REAIM: BACKGROUND, USE, AND APPLICATION TO BEHAVIORAL ONCOLOGY

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RE-AIM BACKGROUND, USE, AND APPLICATION TO
BEHAVIORAL ONCOLOGY
Russell E. Glasgow, Ph.D. Kaiser Permanente
Colorado Behavioral Cooperative Oncology
Group 2005 Fall Conference
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OVERVIEW

• Background, definitions, core concepts, state of
  the science
• Applying RE-AIM Use in planning and evaluation
  self-rating exercise resources
• Applications of RE-AIM Successes and failures
  new developments future directions

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HISTORY/BACKGROUND FOR RE-AIM

• Late 1990s Increasingly clear that major
  problems moving research into practice
• Helpful models for understanding (e.g., Rogers)
  and planning (e.g., Green Kreuter) health care
  programs but no systematic models for translation
• Almost total focus on efficacyassumed that
  linear automatic process of efficacy ?
  effectiveness ? dissemination

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RE-AIM TO HELP PLAN, EVALUATE, AND REPORT STUDIES

• R Increase Reach
• E Increase Effectiveness
• A Increase Adoption
• I Increase Implementation
• M Increase Maintenance

Glasgow, et al. Ann Behav Med 200427(1)3-12
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PURPOSES OF RE-AIM

• To broaden the criteria used to evaluate programs
  to include external validity
• To evaluate issues relevant to program adoption,
  implementation, and sustainability
• To help close the gap between research studies
  and practice by
• Informing design of interventions
• Providing guides for adoptees
• Suggesting standard reporting criteria

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RE-AIM DIMENSIONS AND DEFINITIONS
www.re-aim.org
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RE-AIM DIMENSIONS AND DEFINITIONS (cont.)
www.re-aim.org
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RECOMMENDED PURPOSE OF TRANSLATION/EFFECTIVENESS
RESEARCH

• To determine the characteristics of interventions
  that can
• Reach large numbers of people, especially those
  who can most benefit
• Be widely adopted by different settings
• Be consistently implemented by staff members with
  moderate levels of training and expertise
• Produce replicable and long-lasting effects (and
  minimal negative impacts) at reasonable cost

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BRIEF SMOKING CESSATION IN PLANNED PARENTHOOD
CLINICS A RANDOMIZED TRIAL

• R.E. Glasgow, E.P. Whitlock,
• E.G. Eakin E. Lichtenstein

Am J Public Health200096786-789
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SETTING AND CONTEXT
Four Planned Parenthood Clinics in the Pacific
Northwest

• Serve predominantly female, low-income population
  (57 lt 125 of poverty level)
• Clients seen while at general health and
  contraceptive visits
• Providers are nurse practitioners and physician
  assistants
• Participant average age 24 smoked for 6 years
  lt 30 intended to quit in next month

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ADOPTION

• Approached 4 PP clinics in Portland, Oregon, that
  had most diverse, low SES populations
• All 4 clinics and all of providers in each clinic
  participated

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RECRUITMENT AND REACH

• Approach all female smokers (age 15-35) when in
  waiting room for usual visit
• 99 had smoking status identified
• 76 of these approached participated, n1154
• No differences, participants vs.
  non- participants

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INTERVENTION

• Brief written assessment (barriers, readiness to
  change)
• 9 min. video developed for this project
• Clinician advice to quit
• Brief motivational interviewing, barriers-based
  cessation counseling (12-15 min.)
• 2 follow-up phone calls

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IMPLEMENTATION
100
93
85
Percent ReceivingInterventionComponent
43
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SawVideo
ReceivedCounseling
ProviderAdvice
gt 1Call
gt 2Calls
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EFFECTIVENESS
6-week Cessation Rates(1-week abstinence
criterion)
Intent to Treat
Present at Follow-up
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10.2
7
6.9
Both significant, p lt .05
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MAINTENANCEAT 6 MONTHS

• Intent to treat, 30-day self-report 11.6 vs.
  8.5, NS
• Biochemically confirmed abstinence 6.4 vs.
  3.8, NS
• Small, but statistically significantly greater
  reductions among continuing smokers in
  intervention, p lt .05

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CONCLUSIONS FROM PP STUDY

• Feasible to reach a high percentage of young
  female smokers in these settings
• Regular PP staff able to deliver intervention
  consistently (but high turnover rates)
• Except phone calls

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CONCLUSIONS FROM PP STUDY (cont.)

• Excitement about involvement from clinical staff
  as long as demands are reasonable and are of
  benefit to clients
• Short-term success, but maintenance is
  challenging and need different follow-up support
  components

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ULTIMATE IMPACT OF MAGIC DIET PILL
Dissemination Step Concept Impacted
50 of Clinics Use Adoption 50
50 of Clinicians Prescribe Adoption 25
50 of Patients Accept Medication Reach 12.5
50 Follow Regimen Correctly Implementation 6.2
50 of Those Taking Correctly Benefit Effective
ness 3.2
50 Continue to Benefit After 6
Months Maintenance 1.6
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MORAL OF THE STORY?

• Focus on the Denominator
• (Each step of the dissemination
• sequence, or each RE-AIM
• dimension is important)

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APPLICATIONS OF RE-AIM

• Used in increasing number of publications to
  evaluate health promotion and recently,
  medication safety issues
• Used in planning at least one national physical
  activity program for older adultswith 14
  different grantees
• Used in number of published literature reviews

See www.re-aim.org
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ADOPTION FOR POLICY/DECISION MAKING

• RE-AIM used by CDC to evaluate practicality and
  generalizability of evidence-based obesity
  interventions
• RE-AIM used by national WISEWOMAN program for
  low-income women for qualitative and quantitative
  evaluation
• RE-AIM used by Robert Wood Johnson Foundation to
  help plan and evaluate 13 primary care,
  practice-based research network projects

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BCC Reach and Translation Workshop Health
Behavior Change Literature Review

• PURPOSE Review the recent literature on
  intervention research in major health promotion
  journals concerning reporting on internal and
  external validity issues
• SELECTION CRITERIA Controlled intervention
  study on smoking cessation, nutrition, or
  physical activity published from 1996-2000 in
  10-12 leading behavioral medicine journals
  (chosen based on circulation, publication of
  treatment studies, general not specialty journal)

Funded by a grant from the Robert Wood Johnson
Foundation
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RE-AIM LITERATURE REVIEW CONTROLLED STUDIES
1996-2000 IDENTIFIED BY JOURNAL AND BEHAVIOR
Glasgow, et al., 2004, Ann Behav Med, 28(2)75-80
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PERCENT OF STUDIES REPORTING ON RE-AIM
DIMENSIONSIndividual Level
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PERCENT OF STUDIES REPORTING ON RE-AIM
DIMENSIONSSetting Level
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SUMMARY AND CONCLUSIONS OF REVIEW

• Data are seldom reported on external validity.
  Particular attention is need to the
  representativeness of participants, settings, and
  intervention staff.
• Should report on reach, adoption, implementation,
  and maintenance, in addition to effectiveness.
• The actions and representativeness of
  intervention settings and agents are as important
  as the behavior and representativenss of
  subjectsand have received far less investigation.

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RECOMMENDED PURPOSE OF FUTURE RESEARCH

• To determine the characteristics of interventions
  that can
• Reach large numbers of people, especially those
  who can most benefit
• Be widely adopted by different settings
• Be consistently implemented by staff members
  with moderate levels of training and expertise
• Produce replicable and long-lasting effects
  (and minimal negative impacts) at reasonable
  cost

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CONCLUSION
The world is complex, contextual, and multiply
determined.
Designs and measures for translational research
should also incorporate these characteristics