As discussed under the Cores
summary, the Center for American Indian and Alaska Native Diabetes Translational Research (CAIANDTR) employs Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) as our primary conceptual framework in the development of our multistage and multilevel approach to translational research. As explained below, each the Resource Cores addresses one or two of the RE-AIM constructs.
Resource Core - Engagement
The Engagement Core explicitly addresses the Reach construct of RE-AIM—commonly operationalized as understanding and developing the tools to maximize our ability to engage those most in need of the interventions in question. Too, Community-Based Participatory Research (CBPR) methods, although relevant throughout, are especially critical in this Core.
- Spero Manson, Core Director
- Rachel Simpson, Engagement Core Staff
- Identifying opportunities and building relationships
- Advise on the recruitment and retention of staff and study participants
- Recommending methods for the review and distribution of study findings
Technology Core explicitly addresses the Effectiveness domain of RE-AIM. Common approaches to this construct include
addressing whether or not interventions achieve their targeted outcomes and
avoid unintended negative consequences.
Considerations under Effectiveness focus on those external validity
factors likely to render interventions viable in broad-based settings; this
includes the need for tailoring programs to individuals and their settings as
well as considering innovative techniques for intervention delivery.
- Jan Beals, Core Director
- Rhonda Dick, Technology Core Staff
and adapting intervention technologies appropriate for translational research
among AI/AN populations.
- Provide methodological tools for
- Adapting, developing, and
fielding data collection technologies
Resource Core—Implementation, Dissemination,
The gaps are immense between establishing that interventions are work well in the stting where most clinical trials take place, and the real world of day-to-day care. The parallel gaps in community-level interventions are perhaps best considered chasms by comparison. The Center for American Indian and Alaska Native Diabetes Translational Research (CAIANDTR) has the opportunity to make enormous contributions in bringing research findings to the “real world”.
Following the lead of Rabin and colleagues, we use the term implementation to refer to the process of introducing or integrating effective interventions into practice. Dissemination describes active, planful approaches in spreading such interventions to defined audiences. Finally, diffusion is reserved for the passive and untargeted spread of new interventions. These processes are clearly dynamic and interactive. Yet in considering the appropriate place for these 3 processes in CAIANDTR (especially given the still-evolving science and methods supporting them), we decided to combine them into one core—that of Implementation, Dissemination, and Diffusion (IDD). Common to all 3 is considering organization-and system-level barriers to the uptake of effective interventions.
The IDD Core will address the Adoption and Implementation aspects of the RE-AIM framework. In particular, we will provide CAIANDTR investigators with essential tools for embarking on implementation studies, which in turn will lead to both dissemination studies and research encouraging and monitoring diffusion. It is this guidance that the Indian health system is most primed to accept: how best to move evidence-based interventions into practice in both clinical and community settings.
Julie Marshall, Core Director
Jenn Russell, Core Coordinator
- Developing measurement protocols of common barriers to implementation, dissemination, and diffusion.
- Identifying those practices and interventions with the greatest support for IDD studies.
- Advising about adaptation, development, and fielding of IDD studies in AI/AN communities.
The Sustainability Core explicitly
addresses RE-AIM’s Maintenance construct.
In particular, in this Core we will focus on building a toolkit to
ensure that our research will address factors supporting the long-term
viability of effective interventions in AI/AN communities. In
this Core, as was true for IDD, the Chronic Care Model, with its emphasis on
the need for integrated multi-level care for those with diabetes, is critical
as we consider the implications of electronic medical records, for instance, in
the ability of clinical setting to maintain interventions. As elsewhere, the explicit application of Community-Based
Participatory Methods, is critical as we seek to understand and support the
long-term viability of translational practices of proven efficacy and
We will seek to help CAIANDTR
investigators to better understand, and thereby address, resources needed for
their interventions, the possibilities in building community supports,
provisions for ongoing change/improvement, and the need for policy changes and
support in sustaining of effective programs.
- David West, Core Director
- Ursula Running Bear, Sustainability Core Staff
and informing policy