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


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.

This is a preview of subscription content, access via your institution.

Fig 1


  1. 1.

    Bleich SN, Jarlenski MP, Bell CN, Laveist TA. Health inequalities: Trends, progress, and policy. Annual Review of Public Health. 2012;33:7-40.

    PubMed  Article  Google Scholar 

  2. 2.

    Smedley BD, Stith AY, Nelson AR. Board on health sciences policy, eds. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies, Institute of Medicine; 2003.

    Google Scholar 

  3. 3.

    Department of Health and Human Services. HHS action plan to reduce racial and ethnic health disparities: a nation free of disparities in health and health care. pdf. 2012. Accessed 3/17, 2012.

  4. 4.

    Klesges LM, Estabrooks PA, Dzewaltowski DA, Bull SS, Glasgow RE. Beginning with the application in mind: Designing and planning health behavior change interventions to enhance dissemination. Annals of Behavioral Medicine. 2005;29(Suppl):66-75.

    PubMed  Article  Google Scholar 

  5. 5.

    Glasgow RE, Lichtenstein E, Marcus AC. Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health. 2003;93(8):1261-1267.

    PubMed  Article  Google Scholar 

  6. 6.

    Gaglio B, Glasgow RE. Evaluation approaches for dissemination and implementation research. In: Brownson RC, Colditz GA, Proctor EK, eds. Dissemination and implementation research in health: Translating science to practice. New York: Oxford University Press; 2012:327-356.

    Google Scholar 

  7. 7.

    Zwarenstein M, Treweek S. What kind of randomised trials do patients and clinicians need? Evidence-Based Medicine. 2009;14(4):101-103.

    PubMed  Article  Google Scholar 

  8. 8.

    Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: Increasing the value of clinical research for decision making in clinical and health policy. Journal of the American Medical Association. 2003;290(12):1624-1632.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Thorpe KE, Zwarenstein M, Oxman AD, et al. A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. Journal of Clinical Epidemiology. 2009;62(5):464-475.

    PubMed  Article  Google Scholar 

  10. 10.

    Bennett GG, Warner ET, Glasgow RE, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Archives of Internal Medicine. 2012;172(7):565-574.

    PubMed  Article  Google Scholar 

  11. 11.

    Koh HK, Oppenheimer SC, Massin-Short SB, Emmons KM, Geller AC, Viswanath K. Translating research evidence into practice to reduce health disparities: a social determinants approach. American Journal of Public Health. 2010;100(Suppl 1):S72-80.

    PubMed  Article  Google Scholar 

  12. 12.

    Bennett GG, Glasgow RE. The delivery of public health interventions via the internet: Actualizing their potential. Annual Review of Public Health. 2009;30:273-292.

    PubMed  Article  Google Scholar 

  13. 13.

    Toobert DJ, Strycker LA, King DK, Barrera M Jr, Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for latinas: inverted exclamation markViva bien! Transl Behav Med. 2011;1(3):416-426.

    PubMed  Article  Google Scholar 

  14. 14.

    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health. 1999;89(9):1322-1327.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Annals of Behavioral Medicine. 2004;27(1):3-12.

    PubMed  Article  Google Scholar 

  16. 16.

    Brownson RC, Colditz GA, Proctor EK, eds. Dissemination and implementation research in health: Translating science to practice. 1st ed. New York: Oxford University Press, Inc.; 2012.

    Google Scholar 

  17. 17.

    Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine. 2012;43(3):337-350.

    PubMed  Article  Google Scholar 

  18. 18.

    Glasgow RE, Gaglio B, Bennett G, et al. Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Services Research. 2011;47(3):1051--1067.

    PubMed  Google Scholar 

  19. 19.

    Greaney ML, Quintiliani LM, Warner ET, et al. Weight management among patients at community health centers: the “be fit, be well” study. Obes Weight Manag. 2009;5(5):218-224.

    Google Scholar 

  20. 20.

    Yeh HC, Clark JM, Emmons KE, et al. Independent but coordinated trials: Insights from the practice-based opportunities for weight reduction trials collaborative research group. Clinical Trials. 2010;7(4):322-332.

    PubMed  Article  Google Scholar 

  21. 21.

    Glasgow RE, Strycker LA, Kurz D, et al. Recruitment for an internet-based diabetes self-management program: Scientific and ethical implications. Annals of Behavioral Medicine. 2010;40(1):40-48.

    PubMed  Article  Google Scholar 

  22. 22.

    Ritzwoller D, Glasgow R, Sukhanova A, et al. Economic analyses of the be fit be well program: a weight loss program for community health centers. Journal of General Internal Medicine. Under Review.

  23. 23.

    Samuel-Hodge CD, Garcia BA, Johnston LF, et al. Rationale, design, and sample characteristics of a practical randomized trial to assess a weight loss intervention for low-income women: The weight-wise II program. Contemporary Clinical Trials. 2012;33(1):93-103.

    PubMed  Article  Google Scholar 

  24. 24.

    Congressional Budget Office. Trends in the distribution of household income between 1979 and 2007. 2011;CBO Publication No. 4031.

  25. 25.

    Wilkinson RG. The impact of inequality. Social Research. 2006;73(2):711-732.

    Google Scholar 

  26. 26.

    Washington Post. Landmark: The inside story of America’s new health care law and what it means to all of us. 1st ed. New York: Public Affairs; 2010.

    Google Scholar 

  27. 27.

    Clark D, Chrysler L, Perkins A, et al. Screening, referral, and participation in a weight management program implemented in five CHCs. Journal of Health Care for the Poor and Underserved. 2010;21(2):617-628.

    PubMed  Article  Google Scholar 

  28. 28.

    Samuel-Hodge CD, Johnston LF, Gizlice Z, et al. Randomized trial of a behavioral weight loss intervention for low-income women: the weight wise program. Obesity. 2009;17(10):1891-1899.

    PubMed  Article  Google Scholar 

  29. 29.

    Ockene IS, Tellez TL, Rosal MC, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: The Lawrence Latino diabetes prevention project. American Journal of Public Health. 2012;102(2):336-342.

    PubMed  Article  Google Scholar 

Download references


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.

Author information



Corresponding author

Correspondence to Russell E Glasgow PhD.

Additional information


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.

About this article

Cite this article

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).

Download citation


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