摘要：Interventions that are effective are often improperly or only partially implemented when put into practice. When intervention programs are evaluated, feasibility of implementation and effectiveness need to be examined. Reach, effectiveness, adoption, implementation, and maintenance make up the RE-AIM framework used to assess such programs. To examine the usefulness of this metric, we addressed 2 key research questions. Is it feasible to operationalize the RE-AIM framework using women’s health program data? How does the determination of a successful program differ if the criterion is (1) effectiveness alone, (2) reach and effectiveness, or (3) the 5 dimensions of the RE-AIM framework? Findings indicate that it is feasible to operationalize the RE-AIM concepts and that RE-AIM may provide a richer measure of contextual factors for program success compared with other evaluation approaches. EVIDENCE-BASED PUBLIC health research improves the quality of practice by providing systematic information about tested intervention strategies to public health practitioners. 1 The strongest evidence is often gathered from highly controlled research studies 1 , 2 that are designed to test whether a well-defined intervention results in health improvements under ideal conditions. Such studies, referred to as efficacy studies, 3 , 4 are designed to eliminate alternative explanations of the causes of the health outcomes of the intervention; consequently, a high degree of experimental control is used. Interventions most worthy of replication in practice are those for which efficacy studies show the strongest association between the intervention and the outcome. 5 Because they work to improve the health of large populations, public health scientists seek interventions that appeal to the public at large, are effective in practice, and will be adopted rapidly by practitioners. Interventions designed for efficacy studies generally appeal to only the most motivated participants, are less effective when implemented outside of controlled research situations, 6 and are not easily adopted by practitioners because of their complexity. For a public health scientist, the intervention that warrants replication is the one that has the greatest public health impact, is low-cost, efficient, and feasible to implement in a nonresearch population. The public health field needs a broad, multidimensional approach to evaluate interventions. Abrams and colleagues 7 defined the impact of an intervention as the product of its reach (R) and its efficacy (E), where reach is defined as the percent penetration of the intervention into a defined population. These researchers cited 2 extreme intervention scenarios that could result in zero impact: “(1) a very effective, expensive program (100% efficacy) that fails to attract any clients (0% reach) or (2) a self-help brochure delivered to every smoker (100% reach) that does not work at all (0% efficacy).” 7 (p292) Glasgow et al. 6 expanded the 2-component measure (RE) to a 5-component measure (RE-AIM): reach, efficacy or effectiveness, adoption, implementation, and maintenance. Reach indicates the proportion and representativeness of the target population that participated in the program. Efficacy or effectiveness is the positive program outcomes, minus the negative outcomes. Adoption refers to the proportion and representativeness of settings and people that will adopt the program. Implementation is the extent to which the intervention is implemented as intended. Maintenance is the extent to which the program is sustained over time. The overall public health impact of the intervention is measured by combining all 5 dimensions to create a composite score. The goal of the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) public health program is to improve the health of midlife, uninsured women by providing cardiovascular screening and lifestyle intervention. 8 As part of the program evaluation effort, data from the 15 projects where the WISEWOMAN program is implemented were used to examine the feasibility and effectiveness of adding a cardiovascular disease prevention component to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). To assess whether the RE-AIM framework is useful for evaluating WISEWOMAN public health programs, we addressed 2 key research questions: (1) Is it feasible to operationalize the RE-AIM concepts using existing WISEWOMAN program data? 1 and (2) How does the determination of a successful WISEWOMAN program differ if effectiveness alone or a broader approach, such as RE-AIM, is used as a measure? 2
