Table 2.

Select CFIR constructs that acted as barriers and facilitators to RE-AIM domains in the DPP

RE-AIM domain	Construct	Barrier or facilitator	Representative quote
Reach	External change agents	Facilitator (strong)	“Having the Wellness Coordinator…was extremely instrumental because…she's privy to everyone's blood tests, high-risk issues…So she's able to parlay that information into getting them in the pipeline” (Extension professional J)
	Structural characteristics	Mixed (weak)	“the hospital…I already had a working relationship with…I've already proven why Extension programs work, so just bringing in this list, ‘Hey, I have another resource.’” (Extension professional G)
Effectiveness	Participant receptivity	Facilitator (weak)	“seeing the bonding among the participants…that’s a huge accomplishment because some of my participants…really don’t get out, they’re older. That increases their quality of life…not just their health.” (Extension professional K) “the consistent attendance…even considering we went away from in person…the fact that people are still …actively participating in the groups would show a success.” (Extension professional B)
Adoption	Patient needs and resources	Facilitator (weak)	“I'm just doing it for the health of the people in my community.”(Extension professional B)
	Intervention source	Facilitator (strong)	“if it wasn't for…[state Extension Specialist], I wouldn't have known the program was out there so I would have never implemented the program…” (Extension professional E) “it being a CDC program. I mean, that comes with a lot of clout.” (Extension Professional A)
	Tension for change	Facilitator (weak)	“We've done a lot of programs on managing chronic disease, being on that preventative side is important.” (Extension professional H)
	Evidence strength and quality	Facilitator (strong)	“The evidence…the wide scope of it…how far reaching it was…[I]was like, ‘Oh my goodness, this is definitely something that all Extension offices should be offering because of the positive impact that it has made nationwide.’" (Extension professional D) “I'm about prevention rather than treatment, and I do believe that with healthy eating and regular physical activity you can prevent a lot of things'm (Extension professional F)
	Compatibility	Facilitator (strong)	“I think it aligns extremely well [with the Extension mission] because we’re taking research-based programming and this is one of the best research-based diabetes programs that there has been.” (Extension professional A)
	Cost	Barrier (weak)	“[The state Extension office covering the costs of training and printing] was huge because I certainly couldn’t have come up with that kind of money out of my [county] account.” (Extension professional J)
Implementation	Networks and communications	Facilitator (strong)	“it [the technical assistance calls] helps me to be more accountable and make sure that I am thorough in what it is I'm giving you, what you're asking for." (Extension professional D)
	Learning climate	Facilitator (weak)	“You guys are very approachable and…offer questions and concerns about the program…yourself. So, we don’t feel like we’re just barking at the wrong tree.” (Extension professional B)
	Goals and feedback	Facilitator (weak)	“there were clear goals set out there which makes it easy to know how and what needs to be done from my end to implementhe (Extension professional G)
	Leadership engagement	Facilitator (strong)	“I think it speaks very highly of [DPP coordinator] and [Specialist], because you are implementing the program…you have firsthand some of those same challenges that we have… It's not just the knowledge from research or the curriculum, you actually have firsthand knowledge.” (Extension professional K)
	Formally appointed internal implementation leaders	Facilitator (strong)	“The planning it took…this is where…having a Specialist…or having [a DPP coordinator] and the Specialist kind of helps.” (Extension professional G)
	Opinion leaders	Facilitator (strong)
	Champions	Facilitator (strong)
	Access to knowledge and information	Facilitator (weak)	“for something like this, I think anytime you can have [a registered dietitian] involved…you're definitely meeting a baseline need.” (Extension professional J)
	Individual identification with organization	Mixed (weak)	“being a CEC [County Extension Coordinator, administrative role], there's just always something. I don't know that I ever feel like, on a daily basis, I'm doing everything I could do to support my programing as effectively as I would like to.” “no matter what happens, I'm going to stay in touch with them and support them because I feel like I've made an obligation.” (Extension professional J)
	Evidence strength and quality	Facilitator (strong)	“I believe that it has been done and implemented for long enough that there is strong evidence that by following the program the way it's written, it does have value.” (Extension professional I)
	Knowledge and beliefs about the intervention	Mixed (strong)	“I find it fascinating that there's really no recipes……in general, I'm surprised…that we really don't talk about some of the nuts and bolts of nutrition a little bit more.” (Extension professional J) “the idea is that we spend at least one hour a week sitting with these folks and we've talked to them about fitness breaks…the lesson on fitness breaks incorporates getting up and moving. But none of the other lessons, I don't believe has a fitness break worked into it.” (Extension professional B)
	Complexity	Barrier (weak)	“starting to do the food logs and get feedback is going to be a little bit challenging.” (Extension professional A)
Maintenance	Learning climate	Facilitator (strong)	“I think that it’s something that…we’ve shown…successful…it…definitely falls in line with our mission…I think that it’s…definitely one that’s here to stay.” (Extension professional E)
	Access to knowledge and information	Facilitator (weak)	“there are things that we do need, so it’s not just give me the keys to the car.” (Extension professional B)

CFIR Consolidated Framework for Implementation Research, RE-AIM Reach, Effectiveness, Adoption, Implementation, and Maintenance