RE-AIM.org > Researchers > Adoption

RE-AIM Framework:
Adoption of Health Behavior Interventions

Definition: The absolute number, proportion, and representativeness of settings and intervention agents who are willing to initiate a program.

Research Issue:

Is evaluating the impact of interventions solely at the individual-level (i.e., reach and efficacy) sufficient?

Because different settings (e.g., worksites, medical offices, schools, communities; governing agencies) and agents (e.g., teachers, physicians, health educators) can vary based on the number of resources, level of expertise, and commitment to intervention programs, understanding how adoption of interventions varies among settings and intervention agents (or modalities) is critical to the current and potential impact of an intervention. With the exception of the absolute number of settings involved, researchers seldom report on issues of adoption. As with reach, having information about representativeness unavailable is problematic. If differences do exist between participating sites or agents compared to those who do not, this is evidence of differential adoption. Comparisons should be made on basic information such as resource availability, setting size or location, and interventionist expertise.

Examples of Adoption from recent literature:

• An exemplar study for reporting on Adoption was by Lazovich, et al. In their evaluation of a dietary intervention conducted in primary care practices, they reported on participation at both the site level (6 of 22 clinics) and at the intervention agent level (39 of 193 family practice physicians). Unfortunately, there was no information on the representativeness of the clinics and physicians who participated.

• The SPARK physical activity and fitness trial that targeted elementary students also provides a good example of the proportion component of adoption (Sallis et al., 1997). In this study, the principals of 16 elementary schools were approached for participation in the trial. Twelve of the 16 schools were willing to participate; however, because of the level of research funding only seven of the 12 were selected for participation. Although there were no tests of representativeness of school resources, location, staff-to-student ratio, or other school-level variables, they did document that the seven smallest schools were selected for participation. Based upon this information one could conclude that the effects of the intervention could generalize to other small schools with similar resources, but effects of the intervention may not generalize to larger schools.

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