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.
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The findings and conclusions in this publication are those of the authors and do not necessarily represent the views of the National Cancer Institute, National Institutes of Health. This research was supported by the National Institutes of Health (NIH) Grant 5 U01 HL087071. Erica T. Warner was supported by the National Cancer Institute grant number 5T32CA009001-36 and by the National Institute of General Medical Sciences grant number 5R25GM055353-14.
Policy: Public health impact can be enhanced by use of planning and evaluation frameworks to address issues such as inequitable participation, engagement, outcomes, and sustainability of well-intended programs and policies.
Research: Use of implementation science models such as RE-AIM can be useful for both planning and reporting on programs intended to address health inequities.
Practice: Planning ahead to address frequent challenges to implementation can help enhance program reach, delivery, and reduce health disparities. Additional features are likely needed to increase magnitude of weight losses produced.
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Glasgow, R.E., Askew, S., Purcell, P. et al. Use of RE-AIM to address health inequities: Application in a low-income community health center-based weight loss and hypertension self-management program. Behav. Med. Pract. Policy Res. 3, 200–210 (2013). https://doi.org/10.1007/s13142-013-0201-8
- Weight loss
- Health disparities
- Low income
- Pragmatic trial
- Implementation science