612 - Application of the RE-AIM Framework to characterize disparities in intervention uptake: a scoping review

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 612
Publication Number: 612.32

Amy Bordogna, Cooper Medical School of Rowan University, Andover, MA, United States; Molly Rudman, Geisel School of Medicine at Dartmouth, Centerville, MA, United States; Jordan Taylor, The Dartmouth Institute for Health Policy & Clinical Practice, New Haven, CT, United States; Corrie E. McDaniel, University of Washington, Seattle, WA, United States; JoAnna Leyenaar, Dartmouth Health, Lebanon, NH, United States

Presenting Author(s)

Amy Bordogna, MPH (she/her/hers)

Medical Student
Cooper Medical School of Rowan University
Andover, Massachusetts, United States

Background: Research and quality improvement programs may differentially reach some population groups and not others, thereby worsening health disparities. RE-AIM is a well-established implementation science framework used to evaluate the impact of interventions across five domains: Reach, Effectiveness, Adoption, Implementation, and Maintenance.

Objective: This study aimed to summarize past applications of RE-AIM to evaluate for disparities, particularly among children and National Institutes of Health (NIH)-defined health disparity populations.

Design/Methods: We conducted a systematic scoping review, following the PRISMA Extension for Scoping Reviews. We searched PubMed to identify articles that used the RE-AIM framework to evaluate health disparities, excluding Non-English articles, review articles, articles that did not apply the RE-AIM framework, and those that did not evaluate health disparities. We also conducted a citation review of all included studies and relevant protocols and review articles. We extracted data from each eligible article to determine: (i) which RE-AIM domains were evaluated, and (ii) which population characteristics were assessed for differences in intervention uptake. Studies were grouped based on the inclusion of children < 18 years of age as well as NIH-defined populations that experience health disparities (Table 1).

Results: Of 25 eligible studies (Table 2), all evaluated intervention Reach (100%), 9 evaluated Effectiveness (36%), 8 evaluated Adoption (32%), 7 evaluated Implementation (28%), and 2 evaluated Maintenance (8%, Table 1). While the majority of the eligible studies (18, 72%) evaluated for disparities in >1 RE-AIM domains, only 1 study evaluated all 5 RE-AIM domains. Six studies (24%) included children and 3 of these examined differences in Reach based on age. 23 (92%) studies looked at differences based on sex and/or gender, 20 (80%) analyzed race and/or ethnicity, 17 (68%) assessed socioeconomic status indicators, and 3 (12%) analyzed urban-rural differences. Twenty-five studies (100%) examined differences in other clinical or demographic characteristics.

Conclusion(s): The RE-AIM framework provides an opportunity to evaluate disparities in research and quality improvement initiatives. In studies conducted to date, the domains of Effectiveness, Adoption, Implementation, and Maintenance are under-represented compared to Reach. Additional pediatric-focused research applying this framework to examine disparities in intervention delivery may serve to improve health equity in research and quality improvement.