Applying the RE-AIM conceptual framework for the promotion of physical activity in low- and middle-income countries

Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis

Background

In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic.

Methods

This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions.

Findings

Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability.

Interpretation

Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon.

Funding

NIH/NICHD.

[Evaluative models for complex health interventions]

This paper presents evaluative models for complex health interventions. The complex health interventions are characterized by being dynamic, highly influenced by the con-text (political, social, economic, and cultural), which have multiple actors, multicomponent. Furthermore, they are executed simultaneously with other interventions from other sectors, they require time to show results and sometimes it is difficult to estimate the contribution to the social and individual impact of the target population. This paper aims to identify the proposed evaluative models for complex health interventions with their respective characteristics, to have theoretical references for evaluations of pro-grams of this nature. For a long time, health interventions and their evaluation were understood in a linear manner, however, under the theoretical perspective of the complexity (in which multiple dimensions of the phenomenon are integrated), the context plays a central role, making it possible to understand that interventions do not have the same result in different spaces and that this form of evaluation allows to account for it.

Mecanismos de evaluaciones realistas en intervenciones de atención primaria en salud en poblaciones rurales y urbanas marginales

Objetivo.

Identificar los mecanismos reportados en intervenciones de atención primaria en salud (APS) en poblaciones rurales y urbanas marginales entre los años 1997 y 2019.

Métodos.

Se utilizó el método de revisión sistemática exploratoria para identificar la literatura. La búsqueda de literatura fue realizada en las bases de datos Medline (Pubmed y Ovid), Global health, Embase, Web of science, Scopus y Lilacs. La inclusión de literatura consideró estudios de intervención primaria, observacionales con metodologías cualitativas, cuantitativas o mixtas. Se incluyeron artículos en inglés, portugués y español publicados entre 1997 y 2019. Para la selección de documentos definitivos se utilizó Rayyan QCRI, se excluyeron fuentes de información de literatura gris o investigación en progreso.

Resultados.

A nivel individual se identificaron tres grupos de mecanismos: niveles de relaciones entre las intervenciones y los sujetos, transformaciones que pueden generar en los individuos y las relaciones recíprocas. A nivel institucional se relacionaron con la temporalidad, el dinero, relaciones de poder, relaciones de confianza, el sistema de salud, las expectativas y las condiciones administrativas.

Conclusiones.

Los mecanismos individuales son similares en los diferentes contextos, los mecanismos institucionales son susceptibles a la variación del contexto, se representan en la temporalidad, recursos económicos, relaciones de poder y de confianza, el sistema de salud, las expectativas y condiciones administrativas.

RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review

The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.