Once researchers have engaged with stakeholders who have the potential to mobilize resources and influence systems, those stakeholders must also make a conscious decision whether or not to adopt the intervention. Following a decision to adopt, there are multiple actions required to put the intervention into practice, such as training leaders, securing appropriate sites, marketing, and so forth. Throughout the process, researchers can encourage feedback from partner agencies who are launching interventions “on the ground”—and this feedback can, in turn, inform refinements of the intervention in the lab.
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The framework examines the translatability of public health promotion interventions in five dimensions:
- Reach into the target population: Is the intervention reaching the right people, those it was designed for?
- Efficacy or effectiveness: Does the intervention have a positive impact on the health issue being addressed? Does it actually provide benefits or does it unintentionally cause harm?
- Adoption: Are settings appropriate and accessible for the population you are trying to reach? Are there organizational supports that can help deliver the intervention—through partnering with local agencies, for instance?
- Implementation: Is the intervention being properly delivered? Are the differences seen attributable to that program?
- Maintenance: Is the program or intervention sustainable on both the individual and system levels so that it can be delivered long term?
Framework calculators, tools, and other resources are available on the RE-AIM Web site: www.re-aim.org.
A question-and-answer period following the presentations touched on, among other questions, how researchers might design interventional studies with an eye toward their practical applications in the community. Dr. Belza advised that researchers should design specific and clearly written protocols for instructors and participants. For an exercise such as sit and stand, for instance, the type of chair and exact instructions for the trainer should be clearly spelled out. Researchers should also ask what would work in real life and not just in an academic center or clinic where researchers have more resources (physical therapists, sophisticated testing equipment, etc.) at their disposal. According to Dr. Brady, when the CDC asked its state health-department partners about the elements of a workable program, they responded that “doable” programs would require minimal professional training for instructors (no advanced degrees, for example); minimal expense for participants (no more than $50 each); and minimal equipment (for example, a pedometer only). She and Dr. Belza encouraged researchers and implementers to engage in active dialogue about their public health interventions.