Table 3 Dimensions of RE-AIM in implementation research adapted for pay-it-forward (for MSM-led clinic sites)
Dimensions | Level | Operational definitions | Measurement method |
|---|---|---|---|
Reach | Individual | • The proportion of MSM who enter the clinic who are screened for eligibility • Percent of MSMs who visit the clinic compared to the MSM in the catchment area | • Administrative data will be collected on the demographics, socioeconomics, and geographic location (zip code or equivalent level) of those enrolled in pay-it-forward to test if there are differences in the characteristics of those who get tested and those who do not • The population of MSMs will be collected from public data to assess the potential reach of the pay-it-forward intervention within the overall MSM population in the area |
Effectiveness | Individual | • How effective are the two implementation strategies in promoting gonorrhea and chlamydia test uptake? • Does pay-it-forward influence secondary outcomes (chlamydia testing, treatment, and prevention outcomes)? | • The primary outcome is gonorrhea and chlamydia test uptake from the RCT, which will be measured using administrative data from participating clinics |
Adoption | Individual | • Do the participants find pay-it-forward acceptable and appropriate? • Is there a relationship between acceptability and appropriateness and testing outcomes? • What are the demographic, socio-economic, and geographic differences between those who found pay-it-forward acceptable and appropriate and those who did not? | • Quantitative data will be collected using an adapted version of the Acceptability of Intervention Measure (AIM) and the • Intervention Appropriateness Measure (IAM). Qualitative data will be collected from interviews to gain additional insights into the results from these instruments |
Organizational | • How do feelings of social reciprocity contribute to test adoption and donation behaviors? | • The R = MC2 instrument will be adapted for use in clinics | |
Implementation | Organizational | • What is the extent to which local staff implements the pay-it-forward according to the SOP, and to what extent are legitimate adaptations needed? | • Fidelity checklists (as specified by Carroll et al.) will be used to measure adherence to protocol related to content and dose • Interviews with clinic staff will be used to determine reasons for deviation from protocol and to track and document legitimate adaptation |
Maintenancea | Individual | • What is the average donation per participant in each arm? • Is there a relationship between testing and donations? • What are the facilitators and barriers to donation? • What are the demographic, socio-economic, and geographic differences between men who tested after receiving the gift relative to those who were not? | • The tracking of donations stratified by testing status, socioeconomics, and demographics. Interviews with participants will examine the individual-level context of donating |
Organizational | • What is the average donation per clinic in each arm? • Is organizational readiness associated with higher donation rates? • What are resource commitments from the public health sector, MSM organizations, and others to sustain pay-it-forward? | • Administrative data will be used to track donations at the clinic level • Interviews with organizers who can continue the program after the 12-month RCT phase will examine facilitators and barriers to maintaining the intervention |