RE-AIM: Researchers

RE-AIM Framework:
Implementation of Health Behavior Interventions

Definition: At the setting level, implementation refers to the intervention agents' fidelity to the various elements of an intervention's protocol. This includes consistency of delivery as intended and the time and cost of the intervention.

Research Issue:

Do we know the extent to which the intervention was delivered as intended?

Implementation is assessed by reporting on what percentage of process objectives were achieved (e.g., what proportion of pamphlets were distributed, how many class hours were taught, or prescribed phone calls completed). Further, very few studies report costs or specific staff time commitments associated with intervention implementation — information often very important for determining if others will attempt to try a program.

Examples of Implementation from recent literature:

Baranowski and colleagues provided a good example of rigorously documenting implementation rates of the ñGimme 5 Fruit, Juice, and Vegetables for Fun and Health Trial.î In that study of fourth and fifth grade students, the intervention curriculum included components to be delivered at the school and newsletters with family activities and instructions for intervention at home. Researchers documented the delivery of the curriculum as intended through classroom observations and teacher self-report of the completion of the curriculum activities. All teachers were observed at least once during the 6-week intervention. The observations revealed that only 51% and 46% of the curriculum activities were completed in the fourth and fifth grade years of intervention, respectively. In contrast, teacher self-reported delivery was 90%.
Resnicow, et al. (1997) also demonstrated the need to track implementation of treatment delivery. One component of their self-help smoking cessation program was a telephone booster call. Of the 650 participants in the intervention arm of their study only 31% were reached for the intervention telephone call. They found that those who received the call had a significantly higher abstinence rate than those in the control and those in the intervention who had not received the booster call. Had the authors not documented the delivery of the intervention as intended, the null finding could have been attributed to an ineffective intervention rather than to an ineffective delivery of the intervention.