Translational Behavioral Medicine

, Volume 2, Issue 2, pp 180–187

Adapting and RE-AIMing a heart disease prevention program for older women with diabetes

  • Deborah J Toobert
  • Russell E Glasgow
  • Lisa A Strycker
  • Manuel BarreraJr.
  • Diane K King
Original Research


Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials—the Mediterranean Lifestyle Program and ¡Viva Bien!. Results from these two trials, including readiness for dissemination, are evaluated using the RE-AIM framework in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Program adaptations produced relative high reach as well as consistent and replicated effectiveness and maintenance, and were adopted by a high percentage of primary care offices and clinicians approached. We discuss key findings, lessons learned, future directions for related research, and use of RE-AIM for program development, adaptation, scale-up, and evaluation.


Coronary heart disease Diabetes Latino RE-AIM Evaluation 


  1. 1.
    Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21-e181.PubMedCrossRefGoogle Scholar
  2. 2.
    American Heart Association. Heart disease and stroke statistics. Dallas: American Heart Association; 2009.Google Scholar
  3. 3.
    Chiu C, Wray LA. Gender differences in functional limitations in adults living with type 2 diabetes: Biobehavioral and psychosocial mediators. Ann Behav Med. 2011;41:71-82.PubMedCrossRefGoogle Scholar
  4. 4.
    Emerging Risk Factors Study Group. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829-841.CrossRefGoogle Scholar
  5. 5.
    Norhammar A, Stenestrand U, Lindback J, Wallentin L, on behalf of the Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: A report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Heart. 2008;94:1565-1570.PubMedCrossRefGoogle Scholar
  6. 6.
    Melloni C, Berger JS, Wang TY, et al. Representation of women in randomized clinical trials of cardiovascular disease prevention, Circulation. Published online before print February 16, 2010. doi:10.1161Google Scholar
  7. 7.
    Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-133.PubMedCrossRefGoogle Scholar
  8. 8.
    Silberman A, Banthia R, Estay IS, et al. The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. Am J Health Promo. 2010;24:260-266.CrossRefGoogle Scholar
  9. 9.
    Toobert DJ, Strycker LA, Barrera M Jr, Osuna D, King DK, Glasgow RE. Outcomes from a multiple-risk-factor diabetes self-management trial for Latinas: ¡Viva Bien! Ann Behav Med. 2011;41:310-323. doi:10.1007/s12160-010-9256-7.PubMedCrossRefGoogle Scholar
  10. 10.
    Toobert DJ, Glasgow RE, Radcliffe JL. Physiologic and related behavioral outcomes from the Women’s Lifestyle Heart Trial. Ann Behav Med. 2000;22:1-9.PubMedCrossRefGoogle Scholar
  11. 11.
    Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Angell K. Effects of the Mediterranean Lifestyle Program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Ann Behav Med. 2005;29:128-137. PMCID: PMC 1557654.PubMedCrossRefGoogle Scholar
  12. 12.
    Toobert DJ, Strycker LA, Barrera M Jr, Glasgow RE. 7-Year follow-up of a multiple health behavior intervention for diabetes. Am J Health Behav. 2011;34:680-694.Google Scholar
  13. 13.
    Gaglio B, Glasgow RE. Evaluation approaches for dissemination and implementation research. In: Brownson RC, Colditz G, Proctor E, eds. Dissemination and Implementation Research in Health: Translating Science to Practice. Oxford, UK: Oxford University Press; 2012.Google Scholar
  14. 14.
    Glasgow RE, Linnan LA. Evaluation of theory-based interventions. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education. 4th ed. New York, NY: Wiley, John & Sons, Inc.; 2008.Google Scholar
  15. 15.
    Klesges LM, Dzewaltowski DA, Glasgow RE. Review of external validity reporting in childhood obesity prevention research. Am J Prev Med. 2008;34:216-223.PubMedCrossRefGoogle Scholar
  16. 16.
    Toobert DJ, Glasgow RE, Nettekoven LA, Brown JE. Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Educ Couns. 1998;35:177-188.PubMedCrossRefGoogle Scholar
  17. 17.
    Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J. Improving self-care among older patients with type II diabetes: The “Sixty Something” study. Patient Educ Couns. 1992;19:61-74.PubMedCrossRefGoogle Scholar
  18. 18.
    Toobert DJ, Strycker LA, Glasgow RE, Bagdade JD. If you build it, will they come? Reach and adoption associated with a comprehensive lifestyle management program for women with type 2 diabetes. Patient Educ Couns. 2002;1646:1-7.Google Scholar
  19. 19.
    Toobert DJ, Strycker LA, Glasgow RE, et al. ¡Viva Bien!: Overcoming recruitment challenges in a multiple-risk-factor diabetes trial. Am J Health Behav. 2010;34:432-441.PubMedGoogle Scholar
  20. 20.
    Peterson KE, Hebert JR, Hurley TG, et al. Accuracy and precision of two short screeners to assess change in fruit and vegetable consumption among diverse populations participating in health promotion intervention trials. J Nutr. 2008;138:218S-225S.PubMedGoogle Scholar
  21. 21.
    Patterson RE, Kristal A, Tinker LF, et al. Measurement characteristics of the Women’s Health Initiative Food Frequency Questionnaire. Ann Epidemiol. 1999;9:178-187.PubMedCrossRefGoogle Scholar
  22. 22.
    Stewart AL, Verboncoeur CJ, McLellan BY, et al. Physical activity outcomes of CHAMPS II: A physical activity promotion program for older adults. J Gerontol. 2001;56:M465-M470.Google Scholar
  23. 23.
    Craig CL, Marchall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381-1395.PubMedCrossRefGoogle Scholar
  24. 24.
    Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. Boston: New England Medical Center, The Health Institute; 1997.Google Scholar
  25. 25.
    Brown DW, Balluz LS, Heath GW, et al. Associations between recommended levels of PA and health related QOL findings from the 2001 BRFSS survey. Prev Med. 2003;37:520-528.PubMedCrossRefGoogle Scholar
  26. 26.
    Ritzwoller DP, Toobert D, Sukhanova A, Glasgow RE. Economic analysis of the Mediterranean Lifestyle Program for postmenopausal women with diabetes. Diab Educ. 2006;32:761-769. PMID: 16971709.CrossRefGoogle Scholar
  27. 27.
    Ritzwoller DP, Sukhanova AS, Glasgow RE, et al. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: Economic analysis of ¡Viva Bien!. Trans Behav Med. Published online before print April 07, 2011.Google Scholar
  28. 28.
    Trochim W, Kane C, Graham MJ, Pincus HA. Evaluating translational research: A process marker model. Clin Trans Sci. 2011;4:153-162.CrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2012

Authors and Affiliations

  • Deborah J Toobert
    • 1
  • Russell E Glasgow
    • 2
  • Lisa A Strycker
    • 1
  • Manuel BarreraJr.
    • 3
  • Diane K King
    • 4
  1. 1.Oregon Research InstituteEugeneUSA
  2. 2.Implementation Science, Division of Cancer Control and Population ScienceNational Cancer InstituteRockvilleUSA
  3. 3.Arizona State UniversityTempeUSA
  4. 4.University of Alaska AnchorageAnchorageUSA

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