Understanding and applying the RE-AIM framework: Clarifications and resources
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Introduction: Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework. Methods: This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions. Results: We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework. Conclusions: RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.
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Facilitators of implementation are evidence-based, attractive and updated IMIs adapted for contextual factors and the use of evidence-based frameworks such as RE-AIM or the Consolidated Framework for Implementation Research.
“Facilitators of implementation are evidence-based, attractive and updated IMIs adapted for contextual factors (71) and the use of evidence-based frameworks such as RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) (72) or the Consolidated Framework for Implementation Research (73).”
From Mental health services for German university students: acceptance of intervention targets and preference for delivery modes (2024) · cites this paper as [72]
The review did not assess implementation strategy fidelity or effects on health disparities.
“We did not assess implementation strategy fidelity or effects on health disparities as these are recently adopted reporting standards [27, 28] and not yet widely implemented in current publications.”
From A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022 (2024) · cites this paper as [28]
Outcomes were coded into RE-AIM outcome domains following best practices recommended by framework experts.
“Outcomes were then coded into RE-AIM outcome domains following best practices as recommended by framework experts [26–28].”
From A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022 (2024) · cites this paper as [28]
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“This misconception is likely based on an over reliance on the original RE-AIM source article that highlighted the importance of all five RE-AIM dimensions and proposed that the potential public health impact was the product of results on all dimensions [10].”
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- Authors
- Holtrop, J. S., Estabrooks, P. A., Gaglio, B., Harden, S. M., Kessler, R. S., King, D. K., Kwan, B. M., Ory, M. G., Rabin, B. A., Shelton, R. C., & Glasgow, R. E.
- Affiliations
- University of Colorado Anschutz (US)
- University of Nebraska Medical Center (US)
- Patient-Centered Outcomes Research Institute (US)
- Virginia Tech (US)
- University of Alaska Anchorage (US)
- Texas A&M University (US)
- University of California San Diego (US)
- Columbia University (US)
- Corresponding author
- Holtrop, Jodi Summers
- ORCID
- Venue
- Journal of Clinical and Translational Science
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021
- Volume
- 5
- Issue
- 1
- Pages
- e126-e126
- ISSN
- 2059-8661 (ISSN-L)
- PMC
- PMC8327549
- OpenAlex
- W3160151958
- Cited by
- 549
- References
- 50
- Citations by year
- 2026: 159 · 2025: 167 · 2024: 125 · 2023: 67 · 2022: 27 · 2021: 4
- FWCI
- 63.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Clinical and Translational Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ScholarWorks - UA (University of Alaska System) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- VTechWorks (Virginia Tech) (submittedVersion, cc-by)
- Funders
- Patient-Centered Outcomes Research Institute
- National Cancer Institute (P50CA244688)
- National Institute of General Medical Sciences (U54GM115458)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- RE-AIM framework, implementation science, implementation research frameworks, framework evolution, implementation effectiveness, implementation sustainability
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