RE-AIMing for health equity: Using RE-AIM to evaluate equitable implementation of the family check-up 4 health.

Abstract

A primary goal of implementation science (IS) is to promote access to evidence-based practice; however, without careful attention to equity, IS may inadvertently reify inequities for priority populations who are most affected by access barriers and health inequities. Recently, there has been a push to integrate health equity concepts into IS frameworks. Yet, empirical examples are limited. This study sought to fill that gap by providing an example application of the RE-AIM framework extension for health equity in the evaluation of a family-based preventive intervention implemented in primary care for our priority population: Latinx, Black/African American, and Native American children. The Family Check-Up 4 Health (FCU4Health) is an individually tailored preventive intervention, adapted from the evidence-based Family Check-Up, for delivery in primary care settings. Data came from a Type 2 effectiveness-implementation hybrid study conducted with multiple primary care organizations in the Phoenix area, with 240 children (85% in the priority population) and their parents/caregivers. We present descriptive data guided by the RE-AIM framework's extension for health equity. Quantitative details about adoption and maintenance are supplemented with descriptions of implementation determinants, provided by partners at each site who coauthored this article. Concerning adoption, three of six organizations approached went on to implement the FCU4Health during the trial. Adoption appeared to be driven by perceived appropriateness, relative advantage, and research-related constraints. Reach: Across multiple stages from initial approach to initiation of services, reach was higher for our priority population, although differences were not statistically significant. Implementation: There were no significant differences in fidelity, active participation, and the completion or quality of home practice between our priority and nonpriority populations. Concerning dosage, coordinators spent more time working with families in our priority population on referrals to resources. Maintenance: None of the organizations continued to implement beyond the trial, which was primarily driven by feasibility. The results provide an exemplar of how the RE-AIM equity extension can be applied to assess the ability of preventive interventions to promote equitable implementation in routine primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).