RE-AIM: Researchers

RE-AIM Framework:
Maintenance of Health Behavior Interventions

Definition: The extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies. Maintenance in the RE-AIM framework also has referents at the individual level. At the individual level, maintenance has been defined as the long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact.

Research Issue:

What information is available on long-term individual or institutional effects?

Because the majority of the intervention studies concentrate on reporting early findings related to their programs, it is not surprising that few provide information on the long-term follow up of study participants or program sustainability. In fact, it is very difficult to find any information on institutionalization of interventions.

Examples of Maintenance from current literature:

Project ACTIVE (Dunn et al., 1999), a 24-month randomized clinical trial comparing the effects of two treatment arms on physical activity and cardiorespiratory fitness in adults, provides an example of maintenance data at the participant level. Both treatment groups received six months of intensive intervention. Measures, including physical activity, were obtained at the beginning of the clinical trial, at six months, and at 24 months. Findings indicated that both groups increased activity from the beginning to six months (i.e., during the intensive intervention) but decreased activity from six to 24 months. These findings support the need for multiple assessments of behavior in order to determine the pattern of behavior and, thus, whether participants maintain activity.
Although few studies have documented setting level maintenance or institutionalization, Richmond and colleagues (1998) provide an example of including this information in addition to reporting patient level long-term follow-up results and attrition rates. They followed up on family physicians who had participated in their smoking cessation training program. They found that 6 months after the 2-hour training, 93% of intervention condition physicians reported still using the program.