Table 1 Implementation conditions for policies and interventions aiming at dietary behavior, physical activity, and sedentary behavior change: a synthesis of evidence
RE-AIM domain | Systematic reviews, stakeholders’ documents, and position reviews endorsing respective characteristics | ||
|---|---|---|---|
Characteristics category | |||
Implementation characteristics | Policies only | Interventions only | Policies and interventions |
Domain: Reach | |||
(a) Strategies facilitating recruitment processes | |||
Resources/strategies for implementers helping them to invite and follow-up participants | Systematic reviews [5]. | ||
Awareness raising (strategies to raise awareness of dietary behavior, physical activity, sedentary behaviors, as well as interventions and policies) to help implementers to invite participants | Systematic reviews [29]; Stakeholders’ documents [30, 31]; Position reviews [32–36]. | Systematic reviews [39]; Stakeholders’ documents [40]; Position reviews [41]. | |
Incentives to participate | Position reviews [28]. | ||
(b) Issues in participation processes and their effects on implementation | |||
General attrition ratesa | Systematic reviews [42, 43, 45–50]; Position reviews [51, 52]. | ||
Participation levels, i.e., percent of those agreeing among eligible participantsa | |||
Representativeness of attrition and dropouta | |||
Differential attrition across the program conditions/typesa | |||
(c) Cultural and social issues in reaching target populations | |||
Enhancing cultural competences of intervention/policy (creating culturally sensitive versions of materials) | Systematic reviews [67]. | Systematic reviews [26, 68]; Stakeholders’ documents [69]; Position reviews [70]. | |
Domain: Efficacy | |||
(d) Satisfaction with implementation | |||
Participants’ satisfaction with implementationa | |||
(e) Feasibility and acceptability | |||
Feasibility of implementation and acceptability of implementation among providers, stakeholders, and participantsa | Systematic reviews [57, 74–76]; Position reviews [55, 56, 59, 77]. | ||
Acceptability of the program among participants (e.g., acceptability of: the group size, the type of participants, interventionists’ skills)a | |||
(f) Evaluation of implementation/adoption processes (excluding evaluation of the outcomes of the program) | |||
Evaluation and monitoring results are disseminated to communities, stakeholders, and nationally | Stakeholders’ documents [69]. | ||
Difficulty/a lack of opportunity to assess the impact of one policy separately from ancillary policies/interventions due to the increasing complexity of policies/legislationsa | |||
Domain: Adoption | |||
(g) Training for implementation | |||
Training for implementers and disseminators (e.g., training, certifıcates, workshops, training instructions, skill development) | Stakeholders’ documents [30, 31, 64, 84]; Position reviews [35, 85]. | Systematic reviews [5, 37, 42, 43, 48, 67, 72, 79, 86–90]; Position reviews: [51, 80, 91, 92]; Stakeholders’ documents [93]. | Systematic reviews [26, 27, 54, 57, 71, 76, 94]; Position reviews [28, 56, 70, 95, 96]; Stakeholders’ documents [97]. |
Training instructions/materials for implementers | Position reviews [35]. | ||
Regular meetings or supervision for staff to secure implementation | Position reviews [28]. | ||
(h) Staff expertise for implementation | |||
No additional expertise required for staff involved in implementation | |||
Implementers’ skill, knowledge, and competence to implement the program correctly | Position reviews [35]. | Systematic reviews [26, 27]; Stakeholders’ documents [97]; Position reviews [56]. | |
(i) Collaboration and communication for implementation | |||
Collaboration between implementers; the use of methods to increase communication between implementers | Systematic reviews [26, 27]; Position reviews [28, 96, 101]. | ||
Key political and stakeholders’ support for implementation (stakeholders identified and involved) | Stakeholders’ documents [62, 84, 102]; Position reviews [85, 103, 104]. | ||
Cross-sectorial collaboration: collaboration between sectors of health, sports, food, transportation, planning and housing, green spaces, education, healthcare, and social services | Stakeholders’ documents [63, 64, 81, 84, 102]; Position reviews [34, 104, 106–110]. | Position reviews [91]. | Stakeholders’ documents [40, 69, 97]; Position reviews [41, 70, 95]. |
Involvement of multiple stakeholders at multiple levels | Stakeholders’ documents [31, 64, 84, 102]; Position reviews [35, 107]. | Stakeholders’ documents [97]. | |
Collaboration with professionals and organizations for program implementation | |||
Effective leadership to secure collaboration (between facilitators, institutions, and organizations involved) | Stakeholders’ documents [97]. | ||
Synergy with other existing or operating programs | Position reviews [114]. | Position reviews [41]. | |
Securing food industry involvement/preventing and counteracting food industry resistance | Stakeholders’ documents [64]; Position reviews [35, 36, 109, 113, 115] | ||
(j) Community support for implementation | |||
Securing the involvement of local community in implementation | Systematic reviews [29]; Stakeholders’ documents [31, 84, 102, 116]; Position reviews [33, 107]. | ||
Community organizations support adoption | Stakeholders’ documents [40, 69]; Position reviews [28, 101]. | ||
Building relationships/networks for implementation (between implementing organizations and community organizations) | Systematic reviews [100]. | Systematic reviews [26]. | |
(k) Adoption in physical environment facilitating implementation | |||
Maintenance or development of built and natural environment to enable policies implementation | Stakeholders’ documents [30, 62, 63, 81, 116]; Position reviews [83, 107, 110]. | Systematic reviews [67]. | |
Supportive physical environment in the community promotes implementation and adoption | Stakeholders’ documents [30, 63, 116]; Position reviews [34]. | Systematic reviews [72]. | Stakeholders’ documents [40]. |
(l) Governmental and legislative involvement | |||
Federal (national) government co-issues the program or is involved in program issuing | Systematic reviews [29]; Stakeholders’ documents [84, 102, 116]; Position reviews [107, 109, 115, 117]. | Position reviews [41]. | |
Legal basis/secured legal support for implementation and maintenance (e.g., fiscal, liability instruments, market environment laws) | Stakeholders’ documents [65, 84]; Position reviews [32, 106]. | ||
Accounting for legal instruments to support implementation (existing legal instruments supporting implementation, changes in law, and legal burden for businesses) | |||
Politicians’ collaboration (negotiation with and influencing politicians and policy makers) | |||
Involvement of a local government and accounting for regional regulations | Stakeholders’ documents [63, 102]; Position reviews [33, 34, 109]. | ||
Accounting for conflicting policies in adoption processa | |||
Domain: consistency, cost, and adaptations in Implementation | |||
(m) Simplicity as a factor facilitating implementation | |||
Simplicity of communicating and implementing the program (not too complex, not too difficult to follow) | Stakeholders’ documents [66]. | Systematic reviews [44, 50, 88]; Position reviews [38, 98, 114]. | |
Complexities of existing policies and their interrelations as barriers to implementationa | |||
(n) Accessibility for participants | |||
Increasing accessibility to environmental structures | Stakeholders’ documents [40]. | ||
Financially accessible programs (low-cost, high affordability) | Systematic reviews [44]. | Stakeholders’ documents [40]; Position reviews [28, 55, 112]. | |
Barriers for accessibility in physical environment (e.g., architectural solutions as barriers to exercise; a lack of stairs)a | Stakeholders’ documents [63]. | ||
(o) Evaluating and solving time-related issues in implementation | |||
Lack of time in the community involved in implementationa | Position reviews [33]. | Stakeholders’ documents [69]. | |
Time for implementation: assessment of time needed for implementation conducted and adequate time secured | Systematic reviews [44]. | Stakeholders’ documents [69]. | |
Limited time in curriculum to add new program in respective settings (e.g., schools) | Position reviews [115]. | Position reviews [70]. | |
(p) Fidelity | |||
Fidelity of the program (in reference to the content and the dose of the program) | Stakeholders’ documents [64]. | Systematic reviews [44, 72, 79, 87, 88]; Stakeholders’ documents [124]. | Position reviews [56]. |
Degree to which intervention is delivered as intended (compared to the protocol) | |||
Assessment of fidelity of deliverya | |||
(q) Use of implementation theory/framework | |||
Use of implementation theory for implementation practice | |||
Use of RE-AIM framework for identification, appraisal, and synthesis of material | Systematic reviews [43, 45–47, 79, 125, 127]; Position reviews [51, 52, 98, 128] | ||
(r) Cultural context in implementation | |||
Culture-sensitive implementation, addressing the needs of diverse population in their community context (social, cultural, economic, and political) | Systematic reviews [29]; Stakeholders’ documents [31, 62–66]; Position reviews [35, 83, 104]. | Systematic reviews [67, 79, 86, 89]; Position reviews [80, 91, 114, 123]. | Systematic reviews [26, 71, 94]; Stakeholders’ documents [69, 97]; Position reviews [70, 118]. |
(s) Costs and funding of implementation | |||
Costs of implementation analyzed (e.g., analysis of costs to deliver per person) | Position reviews [33]. | ||
Funding/resources for implementation secured and provided | Systematic reviews [61]; Stakeholders’ documents [62, 65, 84, 102, 116]; Position reviews [103, 107]. | Systematic reviews [27, 71, 75]; Stakeholders’ documents [69]. | |
Lack of/limited funding for implementationa | Position reviews [41]. | ||
Cost targets: low (feasible) costs of implementation, cheap resources, and affordable across settings | |||
Securing funds for long-term maintenance (e.g., through national government funds) | Position reviews [33]. | Stakeholders’ documents [40]. | |
(t) Other resources needed for delivery | |||
Lack of resources for implementation in organizations involved in deliverya | Systematic reviews [71]. | ||
Lack of resources for implementation (from sources other than involved organizations)a | Position reviews [41]. | ||
(u) Delivery characteristics | |||
Extent to which protocol was delivered as intended/protocol adherence | Systematic reviews [45, 47, 99, 125]; Position reviews [52, 128]. | Systematic reviews [71]. | |
Consistency of delivery and evaluation/monitoring of consistency | Position reviews [35]. | ||
Identifying the essential amount of time/number of sessions required to deliver the program | Position reviews [107]. | Systematic reviews: [60]. | |
Mass media involved in delivery and dissemination | Stakeholders’ documents [102]; Position reviews [35, 113, 115]. | Stakeholders’ documents [93]. | |
Involving any available staff into the program delivery | |||
Clear identification of roles and responsibilities in implementation processes | Stakeholders’ documents [93] | ||
Delivery through various professional groups, lay health advisors, and users | |||
Pilots: testing new and existing materials before delivering to the target population | Position reviews [82]. | Position reviews [101]. | |
(v) Settings’ characteristics affecting delivery and implementation | |||
Organizational practices supporting implementation, management participation in implementation | Stakeholders’ documents [30]. | ||
Aims and existing polices within the organization are accounted for (how does the program fit into organizational aims and existing policies?) | Systematic reviews [44]. | ||
(w) Adjustments and customizations in implementation | |||
Deep-structure adaptations (deep cultural and ethnic adaptations to participants, consultations with community advisors on cultural adaptations, consultation with participants) | Systematic reviews [42, 89]; Stakeholders’ documents [124]; Position reviews [38]. | ||
Customization of the program (to target population and local conditions) | Systematic reviews [43, 47]; Stakeholders’ documents [124]; Position reviews [51, 80]. | Systematic reviews [53, 60]; Position reviews [28, 56, 70, 101]. | |
Potential adaptations to enhance the fıt within community contexts | Stakeholders’ documents [64] | Systematic reviews [43, 47, 87]; Stakeholders’ documents [124]. | |
Assessment of adaptations of the intervention/policy made during deliverya | Systematic reviews [72]. | ||
Adoption to settingsa | |||
(x) Planning and monitoring of implementation processes | |||
Plans for implementation | |||
Plans for monitoring and plans for evaluation (how to increase data availability and of high quality?) | Stakeholders’ documents [62, 65]; Position reviews [32, 107]. | Position reviews [92]. | |
Process monitoring and evaluation | Systematic reviews [37, 90]; Position reviews [98]; Stakeholders’ documents [93]. | ||
Monitoring and assessment of adherence to implementation protocol/protocol fidelity | |||
(y) Implementers’ characteristics affecting implementation | |||
Implementers’ expectations regarding the program and perceived control of the programa | |||
Levels of engagement/involvement and awareness of implementers | Position reviews [106]. | Stakeholders’ documents [40]. | |
Support needed (perceived by implementers)a | |||
Domain: Maintenance | |||
(z) Sustainability | |||
Institutionalization of the content of the program and its implementation (e.g., the integration into existing institutional programs) | |||
Strategies to promote long-term participation (maintenance) included | |||
Building capacity to secure maintenance (training and support in organization, aiming at promotion of maintenance) | Stakeholders’ documents [130]. | ||