Glasgow Russell E, Askew Sandy, Purcell Peyton, Levine Erica, Warner Erica T, Stange Kurt C, Colditz Graham A, Bennett Gary G
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
Transl Behav Med. 2013 Jun 1;3(2):200-210. doi: 10.1007/s13142-013-0201-8.
While health inequities are well documented, and there are helpful frameworks to understand health disparities, implementation frameworks are also needed to focus the design, evaluation and reporting on interventions targeting populations at increased risk.
Describe how the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) can be used for these purposes and illustrate its application in the context of a randomized, pragmatic weight-loss and hypertension self-management intervention.
RE-AIM was used to both plan and evaluate the Be Fit Be Well program for urban community health center patients.
The RE-AIM framework helped to focus attention on and produce high rates of adoption and reach. Implementation rates varied across components. Weight losses were statistically significant, but not clinically significant. They were robust across a variety of patient characteristics, and the program was relatively low cost. Individual weight losses and blood pressure reductions were maintained throughout the 24-month period, but the program was not sustained at any of the three settings.
Implementation frameworks such as RE-AIM can help design pragmatic interventions that focus on both the context for disparities reduction and the ultimate goal of public health impact.
虽然健康不平等现象有充分的文献记载，并且有有助于理解健康差异的框架，但还需要实施框架来聚焦针对风险增加人群的干预措施的设计、评估和报告。
描述如何将RE-AIM框架（覆盖范围、有效性、采用率、实施情况和维持情况）用于这些目的，并说明其在一项随机、实用的减肥和高血压自我管理干预措施中的应用。
使用RE-AIM来规划和评估针对城市社区卫生中心患者的“保持健康”项目。
RE-AIM框架有助于集中注意力并实现高采用率和高覆盖范围。各组成部分的实施率各不相同。体重减轻具有统计学意义，但不具有临床意义。体重减轻在各种患者特征中都很显著，并且该项目成本相对较低。个体体重减轻和血压降低在24个月期间一直保持，但该项目在三个地点中的任何一个都没有持续下去。
诸如RE-AIM之类的实施框架有助于设计注重减少差异的背景和公共卫生影响这一最终目标的实用干预措施。
