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 2nd edition of the Physical Activity Guidelines for Americans (PAG) recommends, in part, 150 min of moderate-intensity aerobic physical activity. The PAG states that yoga may be able to help meet ...the guidelines for moderate-intensity aerobic exercise for adults and older adults. Our study aims to objectively measure the proportion of time participants' activity that is categorized as moderate-intensity aerobic activity based on heart rate data and to subjectively measure rate of perceived exertion (RPE). Participants completed the Stanford Leisure-Time Activity Categorical item to establish baseline PAG aerobic activity compliance. Participants then completed four separate 1-h yoga sessions at different tempos (cadence) and temperatures while wearing heart rate monitors. During and directly after the session they also marked their RPE on a modified 10-point scale. All participants reached moderate-intensity aerobic activity for at least some portion of a yoga session based on heart rate monitor data and RPE. The average duration of moderate intensity was 32.75% of the class across all four class types, with no significant differences by condition. Age was a significant factor in time spent in moderate-to-vigorous physical activity for only the thermo-neutral Hatha classes (
= 0.010). Tempo, temperature, and baseline activity levels were not significant factors in time spent in moderate-to-vigorous intensity physical activity based on Pearson Correlation and the Kruskal-Wallis test. Hatha and Vinyasa yoga classes, at room or hot temperatures, can be used to meet a portion of the PAG moderate-intensity activity recommendations.
Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the ...Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S.
Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8).
A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance.
We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities.
The review protocol was registered with PROSPERO: CRD42019116308.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, 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.
Altering food store environments is a promising approach to encourage healthy product purchases by consumers to improve their diet quality and health. Food store owners and managers are ...intermediaries to ensure that environmental changes are enacted. Despite their role as gatekeepers to implement and sustain healthy food environment changes, no systematic review has been published that examines food store owner and manager (retailer) data. Thus a review of retailer information available within the expansive United States (US) food environment literature was the purpose of this research.
The PRISMA protocol was used. A search strategy, including published articles from years 1980-2017, was applied to six databases to locate relevant articles that addressed the perspective of food store retailers in the US. Data were extracted, organized, and agreed upon between two authors based on pre-designed constructs: (1) a social-ecological model to capture factors that influence retailer decision making; and (2) a marketing-mix and choice-architecture framework to examine perspectives of applied (or the prospective application of) strategies at the store-level. Study quality was assessed using quality criteria checklists for qualitative and quantitative research.
Thirty-one articles met inclusion criteria and most studies (n = 22) were qualitative and conducted in urban food stores (n = 23). Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers' healthy choices to support dietary quality. These factors included: conflicting training outcomes to enhance retailers' knowledge and skills (individual, n = 9); the importance of trust (interpersonal, n = 8); views about marketing-mix and choice-architecture strategies in the food environment (n = 25); consumer demand or demographics (community, n = 19); supplier and food store management variables (systems or sectors, n = 18); local and federal policy (n = 8); and support for community health (norms/values, n = 8).
Research partnerships can support favorable business and public health outcomes to align with retailers' business models and available resources. A participatory and translational approach to food environment research will likely maximize public health impact. Urban and rural food store retailers are important actors for future research to inform the feasibility of store retailers to apply MMCA strategies that are profitable and promote health.
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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
To identify endometrial cancer survivors' (ECS) barriers and facilitators for participation in lifestyle interventions to improve their dietary and exercise behaviors. Our secondary objective is to ...determine baseline information: physical activity level, quality of life (QoL), and impact of COVID-19 on exercise, diet, and mental health.
Obese, early-stage ECS participated in 2-part mixed-methods data collection; Part 1: survey gathering sample characteristics, QoL, exercise, and basic endometrial cancer- related knowledge. Part 2: virtual focus group or individual interviews using a brainwriting premortem protocol. Statistical analysis was performed using SAS (version 8.3). Qualitative data were analyzed using deductive thematic coding guided by the RE-AIM framework.
Twenty percent (70/358) of ECS from a survivorship database and clinic recruitment completed the survey; 16 ECS provided qualitative feedback. Common barriers to intervention participation included time and resource costs, meeting frequency, and pessimism about weight loss maintenance. Facilitators included an opportunity to connect with other survivors and a focus on health rather than weight loss. Most ECS could not identify exercise guidelines (60%) and 83% were not meeting these guidelines. Higher BMI was correlated with a lower confidence in completing in moderate physical activity (p-value = 0.0206). Post-COVID-19 pandemic, physical activity, nutritional decisions, and/or mental health worsened for 67% of ECS.
ECS are a disparate population, with worsening behaviors and mental health following the pandemic. The identified ECS-specific barriers and facilitators to behavioral intervention participation are being used to simultaneously improve the reach of and adherence to a lifestyle intervention aimed at improving their health and QoL.
•Appealing intervention components include a health focus, remote delivery, social support, and low impact exercise.•Following the COVID-19 outbreak, endometrial cancer survivors' physical activity, nutrition, and mental health worsened.•Self-efficacy for moderate-vigorous exercise was lower for survivors with class III obesity compared to class I and II.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Background
There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature ...of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers’ situatedness within participatory processes. As an implementation scientist, addressing one’s own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process.
Methods
We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative.
Results
Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers’ lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers’ experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research.
Conclusion
Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one’s values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The RE-AIM Framework is a planning and evaluation model that has been used in a variety of settings to address various programmatic, environmental, and policy innovations for improving population ...health. In addition to the broad application and diverse use of the framework, there are lessons learned and recommendations for the future use of the framework across clinical, community, and corporate settings. The purposes of this article are to: (A) provide a brief overview of the RE-AIM Framework and its pragmatic use for planning and evaluation; (B) offer recommendations to facilitate the application of RE-AIM in clinical, community, and corporate settings; and (C) share perspectives and lessons learned about employing RE-AIM dimensions in the planning, implementation, and evaluation phases within these different settings. In this article, we demonstrate how the RE-AIM concepts and elements within each dimension can be applied by researchers and practitioners in diverse settings, among diverse populations and for diverse health topics.
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