RE-AIM Evaluation Framework: Balancing Internal and External Validity

The RE-AIM framework was developed to help balance the emphasis on internal and external validity in research intended to have population impact. RE-AIM is an acronym for Reach, Effectiveness, Adoption, Implementation, and Maintenance. Together, these factors determine the public health impact of individual-level and community-driven interventions, and policy changes. Reach refers to the percent and representativeness of participants who are exposed to an intervention, and whether the program reaches those for whom it was intended. Effectiveness concerns both the intended impacts of an intervention on targeted outcomes, and the possible negative or unintended consequences of the intervention on quality of life and non-targeted outcomes. In the RE-AIM framework, Adoption and Implementation operate at the setting or contextual level. Adoption refers to the participation rate and representativeness of the settings and staff that conduct an intervention. Implementation refers to the time and costs of program delivery and the extent to which an intervention is delivered consistently across different program components and staff. Maintenance is measured at both individual and setting levels. At the individual level, maintenance refers to the long-term results of an intervention. At the setting level, maintenance refers to the institutionalization and or adaptation of a program. The relationships among various RE-AIM dimensions are as important as the results on any given dimension. All 5 RE-AIM dimensions are important and necessary for program evaluation. RE-AIM provides a generalizable model for such quality assessment and improvement.