Process Evaluation of the Smarter Lunchrooms RCT: Unique Application of the RE-AIM Framework

Abstract

Objective: To adapt the RE-AIM framework for use in process evaluation of the Smarter Lunchrooms (SL) RCT. Design, Setting andParticipants: The SL intervention aimed to improve student food selection using small, low cost environmental changes. During the past two years, SL was implemented in 25 New York state middle school cafeterias. Parallel process evaluation was conducted to assess effectiveness of intervention delivery and inform interpretation of results. Outcome Measures and Analysis: Year one process evaluation methods were categorized according to dimensions of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) in order to identify gaps and future directions. Results:Reach was defined as the number of eligible middle schools participating in the intervention and the number of enrolled students in each school. Effectiveness is typically defined in terms of intervention outcomes; however, from a process evaluation perspective, it could also serve as an outlet for discussion of external influences expected to affect intervention outcomes, specifically sources of contamination and aspects of school cafeterias already aligned with the protocol. Adoption was defined as the number and percentage of cafeteria staff trained and their reported preparedness to initiate the intervention. Implementation was described as fidelity to each component of the intervention protocol, while maintenance was the extent of adherence beyond the intervention end date. Conclusions and Implications: RE-AIM served as a valuable framework for designing a process evaluation for an environmental intervention. This modified model may be useful for future researchers undertaking similar planning or evaluation, and for those seeking to operationalize RE-AIM dimensions to meet unique needs of an environmental intervention. Funding: NIFA.