Original research

Translational Behavioral Medicine

, Volume 3, Issue 2, pp 200-210

Use of RE-AIM to address health inequities: Application in a low-income community health center-based weight loss and hypertension self-management program

  • Russell E GlasgowAffiliated withDivision of Cancer Control and Population Sciences, National Cancer Institute Email author 
  • , Sandy AskewAffiliated withDuke Global Health Institute, Duke University
  • , Peyton PurcellAffiliated withDivision of Cancer Control and Population Sciences, National Cancer Institute
  • , Erica LevineAffiliated withDuke Global Health Institute, Duke University
  • , Erica T WarnerAffiliated withDepartment of Epidemiology, Harvard School of Public Health
  • , Kurt C StangeAffiliated withDepartments of Family Medicine and Community Health, Epidemiology and Biostatistics, and Sociology, Comprehensive Cancer Center
  • , Graham A ColditzAffiliated withDivision of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine
  • , Gary G BennettAffiliated withDuke Global Health Institute, Duke University

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ABSTRACT

While health inequities are well documented, and there are helpful frameworks to understand health disparities, implementation frameworks are also needed to focus the design, evaluation, and reporting on interventions targeting populations at increased risk. This study aims to describe how the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework can be used for these purposes and illustrate its application in the context of a randomized, pragmatic weight loss and hypertension self-management intervention. RE-AIM was used to both plan and evaluate the Be Fit Be Well program for urban community health center patients. The RE-AIM framework helped to focus attention on and produce high rates of adoption and reach. Implementation rates varied across components. Weight losses were statistically significant, but not clinically significant. They were robust across a variety of patient characteristics, and the program was relatively of low cost. Individual weight losses and blood pressure reductions were maintained throughout the 24-month period, but the program was not sustained at any of the three settings. Implementation frameworks such as RE-AIM can help design pragmatic interventions that focus on both the context for disparities reduction and the ultimate goal of public health impact.

KEYWORDS

Weight loss Health disparities Low income RE-AIM Pragmatic trial Implementation science