Coding Sheet for Publications Reporting on RE-AIM Elements
| Journal Citation |
Worksite |
Medical Office |
School |
Community |
(circle) |
| (Author, Journal,
Year, Page) |
PA |
Smoking |
Nutrition |
(circle relevant) |
|
Reported
(Yes/No) |
Data |
Comments |
| Method to identify target population |
|
|
|
| Inclusion criteria |
|
|
|
| Exclusion criteria |
|
|
|
| Sample size and participation rate |
|
|
|
| Characteristics of both participation and non-participation
|
|
|
|
| |
Design |
Conditions |
Design/Conditions
|
|
|
|
Reported
(Yes/No) |
Effect
Size and Raw Outcomes (where applicable) |
p
value |
Comments |
| Measures/Results (at shortest assessment) |
|
|
|
| Intent to treat or present at FU (circle one) |
|
|
|
| Imputation procedures (specify) |
|
|
|
| Quality of life measure |
|
|
|
| Effects at longest (specify time) |
|
|
|
Percent attrition
|
|
|
|
| ADOPTION
- DIFFUSION - Setting Level |
Reported
(Yes/No) |
Data |
Comments |
| Method to identify target delivery
agent |
|
|
|
| Level of expertise of delivery
agent |
|
|
|
| Inclusion/exclusion criteria |
|
|
|
| Rate |
|
|
|
| Characteristics of adoption/non-adoption |
|
|
|
| Measures of cost |
|
|
|
| IMPLEMENTATION |
Reported
(Yes/No) |
Data |
Comments |
| Intervention type and intensity |
|
|
|
| Extent protocol delivered as intended
(%) |
|
|
|
| Measures of cost |
|
|
|
| MAINTENANCE |
Reported
(Yes/No) |
Data |
Comments |
| Was individual behavior assessed
at least 6 months following the completion of the intervention? |
|
|
Follow-up
period = |
| Is the program still in place? |
|
|
Follow-up
period = |
| Was the program modified? Specify |
|
|
Follow-up
period = |
