Skip to main content
SpringerLink
Log in

Beginning with the application in mind: Designing and planning health behavior change interventions to enhance dissemination

  • Published:
Annals of Behavioral Medicine

Abstract

Dissemination of behavior change interventions can be enhanced by considering key elements related to public health impact in the study design and planning phases of research projects. In this article we describe a framework of reach, efficacy/effectiveness, adoption, implementation, and maintenance known as RE-AIM and how it can be used to plan and design studies with features that can strengthen the potential translation of interventions. In describing how RE-AIM concepts were introduced to and adopted by 15 behavior change intervention studies as part of the Behavioral Change Consortium (BCC), we provide an example of practical application of the framework. Recommendations for applying the framework to study planning are based on literature reviews conducted by the RE-AIM workgroup and on discussions with investigators who participated in BCC. Utilizing RE-AIM as a planning framework may have increased attention to issues of external validity among BCC studies and enhanced the potential translation and dissemination of intervention findings into practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McGinnis JM, Foege WH: Actual causes of death in the United States.Journal of the American Medical Association. 1993,270:2207–2212.

    Article  PubMed  CAS  Google Scholar 

  2. Solomon S, Kington R: National efforts to promote behavior-change research: views from the Office of Behavioral and Social Sciences Research.Health Education Research. 2002,17:495–499.

    Article  PubMed  Google Scholar 

  3. Ory MG, Jordan PJ, Bazzarre T: The Behavior Change Consortium: Setting the stage for a new century of health behavior-change research.Health Education Research. 2002,17:500–511.

    Article  PubMed  CAS  Google Scholar 

  4. Glasgow RE, Klesges LM, Dzewaltowski D, Bull SS, Estabrooks P: The future of health behavior change research: What is needed to improve translation of research into health promotion practice?Annals of Behavioral Medicine. 2004,27:3–12.

    Article  PubMed  Google Scholar 

  5. McGlynn EA, Asch SM, Adams J, et al.: The quality of health care delivered to adults in the United States.New England Journal of Medicine. 2003,348:2635–2645.

    Article  PubMed  Google Scholar 

  6. Committee on Health Care in America, Institute of Medicine:Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.

    Google Scholar 

  7. Dzewaltowski DA, Estabrooks PA, Klesges LM, Bull S, Glasgow RE: Behavior change intervention research in community settings: How generalizable are the results?Health Promotion International. 2004,119:235–245.

    Article  Google Scholar 

  8. Bull SS, Gillette C, Glasgow RE, Estabrooks P: Work site health promotion research: To what extent can we generalize the results and what is needed to translate research to practice?Health Education & Behavior. 2003, 30:537–549.

    Article  Google Scholar 

  9. Estabrooks P, Dzewaltowski DA, Glasgow RE, Klesges LM: Reporting of validity from school health promotion studies published in 12 leading journals, 1996–2000.The Journal of School Health. 2003, 73:21–28.

    Article  PubMed  Google Scholar 

  10. Glasgow RE, Bull SS, Gillette C, Klesges LM, Dzewaltowski DA: Behavior change intervention research in health care settings: A review of recent reports, with emphasis on external validity.American Journal of Preventive Medicine. 2002,23:62–69.

    Article  PubMed  Google Scholar 

  11. Tunis SR, Stryer DB, Clancy CM: Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.Journal of the American Medical Association. 2003,290:1624–1632.

    Article  PubMed  CAS  Google Scholar 

  12. Glasgow RE, Lichtenstein E, Marcus A: Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition.American Journal of Public Health. 2003,93:1261–1267.

    PubMed  Google Scholar 

  13. Glasgow RE, Vogt TM, Boles SM: Evaluating the public health impact of health promotion interventions: The RE-AIM framework.AmericanJournal of Public Health. 1999,89:1323–1327.

    Google Scholar 

  14. Leviton L: External validity.International Encyclopedia of the Behavioral and Social Sciences (Vol. 8). Oxford, England: Elsevier, 2001, 5195–5200.

    Google Scholar 

  15. RE-AIM: RE-AIM.org [Home page]. Retrieved March 2, 2005, from http://www.re-aim.org/

  16. Behavioral Change Consortium: Behavior Change Consortium [Home page]. Retrieved DATE from http://www1.od. nih.gov/behaviorchange/

  17. Jo Harris K, Ahluwalia JS, Catley D, et al.: Successful recruitment of minorities into clinical trials: The Kick It at Swope project.Nicotine & Tobacco Research. 2003,5:575–584.

    Article  Google Scholar 

  18. Green LW, Mercer SL: Can public health researchers and agencies reconcile the push from funding bodies and the pull from communities?American Journal of Public Health. 2001,91:1926–1929.

    Article  PubMed  CAS  Google Scholar 

  19. Gittelsohn J, Evans M, Story M, et al.: Multisite formative assessment for the Pathways study to prevent obesity in American Indian schoolchildren.American Journal of Clinical Nutrition. 1999,69(Suppl. 4):767S-772S.

    PubMed  CAS  Google Scholar 

  20. Schulz AJ, Parker EA, Israel BA, et al.: Conducting a participatory community-based survey for a community health intervention on Detroit’s east side.Journal of Public Health Management Practice. 1998,4:10–24.

    CAS  Google Scholar 

  21. Dzewaltowski DA, Estabrooks PA, Johnston JA: Healthy youth places promoting nutrition and physical activity.Health Education Research. 2002,17:541–551.

    Article  PubMed  Google Scholar 

  22. Coday M, Klesges LM, Garrison RJ, et al.: Health Opportunities with Physical Exercise (HOPE): Social contextual interventions to reduce sedentary behavior in urban settings.Health Education Research. 2002,17:637–647.

    Article  PubMed  CAS  Google Scholar 

  23. Saunders SD, Greaney ML, Lees FD, Clark PG: Achieving recruitment goals through community partnerships: The SENIOR Project.Family & Community Health. 2003,26:194–202.

    Google Scholar 

  24. Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Bagdade JD: Enhancing support for health behavior change among women at risk for heart disease: The Mediterranean Lifestyle Trial.Health Education Research. 2002,17:574–585.

    Article  PubMed  Google Scholar 

  25. Coday M, Boutin-Foster C, Goldman Sher T, et al.: Strategies for retaining study participants in behavioral intervention trials: Retention experiences of the NIH Behavior Change Consortium.Annals of Behavioral Medicine. 2005, 29(Suppl. 2):55–65. [this issue]

    Article  PubMed  Google Scholar 

  26. Glanz K, Rimer BK, Lewis FM (eds):Health Behavior and Health Education: Theory, Research and Practice (3rd Ed.). San Francisco: Jossey-Bass, 2002.

    Google Scholar 

  27. Bartholemew LK, Parcel GS, Kok G, Gottlieb N:Intervention Mapping: Designing Theory and Evidence-Based Health Promotion Programs. Mountain View, CA: Mayfield, 2001.

    Google Scholar 

  28. Perry CL:Creating Health Behavior Change: How to Develop Community-Wide Programs for Youth. Thousand Oaks, CA: Sage, 1999.

    Google Scholar 

  29. Jeffery RW: Risk behaviors and health: contrasting individual and population perspectives.American Psychologist. 1989,44:1194–1202.

    Article  PubMed  CAS  Google Scholar 

  30. Abrams DB, Mills S, Bulger D: Challenges and future directions for tailored communication research.Annals of Behavioral Medicine. 1999,21:299–306.

    PubMed  CAS  Google Scholar 

  31. Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO: How effective is tailored print communication?Annals of Behavioral Medicine. 1999,21:290–298.

    PubMed  CAS  Google Scholar 

  32. Stokols D: Social ecology and behavioral medicine: Implications for training, practice, and policy.Behavioral Medicine. 2000,26:129–138.

    Article  PubMed  CAS  Google Scholar 

  33. DiClemente CC, Marinilli AS, Singh M, Bellino LE: The role of feedback in the process of health behavior change.American Journal of Health Behavior. 2001,25:217–227.

    PubMed  CAS  Google Scholar 

  34. McClure JB: Are biomarkers useful treatment aids for promoting health behavior change? An empirical review.American Journal of Preventive Medicine. 2002,22:200–207.

    Article  PubMed  Google Scholar 

  35. Locke EA, Latham GP: Building a practically useful theory of goal setting and task motivation.A35-year odyssey.The American Psychologist. 2002,57:705–717.

    Article  PubMed  Google Scholar 

  36. Strecher VJ, Seijts GH, Kok GJ, et al.: Goal setting as a strategy for health behavior change.Health Education Quarterly. 1995,22:190–200.

    PubMed  CAS  Google Scholar 

  37. Hecht J, Borrelli B, Breger R, et al.: Motivational interviewing in community-based research: Experiences from the field.Annals of Behavioral Medicine. 2005, 29(Suppl. 2):29–34. [this issue]

    Article  PubMed  Google Scholar 

  38. Clark PG, Nigg CR, Greene G, Riebe D, Saunders SD: The study of exercise and nutrition in olders Rhode Islanders (SENIOR): Translating theory into research.Health Education Research. 2002,17:552–561.

    Article  PubMed  Google Scholar 

  39. Strecher V, Wang C, Derry H, Widenhaus K, Johnson C: Tailored interventions for multiple risk behaviors.Health Education Research. 2002,17:619–626.

    Article  PubMed  Google Scholar 

  40. Borrelli B, McQuaid EL, Becker B, et al.: Motivating parents of kids with asthma to quit smoking: The PAQS project.Health Education Research. 2002,17:659–669.

    Article  PubMed  Google Scholar 

  41. Resnicow K, Jackson A, Braithwaite R, et al.: Healthy Body/Healthy Spirit: A church-based nutrition and physical activity intervention.Health Education Research. 2002,17:562–573.

    Article  PubMed  Google Scholar 

  42. Moe EL, Elliott DL, Goldberg L, et al.: Promoting Healthy Lifestyles: Alternative Models’ Effects (PHLAME).Health Education Research. 2002, 17:586–596.

    Article  PubMed  Google Scholar 

  43. Glasgow RE: Translating research to practice: Lessons learned, areas for improvement, and future directions.Diabetes Care. 2003,26:2451–2456.

    Article  PubMed  Google Scholar 

  44. Flay BR: Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs.Preventive Medicine. 1986,15:451–474.

    Article  PubMed  CAS  Google Scholar 

  45. Kaplan RM: The Ziggy Theorem: Toward an outcomes-focused health psychology.Health Psychology. 1994,13:451–460.

    Article  PubMed  CAS  Google Scholar 

  46. Abrams DB, Orleans CT, Niaura RS, et al.: Integrating individual and public health perspectives for treatment of tobacco dependency in managed care: A combined stepped-care and matching model.Annals of Behavioral Medicine. 1996,18:290–304.

    PubMed  CAS  Google Scholar 

  47. Teutsch SM: A framework for assessing the effectiveness of disease and injury prevention.Morbidity and Mortality Weekly Report, recomm Rep. 1992,41(RR-3):1–12.

    CAS  Google Scholar 

  48. King AC, Friedman R, Marcus B, et al.: Harnessing motivational forces in the promotion of physical activity: The Community Health Advice by Telephone (CHAT) project.Health Education Research. 2002,17:627–636.

    Article  PubMed  Google Scholar 

  49. Beyer JM, Trice HM: The utilization process: A conceptual framework and synthesis of empirical findings.Administrative Science Quarterly. 1982, 27:591–622.

    Article  Google Scholar 

  50. Goodman R, Steckler A, Kegler M: Mobilizing organizations for health enhancement: Theories of organizational change. In Glanz K, Lewis FM, Rimer BK (eds),Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass, 1997, 287–312.

    Google Scholar 

  51. Rogers EM:Diffusion of Innovations (5th Ed.). New York: The Free Press, 2003.

    Google Scholar 

  52. Oldenburg B, Hardcastle DM, Kok G: Diffusion of innovations. In Glanz K, Rimer BK, Lewis FM (eds),Health Behavior and Health Education: Theory, Research and Practice San Francisco: Jossey-Bass, 2002, 312–360.

    Google Scholar 

  53. Berwick DM: Disseminating innovations in health care.Journal of the American Medical Association. 2003, 289:1969–1975.

    Article  PubMed  Google Scholar 

  54. Szilagyi P, Vann J, Bordley C, et al.: Interventions aimed at improving immunization rates.Cochrane Database of Systematic Reviews. 2002, (4):CD003941.

  55. Goodwin MA, Zyzanski SJ, Zronek S, et al.: A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP).American Journal of Preventive Medicine. 2001,21:20–28.

    Article  PubMed  CAS  Google Scholar 

  56. National Cancer Institute, Center for Advancement of Health, Robert Wood Johnson Foundation:Designing For Dissemination Conference Summary Report. Washington, DC: National Cancer Institute, 2002. Available at cancercontrol.cancer.gov/ d4d/d4d_conf_sum_report.pdf

    Google Scholar 

  57. Estabrooks PA, Bradshaw M, Fox EH, Berg J, Dzewaltowski DA: The relationship between delivery agents’ physical activity level and the likelihood of implementing a physical activity program.American Journal of Health Promotion (in press).

  58. Green LW: From research to “best practices” in other settings and populations.American Journal of Health Behavior. 2001,25:165–178.

    PubMed  CAS  Google Scholar 

  59. Green L, Daniel M, Novick L: Partnerships and coalitions for community-based research.Public Health Reports. 2001,116(Suppl. 1):20–31.

    Article  PubMed  Google Scholar 

  60. Corbie-Smith G, Ammerman AS, Katz ML, et al.: Trust, benefit, satisfaction, and burden: A randomized controlled trial to reduce cancer risk through African-American churches.Journal of General Internal Medicine. 2003,18:531–541.

    Article  PubMed  Google Scholar 

  61. Schulz AJ, Israel BA, Parker EA, et al.: The East Side Village Health Worker Partnership: Integrating research with action to reduce health disparities.Public Health Reports. 2001,116:548–557.

    PubMed  CAS  Google Scholar 

  62. Stillman FA, Bone LR, Rand C, Levine DM, Becker DM: Heart, body, and soul: A church-based smoking-cessation program for Urban African Americans.Preventive Medicine. 1993,22:335–349.

    Article  PubMed  CAS  Google Scholar 

  63. Kumanyika SK, Story M, Beech BM, et al.: Collaborative planning for formative assessment and cultural appropriateness in the Girls Health Enrichment Multi-site Studies (GEMS): A retrospection.Ethnicity & Disease. 2003, 13(Suppl. 1):S1–1529.

    Google Scholar 

  64. Wagner EH, Glasgow RE, Davis C, et al.: Quality improvement in chronic illness care: A collaborative approach.Joint Commission Journal on Quality Improvement. 2001,27:63–80.

    PubMed  CAS  Google Scholar 

  65. Glasgow RE, Orleans CT, Wagner EH: Does the chronic care model serve also as a template for improving prevention?Milbank Quarterly. 2001,79:579–612, iv-v.

    Article  PubMed  CAS  Google Scholar 

  66. Baranowski T, Stables G: Process evaluation of the 5-a-Day projects.Health Education & Behavior. 2000,27:157–166.

    Article  CAS  Google Scholar 

  67. Steckler A, Linnan L (eds):Process Evaluation for Public Health Interventions and Research. San Francisco: Jossey-Bass, 2002.

    Google Scholar 

  68. Bellg A J, Borrelli B, Resnick B, et al.: Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the Behavior Change Consortium.Health Psychology (in press).

  69. Orleans CT: Promoting the maintenance of health behavior change: Recommendations for the next generation of research and practice.Health Psychology. 2000,19(Suppl. 1):76–83.

    Article  PubMed  CAS  Google Scholar 

  70. Wing RR: Cross-cutting themes in maintenance of behavior change.Health Psychology. 2000,19(Suppl. 1):84–88.

    Article  PubMed  CAS  Google Scholar 

  71. Goodman RM, McLeroy KR, Steckler AB: Development of level of institutionalization scales for health promotion programs.Health Education Quarterly. 1993,20:161–178.

    PubMed  CAS  Google Scholar 

  72. Barab SA, Redman BK, Froman RD: Measurement characteristics of the levels of institutionalization scales: examining reliability and validity.Journal of Nursing Measurement. 1998,6:19–33.

    PubMed  CAS  Google Scholar 

  73. Goodson P, Murphy Smith M, Evans A, Meyer B, Gottlieb NH: Maintaining prevention in practice: Survival of PPIP in primary care settings. Put prevention into practice.American Journal of Preventive Medicine. 2001,20:184–189.

    Article  PubMed  CAS  Google Scholar 

  74. Dzewaltowski DA, Glasgow RE, Klesges LM, Estabrooks PA, Brock E: RE-AIM: Evidence-based based standards and a web resource to improve translation of research into practice.Annals of Behavioral Medicine (in press).

Download references

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline, Suite 633, 38163, Memphis, TN

    Lisa M. Klesges Ph.D.

  2. Kaiser Permanente Colorado, USA

    Paul A. Estabrooks Ph.D.

  3. Community Health Institute, Kansas State University, USA

    David A. Dzewaltowski Ph.D.

  4. University of Colorado Health Sciences Center, USA

    Sheana S. Bull Ph.D.

  5. Kaiser Permanente Colorado, USA

    Russell E. Glasgow Ph.D.

Authors
  1. Lisa M. Klesges Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul A. Estabrooks Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David A. Dzewaltowski Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sheana S. Bull Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Russell E. Glasgow Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa M. Klesges Ph.D..

Additional information

Lisa M. Klesges is now in the Department of Health Sciences Research at the Mayo Clinic.

This work was supported with funding from the Robert Wood Johnson Foundation and National Institutes of Health (NICHD Grant R01 HD37367, NHLBI Grant R01 HL62156, and NCI Grant R01 CA80725).

We acknowledge the members of the Behavioral Change Consortium (BCC) representativeness and translation workgroup, Drs. John Allegrante, Belinda Borrelli, Phillip Clark, Robin Mockenhaupt, and Marcia Ory. Appreciation is also given to Dr. Patricia Jordan for her assistance with the survey and to all BCC investigators who completed our surveys and offered helpful discussion of RE-AIM elements.

About this article

Cite this article

Klesges, L.M., Estabrooks, P.A., Dzewaltowski, D.A. et al. Beginning with the application in mind: Designing and planning health behavior change interventions to enhance dissemination. ann. behav. med. 29, 66–75 (2005). https://doi.org/10.1207/s15324796abm2902s_10

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1207/s15324796abm2902s_10

Keywords

Search

Navigation