BackgroundThe reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study.MethodsIn April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015.ResultsEighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs.ConclusionsThe RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0141-0) contains supplementary material, which is available to authorized users.

PURPOSE Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care. METHODSAs part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)-an electronic or paperbased health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach). RESULTSMost practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higher reach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P <.001). No practices were able to sustain the complete MOHR assessment without adaptations after study completion. Fielding MOHR increased staff and clinician time an average of 28 minutes per visit.CONCLUSIONS Primary care practices can implement health behavior and mental health assessments, but counseling patients effectively requires effort. Practices will need more support to implement and sustain assessments. INTRODUCTIONA substantial burden of unhealthy behaviors leads to chronic diseases and mental health disorders among patients seen in primary care settings.1 Health risk assessments (HRAs) can help identify and address factors that place a person at enhanced risk for morbidity or mortality. Primary care is a promising setting to conduct HRAs because risk identification can be linked to assistance from clinicians who have a longstanding and trusting relationship with the patient.2 Unfortunately, many primary care practices are overwhelmed by competing demands, and typical office visits provide little time to address health risk information. 3,4 As early as 1970, clinician manuals promoted sample HRA questionnaires, risk computations, and feedback strategies.5 While HRAs were not widely adopted by the medical profession, they proliferated in workplaces and community-based programs. 6,7 In these settings, HRAs improved health indicators such as blood pressure, weight, physical activity, and general health status. 8,9 A critical finding was that merely administering an HRA questionnaire does not produce behavior change. [10][11][12] Comprehensive, well-resourced follow-up is essential to help individuals gain the skills they needed to change h...

Integrated research-practice partnerships (IRPPs) may improve adoption of evidence-based programs. The aim of this study is to compare adoption of an IRPP-developed physical activity (PA) program (Fit Extension, FitEx) to a typical efficacy-effectiveness-dissemination pipeline model program (Active Living Every Day, ALED). Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, a randomized controlled trial assigned health educators (HEs) to FitEx (n = 18) or ALED (n = 18). Fourteen HEs adopted FitEx, while two HEs adopted ALED (χ 2 = 21.8; p < 0.05). FitEx HEs took less time to deliver (p < 0.05), stated greater intentions for continued program delivery (p < 0.05), and reached more participants (n = 1097 total; 83 % female; 70 % Caucasian; M age = 44 ± 11.8) per HE than ALED (n = 27 total; 60 % female; 50 % Caucasian; M age = 41 ± 11.3). No significant difference existed in FitEx or ALED participants' increased PA (M increase = 9.12 ±29.09 min/ day; p > 0.05). IRPP-developed programs may improve PA program adoption, implementation, and maintenance and may also result in programs that have higher reach-without reducing effectiveness. KeywordsTranslation, Physical activity, RE-AIM, Researchpractice Regular physical activity plays an important role in the prevention, onset, and management of many adverse chronic health conditions [1]. Conversely, physical inactivity is one of the primary behavioral causes of death in the USA [2] and contributes to the 483.8 billion dollars spent each year for the management and treatment of cardiovascular diseases and diabetes [3]. Unfortunately, less than half of the adult population is active at a recommended level [4] of moderate intensity for at least 30 min/day, 5 days or more per week [5]. While interventions (programs, policy, and practice) exist that aim to increase physical activity, there is a lack of translation of effective evidence-based programs into practice [6].Reasons for this lack of translation are related to both research and practice. First, using research reporting guidelines that are predominantly focused on internal validity (e.g., CONSORT Statement [7]) results in a body of literature that values the strong internal validity but attributes only a passing focus on issues of external validity [8]. In fact, a series of reviews of intervention studies published in leading journals that targeted physical activity (as well as nutrition and smoking) bears this out, showing that external validity (e.g., participant's representativeness, organizational adoption, and program sustainability) was rarely reported [9][10][11]. Second, a linear (or top down) model of dissemination, which highlights the researcher as the expert and developer of products, and the delivery system as a simple receptor of evidence-based programs are a common depiction of translation of research to practice [12]. A linear model has a number of drawbacks for translation of research to practice: (1) it fails to address the organizational and community ca...

The implementation of evidence-based physical activity interventions is improved when integrated research-practice partnerships are used. These partnerships consider both research- and practice-based evidence that moves beyond only assessing program efficacy. Our novel hypothesis is that integrated research-practice partnerships may lead to interventions that are practical and effective, reach more participants, and are more likely to be sustained in practice.

Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial Registration Clinicaltrials.gov identifier: NCT01825746