Examining the potential public health impact of Vida Sana using the RE-AIM framework: a longitudinal qualitative study.

BACKGROUND: Vida Sana is an evidence-based, culturally adapted weight management program based on Social Cognitive Theory for Latino adults classified as overweight with metabolic syndrome or prediabetes. Few studies have evaluated the implementation potential of these types of interventions conducted in clinical settings that seek to support weight management and reduce metabolic risk among Latino adults. PURPOSE: To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to understand implementation barriers and facilitators among multiple groups (patients, physicians, health coaches, recruiters) to guide future intervention refinement and delivery. METHODS: A longitudinal qualitative implementation evaluation was conducted to contextualize the results of the Vida Sana Hybrid Type 1 trial. Semistructured interviews were conducted with a subsample of 15% (n = 28) randomly selected main trial participants (patients) at baseline, 12 months (end of intervention), and 24 months (end of follow-up). Two health coaches and two physician champions were also interviewed. Four recruiters completed brief feedback forms. A framework analysis was conducted to analyze themes (RE-AIM domains) and deductive codes and to develop subthemes for each RE-AIM domain across time and group type. RESULTS: Analyses identified important implementation barriers and facilitators across RE-AIM domains potentially linked to Vida Sana's success. Patients indicated the intervention facilitated knowledge, skills, and self-monitoring for managing diet, physical activity, and weight. Barriers that may need to be addressed to increase effectiveness and sustainability include better health system supports. Although cultural adaptation was mentioned as supporting effectiveness, additional adaptations may be needed to maintain behavioral changes. CONCLUSIONS: Vida Sana is implementable in primary care settings. Patients, clinicians, and study staff identified factors across RE-AIM dimensions that could increase the public health impact of the intervention by addressing barriers and building on facilitators.