AUTHOR=Balis Laura E. , Strayer Thomas 

TITLE=Evaluating “Take the Stairs, Wyoming!” Through the RE-AIM Framework: Challenges and Opportunities

JOURNAL=Frontiers in Public Health

VOLUME=7

YEAR=2019

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2019.00368

DOI=10.3389/fpubh.2019.00368

ISSN=2296-2565

ABSTRACT=<p><bold>Introduction:</bold> Health promotion delivery systems are increasingly being asked to implement policy, systems, and environmental interventions (PSEs). However, evaluating PSEs is challenging, especially in low-resource community settings. This paper describes the use of RE-AIM to evaluate a physical activity PSE delivered through University of Wyoming Extension and highlights challenges and opportunities in pragmatic, real-world program evaluation.</p><p><bold>Methods:</bold> Extension health educators adapted a point-of-decision prompt intervention encouraging stairway use through posters, called Take the Stairs, Wyoming! <italic>Reach</italic> was assessed through estimates of daily traffic, <italic>effectiveness</italic> was assessed through opportunistic interviews, <italic>adoption</italic> was calculated as the number and proportion of sites that agreed to hang posters, <italic>implementation</italic> was calculated as the proportion of sites with a poster in place at a 2-weeks follow-up visit, and <italic>maintenance</italic> was assessed through 6-months opportunistic interviews (individual level) and proportion of sites with a poster in place (organizational level).</p><p><bold>Results:</bold> Overall, the posters were widely <italic>adopted</italic> and most posters were <italic>implemented</italic> as intended. However, capturing <italic>reach, effectiveness</italic>, and <italic>maintenance</italic> was challenging, as health educators found the evaluation burdensome. Therefore, it was difficult to determine if the posters were effective at increasing physical activity levels.</p><p><bold>Discussion:</bold> Suggestions are provided for capturing <italic>reach, effectiveness</italic>, and <italic>maintenance</italic> data in community settings. Future efforts are needed to create evaluation tools to pragmatically measure effectiveness of PSEs on changing behaviors, as well as to prioritize program evaluation in Extension.</p>