Table 3.

Expanded operationalization of RE-AIM.

Dimension	Expanded operational definition
Reach	• Number of participants or individuals that participate in or are exposed to a clinical or public health intervention • Proportion of the intended audience that participate in or are exposed to a clinical or public health intervention • The representativeness of participants relative to the intended population that participate in or are exposed to a clinical or public health intervention • Antecedent assessments—service recipient perceptions of:     ◦ Appropriateness (IOF definition—consumer level)     ◦ Acceptability (The perception among service recipients that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory)     ◦ Feasibility (The extent to which a new treatment, or an innovation, can be successfully used or carried out by a service recipient) • Cost of dissemination strategies intended to increase participation of those whose health would benefit from the intervention*
Effectiveness	• The degree to which the intervention is producing its intended effects while assessing potential unintended consequences and changes in quality of life • Cost-benefit based on total intervention costs by magnitude of effectiveness • No expansion proposed for this dimension
Adoption	• Number of settings that participate in or are exposed to the public health intervention • Proportion of the intended settings and staff that deliver or are exposed to the public health intervention • Representativeness of settings relative to the intended population that participate in or are exposed to the public health intervention • Antecedent assessments—organizational staff and stakeholder perceptions of:     ◦ Acceptability (organizational satisfaction with various aspects of the public health intervention and intervention congruence with organizational mission)     ◦ Appropriateness (IOF definition—organization or setting level)     ◦ Feasibility (IOF definition– The extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting) • Start-up cost assessment • Costs of dissemination strategies intended to increase participation of staff and settings in implementation of the EBI
Implementation	• Consistency of delivery as intended and in the time required across staff and organizations • Adaptation     ◦ Assessing indicators of adaptation prior to, during, and following implementation of the intervention     ◦ Document who, what, when, where, and why adaptations were made (18, 20)     ◦ Document how the adaptation was consistent with the underlying evidence-based principles of the intervention as previously tested (20) • Antecedent assessments:     ◦ Organizational experience of acceptability (organizational satisfaction with various aspects of the public health intervention and intervention congruence with organizational mission)     ◦ Organizational experience of appropriateness (IOF definition—organization or setting level)     ◦ Organizational experience of feasibility (IOF definition– The extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting) • Cost of implementation • Cost of strategies targeting quality of implementation • Budget impact assessment
Maintenance—individual level	• The extent to which the intervention's primary outcome is sustained ≥6 months after intervention completion • No expansion recommended for this dimension
Maintenance—organizational level	The public health intervention becomes institutionalized or part of the routine organizational practices and policies • Antecedent assessments     ◦ Experienced acceptability (Organizational satisfaction with various aspects of the public health intervention and intervention congruence with organizational mission)     ◦ Experienced appropriateness (IOF definition—organization or setting level)     ◦ Experienced feasibility of EBI to the intended staff and setting intended to implement. • Cost of sustained implementation • Cost of strategies targeting sustained implementation
Combined metrics	• Individual-level impact: reach X effectiveness • Individual-level impact efficiency: incremental cost increases by unit of reach X effectiveness • Organizational level impact: adoption X implementation (or organizational maintenance) • Attributable individual-level impact: population prevalence X individual level impact • Attributable organizational-level impact: population prevalence X organizational level impact • Comprehensive individual/organizational impact: reach + effectiveness (or individual level maintenance) + adoption + implementation/4 maintenance • Penetration: reach X adoption X organizational maintenance • Individual level utility: participant ratings of acceptability X appropriateness X feasibility • Service provider utility: implementation staff ratings of acceptability X appropriateness X feasibility • Organizational utility: organizational decision maker ratings of acceptability X appropriateness X feasibility • Systemic Utility: individual utility + service provider utility + organizational utility

^*Text in Italics represents new components of each RE-AIM dimension.