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Why a translation framework
A DNP project can show that an intervention worked for the patients who received it and still have little public health impact, if few eligible people were reached, few sites adopted it or it stopped when the project ended. RE-AIM was developed to evaluate programs on the dimensions that together determine population impact.
The RE-AIM framework
Glasgow et al. (1999) proposed five dimensions, which operate at individual, organizational and community levels:
| Dimension | Question | Level |
|---|---|---|
| Reach | What proportion and how representative are the people who take part? | Individual |
| Efficacy or effectiveness | What is the impact on outcomes, including unintended effects? | Individual |
| Adoption | What proportion and how representative are the settings and staff that take it up? | Organization |
| Implementation | How consistently is it delivered as intended, and at what cost? | Organization |
| Maintenance | Are effects and delivery sustained over time? | Both |
The authors argued that failing to evaluate all five dimensions wastes resources and limits public health improvement. In a 20-year review, Glasgow et al. (2019) reported that RE-AIM had been cited in more than 2,800 publications. They encouraged pragmatic use of the key dimensions rather than exhaustive measurement of every element, greater attention to cost and to adaptations, and qualitative methods to understand how and why results occurred.
Applying RE-AIM to a DNP project
The project introduces an evidence-based fall prevention exercise program for older adults across five senior centers in a county. The program and its figures are illustrative.
| Dimension | Measures | Data sources |
|---|---|---|
| Reach | Number enrolled ÷ number of eligible adults screened at each center; comparison of participants' age, sex, race and fall history with all center members | Enrollment logs; center membership data |
| Effectiveness | Change in Timed Up and Go score and fear-of-falling scale at 12 weeks; self-reported falls at 6 months; adverse events during classes | Assessments; follow-up calls |
| Adoption | Number of centers offering the program ÷ number approached; characteristics of centers that declined | Partnership records; interviews with center directors |
| Implementation | Percentage of sessions delivered as designed; adaptations made and why; cost per participant | Fidelity checklists; instructor logs; budget |
| Maintenance | Individual: falls and function at 12 months. Organizational: programs still running 6 months after the project ends | Follow-up; center schedules |
Analytic plan
- Reach and adoption: report proportions with denominators, and compare participants with nonparticipants to identify who isn't being reached.
- Effectiveness: paired comparisons of pre- and post-program scores, with effect sizes and confidence intervals.
- Implementation: descriptive fidelity percentages; a qualitative summary of adaptations, following the call for attention to adaptation (Glasgow et al., 2019).
- Maintenance: follow-up rates and the proportion of centers continuing the program.
Using results
A program with high effectiveness but low reach, for example among men or non-English speakers, would point to recruitment changes. Low adoption would point to center-level barriers, such as space or instructor availability. Reporting all five dimensions gives decision-makers a realistic picture of what spreading the program would achieve.
References
Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Frontiers in Public Health, 7, Article 64. https://doi.org/10.3389/fpubh.2019.00064
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327. https://doi.org/10.2105/AJPH.89.9.1322
