Community Leaders: Applying the RE-AIM Framework

Reach–Read about Reach.
Go directly to a list of ways to improve reach.
Efficacy/Effectiveness–Read about Efficacy/Effectiveness.
Adoption–Read about Adoption.
Go directly to a list of ways to improve adoption.
Implementation–Read about Implementation.
Go directly to a list of ways to improve implementation.
Maintenance–Read about Maintenance.

Applying the RE-AIM Framework

Are both individual and setting-, or organizational-, levels of impact important?

Yes. Learn why and how they differ as you continue reading.

Levels of Impact

Reach and efficacy have an impact at the individual level. Adoption and implementation have an impact at the setting or organizational level. Maintenance applies to both the individual and setting levels. Evaluating both levels provides valuable independent information about the impact of a program.

Individual Level

Within a setting or community, the goal is to reach a large proportion of a target audience with an intervention that has efficacy. In evaluating interventions, we need to make sure that the target audience is representative of the target population.

A much greater potential for disseminating and translating a program to widespread practice exists when program developers are mindful of a program’s efficacy. Program developers should be sure that efficacy does not require staff in a setting to make huge investments and work only with their best clients.

As an example, let’s say that a school-based intervention has a large impact in terms of reach and efficacy at the individual level. However, the program requires specific resources that are unavailable in typical schools. Because of limited resources, only a small number of schools adopt, implement, and maintain the program.

Setting or Organizational Level

If you were to evaluate the program described above only at the individual level, you might conclude that it has potential for a large public health impact. In reality, this is unlikely because it is impractical for the program to be adopted, implemented, and maintained in real-world settings.

Likewise, if an intervention has systemic organizational adoption, implementation, and maintenance with little reach, efficacy, or maintenance at the individual level, it won’t have a large impact on public health. If you assess only one level (i.e., the organizational level), you might wrongly consider a program to have a large impact, even though it lacks individual-level reach, efficacy, and maintenance.