Glasgow, R.E., Klesges,
L.M.
(2003) , 1996-2000. Journal of School Health, 73(1):
21-28.
Review of External Validity Reporting in Childhood
Obesity Prevention Research.
Klesges LM, Dzewaltowski DA, Glasgow RE.
Am J Prev Med 2008;34(3):216-223.
Smoking cessation
interventions among hospitalized patients: What have we
learned?
France, E.K., Glasgow, R.E., Marcus, A.
(2001) Preventive Medicine, 32(4):376-388.
Translating physical activity interventions for
breast cancer survivors into practice: an evaluation of randomized
controlled trials.
White SM, McAuley E, Estabrooks PA, Courneya KS.
Ann Behav Med. 2009 Feb;37(1):10-9. Epub 2009 Mar 3.
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