Goal of RE-AIM
-Encourage program planners to pay attention to essential program elements, including external validity, that can improve the sustainable adoption and implementation of effective, generalizable, interventions
External Validity
-Does it work outside of the lab/controlled setting/in real life (where other factors are in place)?
Reliability
-If I measure this will it be the same over time?
Validity
- Is this what I am actually trying to present?
- Does it work in various context?
Each letter of RE-AIM stands for…
R = Reach E = Effectiveness A = Adoption I = Implementation M = Maintenance
Reach
- How do I reach those who need this intervention?
- Whose behaviour is it we are trying to change?
- The absolute number, proportion and representativeness of target individuals willing to participate in a given initiative (who actually did the intervention)
- Are the people who participate, representative of the population?
Effectiveness
- How do I know my intervention is working?
- Is the intervention actually working/doing what you hoped it would do?
Adoption
- How do I develop organizational support to deliver my intervention?
- Are the people willing to adopt and do the intervention?
Implementation
- How do I ensure the intervention is delivered properly?
- are the people using and implementing it the way you have intended?
Maintenance
- How do I incorporate the intervention so it is delivered over the long term?
- Is the target audience adhering to long term behaviour change?
Representativeness
-The similarity or differences between those who participate and those who are eligible but do not
What happens if there are differences in those who participate in an intervention?
- An intervention can have a differential impact based on variables that can’t be determined because of lack of representativeness of the sample
- The intervention can be effective for the group participating and can have different impact on them compared to general population
What happens if there are no differences between the participating population?
-A stronger case can be made for the generalization of the intervention into real-world settings
Generalizability
- Are the people participating actually representative of the general population?
- If not, we want to look at why this group participated more and the rest of society, not.
How to improve REACH?
- Build relationships with target population (presentations, assist with events, volunteer in similar places, class talks, etc)
- Involve target population in creating the program (ask what will motivate them, make it more meaningful for them, what information do they want, etc)
- What are the best ways to recruit people to the program? (professionals, experts, etc)
What to ask when determining REACH?
-Who is the intervention most likely to reach? (participate, demographic differences)
-How would you figure out who you are reaching? (questionnaires, surveys, ask)
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Efficacy/Effectiveness
- The impact of an intervention on important outcomes (potential negative effects, quality of life, economic)
- What is the cost?
- What would you determine changed? What are you seeing changed?
- What would you measure to determine how well the intervention is working?
What is efficacy?
-The test of an intervention under controlled, ideal conditions (an experiment)
What is effectiveness?
-The test of an intervention in the “real world” where things can’t be controlled
What is adoption?
- The absolute number, proportion, and representativeness of settings and intervention agents who are willing to initiate a program
- Who will actually give out/deliver the intervention? And why?
- How representative are they of different programs and settings?
- Can have many levels (What are the levels within an organization where you are trying to get people to adopt?)
- Who might be the staff/settings in which this program is adopted?
Make it easy for decision makers to say yes to these 2 questions…
- As an organization, will we add value to our service and mission by offering this program? (will it be helpful to the people I’m working with? What is in it for me?)
- Does our organization have the capacity, resources, or expertise necessary to deliver the program? (Is it feasible for us? Do we have enough people, resources or expertise who can deliver it? Does it make sense for the people I am asking to implement it?)
Who are decision makers?
-Those who have to decide if they want to participate in your program/deliver your program
What is implementation?
- The intervention agents’ fidelity to the various elements of an intervention’s protocol
- Consistency of delivery as intended and time of the intervention (Is the intervention delivery consistent as intended and over time?)
- Includes any adaptations made to interventions and implementation strategies (tweaks made because they forgot overtime or think it is what they should be doing)
- Is the intervention being implemented the way you intended?
How do we assess implementation?
- Assessed by reporting on what percentage of prices objectives were achieved
- How many objectives within the process itself were achieved?
- How much was actually done?
