Operationalizing Iterative RE-AIM in two pragmatic nursing home trials to support an adaptation learning cycle.

INTRODUCTION

Complex, heterogeneous settings such as nursing homes require ongoing adaptation of interventions and implementation strategies. Iterative RE-AIM offers a structured approach to guide adaptations, but how the approach is operationalized may need to vary across implementation contexts. We describe how two pragmatic nursing home trials operationalized Iterative RE-AIM with FRAME-IS to enable a systematic adaptation learning cycle.

METHODS

We conducted a narrative analysis of two ongoing multi-site trials: TEAM EFFORT (focused on falls reduction in State Veterans Homes) and 40 WINKS (focused on sleep improvement in nursing home residents with dementia). Both used RE-AIM for evaluation and FRAME-IS to document adaptations. Each operationalized the Iterative RE-AIM steps based on study scope, resources, team structure, and implementation timing, with a primary focus on refining a coach-supported implementation strategy.

RESULTS

TEAM EFFORT embedded adaptation-related data collection, deliberation, and decision-making within weekly team meetings, supported by an ongoing input tool; 40 WINKS used individual-level surveys followed by structured, once-per-wave team gatherings to decide on adaptations. These two operationalizations illustrate how the timing, methods, and cadence of an adaptation learning cycle based on Iterative RE-AIM can vary in response to implementation context.

DISCUSSION: Iterative RE-AIM can be operationalized differently across implementation contexts while remaining faithful to its underlying intent. Paired with FRAME-IS, Iterative RE-AIM can enable an adaptation learning cycle that integrates systematic documentation of adaptations with structured team deliberation. Rather than prescribing a single Iterative RE-AIM implementation protocol, these findings suggest that operationalization can respond to the context in which implementation occurs.