The Power of Implementation Frameworks: Insights from the Breathewell Study

In healthcare, implementing new interventions successfully is a complex puzzle. The article Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study published in Frontiers in Public Health unravels this complexity. This blog aims to demystify the findings of this study, shedding light on how frameworks like RE-AIM and CFIR can guide the successful implementation of healthcare interventions, especially using the case study of a technology-delivered asthma care intervention called Breathewell.

Understanding the Frameworks

Before diving into the study, let’s understand the frameworks used. RE-AIM stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance. It’s a tool for evaluating the impact of health interventions. CFIR, or the Consolidated Framework for Implementation Research, offers an extensive lens to understand what affects an intervention’s successful implementation and maintenance. Together, these frameworks provide a comprehensive picture of the implementation process.

The Breathewell Study: A Case in Point

The study focuses on the implementation of Breathewell in an integrated care organization. This technology-driven intervention aimed to streamline asthma care services. The researchers employed RE-AIM to evaluate the intervention’s alignment with key domains and CFIR to understand the nuances of pre-implementation planning.

Findings: A Mixed Bag of Alignment and Challenges

The qualitative analysis revealed that the planning team’s priorities aligned well with RE-AIM domains like Reach and Implementation. However, there was less confidence in the adoption and maintenance post-trial, attributed to weaker alignment with several CFIR constructs like leadership engagement and relative priority.

Implications for Evaluation Practice

This study illuminates the importance of comprehensive planning for healthcare interventions. It highlights the need for balancing both frameworks – RE-AIM to assess practical aspects like reach and effectiveness and CFIR to delve into the contextual factors affecting these outcomes.

  1. Aligning with Organizational Culture: The study underscores the importance of interventions aligning with the organization’s existing workflows and cultural ethos.
  2. Leadership Engagement: Critical to the success of an intervention is the involvement and support of the organization’s leadership, ensuring the initiative aligns with broader goals and receives necessary resources for sustainability.
  3. Adapting and Tailoring: Recognizing an organization’s unique challenges and opportunities is key. Interventions need to be adaptable to fit the specific context in which they are implemented.


The Breathewell study is a potent example of how theory-driven frameworks can enhance the planning and evaluation of healthcare interventions. By leveraging the strengths of RE-AIM and CFIR, healthcare professionals can better navigate the intricate landscape of intervention implementation, ultimately leading to more effective and sustainable healthcare solutions.