The application of the RE-AIM and PRISM framework to process evaluations of diabetes self-management programs
A systematic review and secondary analysis of literature
Bibliographic Data
Background: Diabetes self-management programs, often known as DSMPs, are crucial interventions for enhancing clinical and behavioral outcomes in individuals with diabetes. Despite the well-established advantages of these programs, little is known about how they are carried out and maintained in real world environments. This systematic review builds upon a previously published prequel by applying the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and PRISM (Practical, Robust Implementation and Sustainability Model) frameworks to examine the process evaluations of traditional, group-based DSMPs, with the goal of identifying implementation strengths, gaps, and contextual influences. Methods: = 78 articles) met inclusion criteria. Data were extracted and synthesized using RE-AIM and PRISM components, and study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: = 78) satisfied the requirements for inclusion. Fewer research addressed Adoption (k = 5), Implementation (k = 24), and Maintenance (k = 26), whereas the majority focused on Reach (k = 66) and Effectiveness (k = 66). Only four studies found external contextual influences, compared to nineteen that found internal contextual elements. Process-level indicators-such as implementation fidelity, cost, sustainability, and provider engagement-were often underreported, despite consistent evidence of positive clinical and behavioral outcomes. Discussion: The review highlights a critical gap between outcome evaluation and implementation reporting in DSMP research. The organizational and contextual elements that affect program scalability and durability were overlooked in favor of patient-level outcomes in most of the studies. When the RE-AIM and PRISM frameworks were used systematically, it was discovered that several process components that are essential for long-term integration were underreported. Resolving these shortcomings can help direct the creation of scalable, context-aware DSMPs that are more adaptable to diverse populations and settings. Conclusion: Process evaluations should be thorough, context-sensitive, and theory-driven to improve the implementation, execution, and long-term effects of DSMPs. A more comprehensive analysis of program success is made possible by integrating the RE-AIM and PRISM frameworks, which closes the gap between research and real-world implementation. To educate healthcare policy and practice, future evaluations should use mixed method designs that evaluate implementation as well as results. Systematic review registration: This systematic review was registered in PROSPERO. The registration number is CRD42020177170
MEDLINE · Prism · Systematic process · Systematic review · Diabetes Management and Education · Health Education and Validation · Health Policy Implementation Science
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