REAIM Review of Selected Health Behavior Intervention Studies

1
RE-AIM Review of Selected Health Behavior
Intervention Studies
RE-AIM Conference Reach Translation Working
Group Behavior Change Consortium (BCC) July 11,
2001
2
Purposes

• To determine the extent to which the RE-AIM
  dimensions were reported in recent intervention
  literature (last 5 years).
• For those studies reporting information, to
  summarize the RE-AIM dimensions by delivery
  sites.

3
Method

• Hand search of selected journals 1996-2000
• Selection criteria
• Randomized controlled trial or quasi-experimental
  study with at least a comparison group
• Intervention study with health behavior as
  outcome
• Smoking
• Nutrition
• Physical activity
• Multiple
• Conducted in the following sites
• Worksite
• Health Care
• School
• Community

4
Journals

• 10 Journals Hand Searched For Each Site and
  Behavior
• American Journal of Health Promotion
• American Journal of Preventive Medicine
• American Journal of Public Health
• Annals of Behavioral Medicine
• Australian and New Zealand Journal of Public
  Health
• Canadian Journal of Public Health
• Health Education and Behavior
• Health Education Research
• Journal of Behavioral Medicine
• Preventive Medicine

5
Additional Journals

• Worksite and Medical Office
• Journal of Occupational and Environmental
  Medicine
• Patient Education and Counseling
• Med Care
• School and Community
• American Journal of Community Psychology
• Journal of Adolescent Health
• Journal of School Health

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Worksite Journal Summary
Note This represents 16 studies reported in
24 separate articles
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School Journal Summary
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Percent of Studies Reporting on RE-AIM Components
from Worksites N24  
 
9
Percent of Studies Reporting on RE-AIM Components
from Schools N32  
 
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Figure. Means and Range of Results from School
Studies Reporting on RE-Aim Dimension
Reach N16
Implementation N11
Maintenance N0
Adoption N2
Efficacy N26
( participation)
( completion)
( participation)
( delivery)
( continue)
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Conclusions

• Satisfactory reporting of reach participation
• Needs improvement on describing
  representativeness, intervention fidelity,
  adoption at setting level, and maintenance of
  intervention
• The site of the study appears to influence the
  level of reporting of RE-AIM dimensions

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RE-AIM Survey of BCC Investigators

• RE-AIM Conference
• Reach Translation Working Group
• Behavior Change Consortium (BCC)
• July 11, 2001

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Purpose

• Assess feasibility of cross-site collaboration
• Assess evaluation framework to
• Transition from research to program application
  and dissemination
• Estimate potential public health impact of
  behavioral methods

14
Methods

• On-line survey administered to BCC investigators
  (www1.od.nih.gov/behaviorchange/surveys/
  reaim.htm)
• Queried the extent to which RE-AIM dimensions
  were addressed in current study Reach,
  Implementation, Efficacy/Effectiveness, Adoption,
  Maintenance
• Responses from 14 of 15 sites (93)

15
Reach

• Representativeness of Study Participants --
• 87 of sites estimating of targeted
  individuals that participate
• 71 recruiting from a defined population
• 79 comparing characteristics of participants
  nonparticipants
• 87 asking reasons for non-participation

16
Implementation

• Intervention Fidelity --
• 100 documenting tx received by individual and tx
  delivered by staff
• 100 comparing characteristics of high vs low
  level participation
• 86 analyzing interventionist characteristics
  related to outcome

17
Efficacy/effectiveness

• Short-term Impact/Outcomes on Participants
• 100 collecting multiple, objective outcome
  measures
• 93 documenting negative outcomes (e.g., QoL,
  pain discomfort)
• 64 reporting cost data (53 conducting economic
  analyses)

18
Adoption

• Participation and Representativeness of Sites --
• 29 estimating of eligible sites in study
  community
• 38 estimating of targeted sites approached
  that participate
• 31 will compare characteristics of participating
  nonparticipating sites

19
Adoption

• Participation and Representativeness of Sites --
• 46 formative assessment of intervention features
  desirable to program adoptees
• 77 plan to make intervention materials available
  to other programs or sites if successful outcomes

20
Maintenance

• Long-term outcomes at organizational level
• 54 will offer revised protocol to site after
  study ends
• 23 will follow program after funding is
  terminated
• 69will provide consultation to settings who wish
  to continue the intervention

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Conclusions

• RE-AIM practices of a select group of health
  behavior researchers (NIH-funded)
• Satisfactory in dimensions of
  representativeness of participants, intervention
  fidelity, measurement of outcomes
• Needs improvement on describing adoption at
  setting level, cost analyses, formative
  assessment of program sites, maintenance of
  interventions

22
RE-AIM Survey of Potential Program
AdopteesMarket Demand Perspective

• RE-AIM Conference
• Reach Translation Working Group
• Behavior Change Consortium (BCC)
• July 11, 2001

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Background

• Few behavior change programs translated from
  efficacy trials to dissemination
• Descriptive studies of dissemination of health
  promotion are available but theory testing not
  widely adopted by research community
• Dissemination research tends to take the
  perspective of the researcher rather than
  practitioners or potential program adopters

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Purpose

• Develop and administer a survey to organizations
  who have potential to adopt health promotion
  programs
• Better understand factors influencing adoption,
  implementation, and maintenance of behavioral
  change programs from practitioner perspective

25
Methods

• Surveys sent to schools, health care facilities,
  worksites, and community-based organizations
  identified by BCC investigators
• Targeted organizations that have adopted programs
  in the past and those that have not
• 67 of BCC sites offered 140 organizations
• Study is in progress -- awaiting responses

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Survey Development

• Guided by theories of organizational staging and
  organizational change diffusion process
• Awareness
• Search for response to problem
• Evaluate alternatives
• Decision to act
• Implementation
• Institutionalization

27
Survey Development

• Awareness --
• Health problems not perceived
• Risk information not available or trusted
• Preferred channels of communication to receive
  health risk information not used
• Program need not justified by risk assessment

28
Survey Development

• Search for response to perceived problem --
• Benefit of offering program not perceived
• Information on programs not available, trusted,
  or valued
• Preferred sources of program information not used
  
• Linking agents not available

29
Survey Development

• Evaluate program options --
• Poor credibility of program provider
• Cost (start-up and ongoing costs of staff, space,
  time, materials) prohibitive
• Complexity, relative advantage, risk,
  compatibility, flexibility, reversability

30
Survey Development

• Decision to act --
• Available information on program efficacy,
  efficiency, and effectiveness
• Local availability of programs
• Accessibility of replication data from successful
  program

31
Survey Development

• Implementation --
• Capacity to operate program in terms of staff
  availability, level of training required,
  facilities
• Availability of intervention materials
• Availability of training and technical assistance
  for start-up

32
Survey Development

• Institutionalization --
• Intervention effects not observable or realized
• Ownership not accepted by organization
• Collaborative exchange with technical advisors
  not available or adequate
• Program quality not maintained

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Anticipated Outcomes

• Survey responses will be used to
• Identify strategies to improve translation of
  programs from perspective of adopters
• Aid program developers to address key factors of
  adoption, implementation and maintenance
• Describe strategies to improve communication
  between health promotion researchers and
  potential program adopters

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Next Steps

• Evaluation report of survey responses made
  available to RWJ and BCC investigators
• Results discussed at 2 future meetings
• Dissemination panel of practitioners and
  decision-makers
• Combined meeting of researchers practitioners,
  decision-makers
• Documentation of conclusions and recommendations
  from panel meetings

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Discussion

• Does proposed model to link stages of research
  development with organizations and audience of
  potential program adopters make sense?
• How to improve researchers interest and skill in
  issues of dissemination at all phases of program
  planning and testing?
• How to increase information exchange between
  researchers and potential program adopters?