JMIR Publications

ABSTRACT

Background:

Frameworks for implementation evaluation and program theory have been increasingly used to support the design, implementation, and assessment of complex health interventions. The RE-AIM framework provides a structured approach to evaluating reach, effectiveness, adoption, implementation, and maintenance, while Theory of Change and logic models explicitly articulate causal mechanisms and pathways of impact. Despite their conceptual complementarity, how these approaches have been jointly applied in empirical studies, particularly in digital health and telehealth contexts, remains insufficiently mapped.

Objective:

This scoping review aimed to map and characterize how empirical studies have integrated the RE-AIM framework with Theory of Change or logic models in the design, implementation, and evaluation of health interventions, to identify levels and patterns of integration, and to examine how this combined use has been applied in digital health and telehealth interventions.

Methods:

A scoping review was conducted following the methodological guidance of the Joanna Briggs Institute and reported in accordance with the PRISMA-ScR checklist. Searches were performed in PubMed/MEDLINE, Embase, Scopus, and Web of Science without restrictions on language, study design, or publication year. Eligible studies were peer-reviewed empirical studies, protocols, and implementation reports that explicitly applied both the RE-AIM framework and Theory of Change or logic models in the context of health interventions. Data were extracted using a structured chart and analyzed descriptively to identify characteristics of the included studies, levels of framework integration, and patterns of use across intervention types.

Results:

A total of 29 studies published between 2016 and 2025 met the inclusion criteria. Most studies focused on non-digital health interventions (21/29, 72.4%), while eight studies (27.6%) evaluated digital or telehealth interventions. Strong integration between RE-AIM and Theory of Change or logic models was identified in 17 studies (58.6%), moderate integration in nine (31.0%), and weak integration in three (10.4%). Logic models and Theory of Change were predominantly used to clarify intervention mechanisms and guide planning, whereas RE-AIM was primarily applied as an evaluative framework for implementation outcomes. Digital health interventions demonstrated more robust evaluation when explicit causal models were combined with RE-AIM metrics, although such applications remained limited. Across studies, the Maintenance dimension of RE-AIM was least frequently addressed.

Conclusions:

The integration of RE-AIM with Theory of Change or logic models represents a promising methodological strategy for strengthening the planning, implementation, and evaluation of complex health interventions, including digital health initiatives. While the combined use of these frameworks has increased over time, important gaps persist, particularly regarding long-term sustainability assessment and systematic application in telehealth and digital health contexts. Greater methodological rigor and deeper integration between causal models and implementation metrics are needed to advance the field. Clinical Trial: This study does not involve a clinical trial