The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. ...This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
The subjective nature of self-reported dietary intake assessment methods presents numerous challenges to obtaining accurate dietary intake and nutritional status. This limitation can be overcome by ...the use of dietary biomarkers, which are able to objectively assess dietary consumption (or exposure) without the bias of self-reported dietary intake errors. The need for dietary biomarkers was addressed by the Institute of Medicine, who recognized the lack of nutritional biomarkers as a knowledge gap requiring future research. The purpose of this article is to review existing literature on currently available dietary biomarkers, including novel biomarkers of specific foods and dietary components, and assess the validity, reliability and sensitivity of the markers. This review revealed several biomarkers in need of additional validation research; research is also needed to produce sensitive, specific, cost-effective and noninvasive dietary biomarkers. The emerging field of metabolomics may help to advance the development of food/nutrient biomarkers, yet advances in food metabolome databases are needed. The availability of biomarkers that estimate intake of specific foods and dietary components could greatly enhance nutritional research targeting compliance to national recommendations as well as direct associations with disease outcomes. More research is necessary to refine existing biomarkers by accounting for confounding factors, to establish new indicators of specific food intake, and to develop techniques that are cost-effective, noninvasive, rapid and accurate measures of nutritional status.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract Introduction Energy-containing beverages, specifically sugar-sweetened beverages, may contribute to weight gain and obesity development. Yet, no rapid assessment tools are available which ...quantify habitual beverage intake (grams, energy) in adults. Objective Determine the factorial validity of a newly developed beverage intake questionnaire (BEVQ) and identify potential to reduce items. Methods Participants from varying economic and educational backgrounds (n=1,596, age 43±12 years, body mass index calculated as kg/m2 31.5±0.2) completed a 19-item BEVQ (BEVQ-19). Beverages that contributed <10% to total beverage, or sugar-sweetened beverages, energy and grams were identified for potential removal. Factor analyses identified beverage categories that could potentially be combined. Regression analyses compared BEVQ-19 outcomes with the reduced version's (BEVQ-15) variables. Inter-item reliability was assessed using Cronbach's α. Following BEVQ-15 development, a subsequent study (n=70, age 37±2 years; body mass index 24.5±0.4) evaluated the relative validity of the BEVQ-15 through comparison of three 24-hour dietary recalls' beverage intake. Results Three beverage items were identified for elimination (vegetable juice, meal replacement drinks, and mixed alcoholic drinks); beer and light beer were combined into one category. Regression models using BEVQ-15 variables explained 91% to 99% of variance in the four major outcomes of the BEVQ-19 (all P <0.001). Cronbach's α ranged .97 to .99 for all outcomes. In the follow-up study, BEVQ-15 and three 24-hour dietary recalls' variables were significantly correlated with the exception of whole milk; BEVQ-15 sugar-sweetened beverages ( R2 =0.69), and total beverage energy ( R2 =0.59) were more highly correlated with three 24-hour dietary recalls' than previously reported for the BEVQ-19. The BEVQ-15 produced a lower readability score of 4.8, which is appropriate for individuals with a fourth-grade education or greater. Conclusions The BEVQ-19 can be reduced to a 15-item questionnaire. This brief dietary assessment tool will enable researchers and practitioners to rapidly (administration time of ∼2 minutes) assess habitual beverage intake, and to determine possible associations of beverage consumption with health-related outcomes, such as weight status.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract
Background
The Practical, Robust Implementation and Sustainability Model (PRISM) was developed in 2008 as a contextually expanded version of the broadly used Reach, Adoption, Effectiveness, ...Implementation, and Maintenance (RE-AIM) framework. PRISM provides researchers a pragmatic and intuitive model to improve translation of research interventions into clinical and community practice. Since 2008, the use of PRISM increased across diverse topics, populations, and settings. This citation analysis and scoping systematic review aimed to assess the use of the PRISM framework and to make recommendations for future research.
Methods
A literature search was conducted using three databases (PubMed, Web of Science, Scopus) for the period of 2008 and September 2020. After exclusion, reverse citation searches and invitations to experts in the field were used to identify and obtain recommendations for additional articles not identified in the original search. Studies that integrated PRISM into their study design were selected for full abstraction. Unique research studies were abstracted for information on study characteristics (e.g., setting/population, design), PRISM contextual domains, and RE-AIM outcomes.
Results
A total of 180 articles were identified to include PRISM to some degree. Thirty-two articles representing 23 unique studies integrated PRISM within their study design. Study characteristics varied widely and included studies conducted in diverse contexts, but predominately in high-income countries and in clinical out-patient settings. With regards to use, 19 used PRISM for evaluation, 10 for planning/development, 10 for implementation, four for sustainment, and one for dissemination. There was substantial variation across studies in how and to what degree PRISM contextual domains and RE-AIM outcomes were operationalized and connected. Only two studies directly connected individual PRISM context domains with RE-AIM outcomes, and another four included RE-AIM outcomes without direct connection to PRISM domains.
Conclusions
This is the first systematic review of the use of PRISM in various contexts. While there were low levels of ‘integrated’ use of PRISM and few reports on linkage to RE-AIM outcomes, most studies included important context domains of implementation and sustainability infrastructure and external environment. Recommendations are provided for more consistent and comprehensive use of and reporting on PRISM to inform both research and practice on contextual factors in implementation.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural ...communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012-2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmartER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes.
Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes.
Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59%) eligible, 301 (49%) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93% Caucasian, 81% female, 31 % ≤ high-school educated, 43% < $14,999 household income, and 33% low health literate. Retention rates (74%) and program engagement was not statistically different between conditions. Compared to MoveMore, SIPsmartER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmartER participants significantly decreased SSB intake by 227 (95% CI = -326,-127, p < 0.001) kcals/day from baseline to 6 months when compared to the decrease of 53 (95% CI = -88,-17, p < 0.01) kcals/day among MoveMore participants (p < 0.001). SIPsmartER participants decreased BMI by 0.21 (95% CI = -0.35,-0.06; p < 0.01) kg/m(2) from baseline to 6 months when compared to the non-significant 0.10 (95 % CI = -0.23, 0.43; NS) kg/m(2) gain among MoveMore participants (p < 0.05). Significant 0-6 month effects were observed for about half of the theory-based constructs, but for no biological outcomes. Health literacy status did not influence retention rates, engagement or outcomes.
SIPsmartER is an effective intervention to decrease SSB consumption among adults and is promising for translation into practice settings. SIPsmartER also yielded small, yet significant, improvements in BMI. By using health literacy-focused strategies, the intervention was robust in achieving reductions for participants of varying health literacy status.
Clinicaltrials.gov; ID: NCT02193009 .
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract Objective Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs. Methods We report 12-month results of an Internet-based diabetes ...self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients ( n = 463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors. Results Internet conditions improved health behaviors significantly vs. usual care over the 12-month period ( d for effect size = .09–.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants. Conclusions The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes. Practice implications Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Few measures exist to measure the overall home environment for its ability to support physical activity (PA) and healthy eating in overweight children. The purpose of this study was to develop and ...test the reliability and validity of such a measure.
The Home Environment Survey (HES) was developed to reflect availability, accessibility, parental role modelling, and parental policies related to PA resources, fruits and vegetables (F&V), and sugar sweetened drinks and snacks (SS). Parents of overweight children (n = 219) completed the HES and concurrent behavioural assessments. Children completed the Block Kids survey and wore an accelerometer for one week. A subset of parents (n = 156) completed the HES a second time to determine test-retest reliability. Finally, 41 parent dyads living in the same home (n = 41) completed the survey to determine inter-rater reliability. Initial psychometric analyses were completed to trim items from the measure based on lack of variability in responses, moderate or higher item to scale correlation, or contribution to strong internal consistency. Inter-rater and test-retest reliability were completed using intraclass correlation coefficients. Validity was assessed using Pearson correlations between the HES scores and child and parent nutrition and PA.
Eight items were removed and acceptable internal consistency was documented for all scales (alpha = .66-84) with the exception of the F&V accessibility. The F&V accessibility was reduced to a single item because the other two items did not meet reliability standards. Test-retest reliability was high (r > .75) for all scales. Inter-rater reliability varied across scales (r = .22-.89). PA accessibility, parent role modelling, and parental policies were all related significantly to child (r = .14-.21) and parent (r = .15-.31) PA. Similarly, availability of F&V and SS, parental role modelling, and parental policies were related to child (r = .14-36) and parent (r = .15-26) eating habits.
The HES shows promise as a potentially valid and reliable assessment of the physical and social home environment related to a child's physical activity and eating habits.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background: Despite the health benefits of regular physical activity, across the globe older adults represent the least active section of society. Purpose: The GrOup-based physical Activity for oLder ...adults (GOAL) trial was a three-arm parallel randomized controlled trial (RCT) that was designed to test the efficacy of two group-based exercise programs for older adults, informed by self-categorization theory (SCT), in comparison to a standard group-based exercise program. Methods: RCT conducted in Greater Vancouver, Canada, enrolled 627 older adults (Mage = 71.57 years, SD = 5.41; 71.0% female). Participants were randomized to similar age same gender (SASG), similar age mixed gender (SAMG), or 'standard' mixed age mixed gender (MAMG) exercise group conditions. In addition to group composition, the intervention programs operationalized principles from SCT designed to foster a sense of social connectedness among participants. The primary outcome of the trial was exercise adherence behavior over 12 and 24 weeks. Results: Analyses of variance revealed that older adults randomized to the SAMG (12-weeks d = .51, p < .001; 24-weeks d = .47, p < .001) and SASG (12-weeks d = .28, p = .012; 24-weeks d = .29, p = .016) conditions adhered to a greater extent than those in the MAMG comparison condition. There were no significant differences between the SAMG and SASG conditions. Conclusions: The results provide support for the efficacy of group-based physical activity programs informed by SCT. Furthermore, the results suggest that community group-based exercise programs should attempt to engage in age-targeting but not necessarily gender-targeting among older adults.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Abstract
Introduction:
Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the ...large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework.
Methods:
This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions.
Results:
We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework.
Conclusions:
RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.
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