An Extension of RE-AIM to Enhance Sustainability: Addressing Dynamic Context and Promoting Health Equity Over Time
Open accessAbstract
RE-AIM is a widely adopted, robust implementation science (IS) framework used to inform intervention and implementation design, planning, and evaluation, as well as to address short-term maintenance. In recent years, there has been growing focus on the longer-term sustainability of evidence-based programs, policies and practices (EBIs). In particular, investigators have conceptualized sustainability as the continued health impact and delivery of EBIs over a longer period of time (e.g., years after initial implementation) and incorporated the complex and evolving nature of context. We propose a reconsideration of RE-AIM to integrate recent conceptualizations of sustainability with a focus on addressing dynamic context and promoting health equity. In this Perspective, we present an extension of the RE-AIM framework to guide planning, measurement/evaluation, and adaptations focused on enhancing sustainability. We recommend consideration of: (1) extension of "maintenance" within RE-AIM to include recent conceptualizations of dynamic, longer-term intervention sustainability and "evolvability" across the life cycle of EBIs, including adaptation and potential de-implementation in light of changing and evolving evidence, contexts, and population needs; (2) iterative application of RE-AIM assessments to guide adaptations and enhance long-term sustainability; (3) explicit consideration of equity and cost as fundamental, driving forces that need to be addressed across RE-AIM dimensions to enhance sustainability; and (4) use or integration of RE-AIM with other existing frameworks that address key contextual factors and examine multi-level determinants of sustainability. Finally, we provide testable hypotheses and detailed research questions to inform future research in these areas.
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Penetration and sustainment of evidence-based care to the entirety of a system's service recipients or a community's under-resourced populations can serve as measurable indicators of equitable access and reach.
“Similarly, penetration and sustainment of evidence-based care to the entirety of a system’s service recipients or a community’s under-resourced populations can serve as measurable indicators of equitable access and reach [63, 64], consistent with calls to prioritize structural racism in contextual analyses [65].”
From Ten years of implementation outcomes research: a scoping review (2023) · cites this paper as [63]
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 [27]
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 [27]
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- Authors
- Shelton, R. C., Chambers, D. A., & Glasgow, R. E.
- Affiliations
- Columbia University (US)
- National Institutes of Health (US)
- VA Eastern Colorado Health Care System (US)
- Corresponding author
- Shelton, Rachel C.
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2020-05-12
- Volume
- 8
- Pages
- 134-134
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC7235159
- OpenAlex
- W3024052173
- Cited by
- 448
- References
- 46
- Citations by year
- 2026: 48 · 2025: 69 · 2024: 114 · 2023: 94 · 2022: 67 · 2021: 48 · 2020: 6 · 2019: 1
- FWCI
- 55.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- American Cancer Society (RSG 17-156-01-CPPB)
- National Heart, Lung, and Blood Institute
- National Institutes of Health
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- RE-AIM framework, dynamic context, health equity, evolvability, intervention adaptation, de-implementation, long-term maintenance, implementation evaluation, cost
- MeSH terms
- Health Equity, Implementation Science
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