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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making
the adaptations of interventions to the characteristics of the setting, population, and time; to use professional consultations to pool the experience of other decision makers in addressing populations and settings similar to those at hand; and to use community involvement to patch the gaps in evidence, theory, and professional experience by engaging local residents to offer their interpretation of the proposed intervention and their perception of its fit with their needs.
Evaluating the Impact of Interventions
Estimates of the effectiveness of an intervention within a well-defined population or setting provide important information for policy decisions. It is important to use such estimates to begin to assess the potential of an intervention to address a public health problem such as obesity. Although consensus does not exist on the criteria necessary to confirm that an intervention has produced a significant public health impact, the RE-AIM framework provides a comprehensive model for evaluating the potential impact of a public health intervention. The five dimensions that form the framework’s acronym are reach, effectiveness, adoption, implementation, and maintenance. Reach refers to the size and characteristics of the population affected by an intervention. Public health interventions may be intended to reach all of part of the general population; may be characterized as universal, selective, or indicated based on the targeted population, which is determined on the basis of risk characteristics (as described in Chapter 2); or may be intended to reach those who can help the intended population (e.g., parents of obese children, policy makers). Typically, an intervention will reach only a portion of the intended population. Effectiveness is the impact of the intervention on targeted outcomes and quality of life. Adoption refers to the proportion and representativeness of settings and intervention staff that agree to deliver a program. Implementation is the extent to which the intervention is implemented as intended. Finally, maintenance denotes the extent to which a program is sustained over time within the delivering organization.
Consideration of each of the five dimensions of the RE-AIM framework can help evaluators understand the broad array of issues an effective program needs to address. Glasgow and colleagues (2006) propose several combined impact indices and discuss the strengths and weaknesses of each. They suggest that combining the RE-AIM dimensions, rather than considering each individually, would be most useful for making policy decisions. The metrics involved in calculating the impact indices are beyond the scope of this report but are described by the authors.
Within the three broad categories of intended reach (universal, selective, or indicated populations), each intervention may also be examined to determine uptake—the proportion of the intended population that the intervention will actually reach. Consider, for example, two different universal interventions: tax policies may well reach the entire population, although the effect may be variable depending on individual resources, while public awareness campaigns designed to reach an entire community typically reach only a portion of the community, depending on the outreach