One successful site is not a whole system
Imagine a program that enrolls most eligible residents at one center but is offered by only one of twenty eligible centers. Its local reach may be strong while organizational adoption is limited.
Alternatively, every center may offer the program while few residents enroll.
Use two denominators
| Measure | Illustrative denominator |
|---|---|
| Individual reach | Eligible people in the intended population |
| Setting adoption | Eligible sites invited or intended to participate |
The denominator needs a documented definition. Counting only sites that already agreed hides the adoption question.
Representativeness matters at both levels
Participating people may differ from those not reached. Participating sites may also have unusually strong staffing, space, or leadership support. Results from those sites may not transfer easily to less-resourced settings.
RE-AIM distinguishes these dimensions to make public-health impact more visible. The framework does not require treating every dimension as a single score.
Let the finding guide the response
Low individual reach may call for investigating enrollment barriers or fit. Low site adoption may involve staffing, resources, or organizational priorities. A generic instruction to “promote the program more” can miss both. Identify which level is constrained before selecting an implementation response.
