Use of RE-AIM to address health inequities: Application in a low-income community health center-based weight loss and hypertension self-management program
Use of RE-AIM to address health inequities: Application in a low-income community health center-based weight loss and hypertension self-management program
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DOI：
10.1007/s13142-013-0201-8
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发表时间：
2013-06-01
影响因子：
3.6
通讯作者：
Bennett, Gary G.
中科院分区：
文献类型：
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作者：
Glasgow, Russell E.;Askew, Sandy;Bennett, Gary G.
虽然卫生不公平现象有充分的记录，并且有有助于了解卫生差距的框架，但还需要实施框架，以便重点设计、评估和报告针对风险增加人群的干预措施。本研究旨在描述RE-AIM框架如何达到、有效性、采用、实施和维持这些目的，并说明其在随机、实用的减肥和高血压自我管理干预中的应用。RE-AIM用于规划和评估城市社区卫生中心患者的Be Fit Be Well项目。RE-AIM框架有助于集中注意并产生高采用率和覆盖面。各个组件的执行率各不相同。体重减轻有统计学意义，但没有临床意义。它们在各种患者特征上都是稳健的，而且该计划的成本相对较低。在整个24个月的时间里，个体体重减轻和血压降低都保持了下来，但该计划在三种情况下都没有持续下去。诸如REAIM等实施框架可以帮助设计务实的干预措施，既注重减少差距的背景，又注重对公共卫生产生影响的最终目标。
While health inequities are well documented, and there are helpful frameworks to understand health disparities, implementation frameworks are also needed to focus the design, evaluation, and reporting on interventions targeting populations at increased risk. This study aims to describe how the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework can be used for these purposes and illustrate its application in the context of a randomized, pragmatic weight loss and hypertension self-management intervention. RE-AIM was used to both plan and evaluate the Be Fit Be Well program for urban community health center patients. The RE-AIM framework helped to focus attention on and produce high rates of adoption and reach. Implementation rates varied across components. Weight losses were statistically significant, but not clinically significant. They were robust across a variety of patient characteristics, and the program was relatively of low cost. Individual weight losses and blood pressure reductions were maintained throughout the 24-month period, but the program was not sustained at any of the three settings. Implementation frameworks such as REAIM can help design pragmatic interventions that focus on both the context for disparities reduction and the ultimate goal of public health impact.