. 2020 Jun 27;1:100026. doi: 10.1016/j.puhip.2020.100026

Table 2.

Pragmatic features of 4HS using RE-AIM; dimensions, pragmatic questions and self rating score.

RE-AIM Dimension^a	Key Pragmatic Questions Considered^b	Features of 4HS that support pragmatic criteria	RE-AIM dimensional self rating^c
Reach At the level of patients, clients, or participants. Important to consider not only how many persons participate out of those intended or targeted, but also the characteristics of those who take part compared with those who do not. Given the impact of health disparities, participation levels of various key underserved and vulnerable subgroups are especially important.	WHO is (was) intended to benefit and who actually participates or is exposed to the intervention? Measured by number and similarity of participants to your target group.	• any child within eligible age range 2–5.5years. • any family living in NE, Dundee (SIMD 1 or 2). • thus participants were typical individuals.	9
Effectiveness at the patient, client, citizen, or participant level. Responses to this question include defining the key or desired outcomes and the impact on different subgroups (eg, men vs women; those at high risk vs those at low risk; those with high incomes or education vs those with low incomes or education). Additional outcomes include quality of life indicators and any negative effects or unintended consequences from the program.	WHAT are (were) the most important benefits you are trying to achieve and what is (was) the likelihood of negative outcomes? Measured by change on key outcome(s) and consistency across subgroups.	• Primary outcome measures were acceptability & practicability of 4HS see Gillespie et al. [16] • Secondary outcomes include Quality of life measured using peds QL. (will be addressed in later 4HS outcomes paper)	8
Adoption participation is critical to understand the number and types of organizations, clinics, or agencies that initiate a program or policy. This participation involves considering the characteristics of the settings that are approached or targeted to participate compared with those that actually do. It also involves understanding barriers to and facilitators of adoption as well as how the program or policy fits with organizational priorities and existing workflow.	WHERE is (was) the program or policy applied and WHO applied it? Measured by what settings and staff take up the intervention and which do not.	• No setting exclusions • setting purposively selected e.g area of deprivation and with no other similar intervention. • Researcher used participatory and inclusive approach to make links with key stakeholders in local area. • Co-production approach	8
Implementation How questions also include the organizational resources that are required and how much the policy or program costs to implement. At minimum, it is important to report the time and staff resources required so that people in other settings can decide if they have the resources to adopt a program or policy.	HOW consistently is (was) the program or policy delivered, HOW will it be (was it) adapted, HOW much will (did) it cost, and WHY will (did) the results come about?	• One researcher delivered all elements of the study and delivered intervention. • Local stakeholders involved in adaptations. • Costs were minimised, suitable for low resourced setting.	8
Maintenance This dimension can be operationalized as the sustainability of the policy or program and includes consideration of many factors, including but not limited to resource availability; alignment of the policy or program with organizational mission, objectives, and goals; and integration into job descriptions and performance evaluations.	WHEN will (was) the initiative become operational; how long will (was) it be sustained (setting level); and how long are the results sustained (individual level)? Measured by longevity of effects (individual level) and program sustainability (setting level).	• Explicit discussion about how 4HS will be operational beyond the research study through a test of change in routine practice within one heath board area in Scotland (sustainability) (will be addressed in later4HS outcomes paper).	8

Available at http://www.re-aim.org/wp-content/uploads/2016/09/questions.pdf.

Available at http://www.re-aim.org/2017-pragmatic-applications-of-re-aim-for-health-care-initiatives-in-community-and-clinical-settings/https://www.cdc.gov/pcd/issues/2018/17_0271.htm.

(9–10 = excellent, 7–8, good but could do with a little work, 5–6 = fair, need planning <5 needs serious attention).