Health equity in action: assessing the impact of the Healthy Kids Family Program using the RE-AIM Framework

Abstract

Background: Families living in equity-deserving communities experience disproportionate barriers to engaging in health-promoting behaviours such as healthy eating and physical activity due to intersecting social determinants of health. Community-based health promotion programs are well positioned to address these inequities; however, there remains a need for comprehensive, real-world evaluations. The RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), is a robust tool for evaluating community-based initiatives, yet its application within family-focused, equity-oriented interventions remains under- represented.

Purpose: The purpose of this study was to conduct a summative evaluation of the Healthy Kids Family Program (HKFP), a four-week, community-based health promotion program delivered in equity-deserving neighbourhoods in Thunder Bay, Ontario. Guided by the RE-AIM Framework, this study aimed to assess the utility, impact, and sustainability of the HKFP as a model for fostering health behaviours in families and children.

Method: A pragmatic mixed methods case study design was employed, using a combination of quantitative and qualitative data collected from 2021 – 2025. Involving a priori and new data and in-line with the RE-AIM Framework, this entailed an assessment of the: (1) Reach associated with the target population; (2) Effectiveness of the program; (3) Adoption by program providers and resident participants; (4) Implementation fidelity with respect to anticipated versus actual program delivery; and (5) Maintenance of program-related outcomes among recipients over time. Quantitative data were obtained from validated health measurement tools assessing health behaviours, self-efficacy for nutrition, and quality of life via two summary scores involving Physical and Mental health. These surveys were administered at baseline, immediately post-intervention, and 6-weeks post-intervention across 11 iterations of the HKFP. Analysis of Variance (ANOVA) testing, dependent t-testing, and descriptive statistics were employed to analyze quantitative data to examine changes over time. Qualitative data were derived from multiple sources including semi-structured interviews with program participants and staff, as well as program documentation including program fidelity notes, and were analyzed using reflexive thematic analysis. Data sources were triangulated and organized deductively via RE-AIM dimensions to provide a comprehensive evaluation of the program and its impact.

Results: Data from 60 participants were obtained from HKFP assessments. Participant demographics revealed that the majority who participated were female (n = 52), aged 22-48 years (M = 35.52), with a mean monthly income of $3,396. Results for Reach showed that the HKFP engaged primarily female individuals across diverse areas of Thunder Bay, though participation was influenced by structural barriers including childcare and scheduling conflicts. Significant improvements were noted in Effectiveness. Quantitative results indicated a significant increase in Self-Efficacy for Nutrition scores between baseline (M = 3.43, SD = 0.89) and follow-up (M = 3.93, SD = 0.72), p < 0.001, η² = .11. No significant improvements in health behaviours or quality of life took place. Assessment of Adoption revealed that the HKFP was supported through strong community partnerships and collaboration. Implementation revealed that program delivery was shaped and adapted by both facilitators to engagement (i.e., supportive environments and resource access) and barriers to engagement (i.e., duration of program session, pandemic-related restrictions). Regarding Maintenance, participants shared that they applied knowledge learned through program delivery into their daily lives; however, longer-term sustainability was influenced by ongoing structural challenges. Qualitatively, participation in the HKFP was described by participants as influenced by contextual barriers including conflicting schedules, transportation, and childcare. Qualitative findings obtained from HKFP participant interviews (n = 7) highlighted themes related to structural barriers (i.e., childcare, financial constraints), social support and community (i.e., peer connection, sense of belonging), as well as empowerment and increased confidence in health behaviours (i.e., self-efficacy and feeling capable of making change). Other qualitative findings obtained from the administrative team of the HKFP (n = 3) contextualized the realities of program offerings and described the importance of collaboration between organizations offering health promotional programming.

Conclusion: This study demonstrated the importance of employing a robust, well-rounded framework when considering study design, specifically when working with equity-deserving communities. For example, statistically significant gains were made in self-efficacy related to nutrition, which may be attributed to the program’s emphasis on skill-building, resource access, and supportive learning environments. Qualitative findings suggest that a meaningful shift in perception surrounding healthy eating took place. They also highlight the importance of contextualized measures of success that extend beyond traditional behavioural outcomes to include empowerment, feasibility, and sustainability. The HKFP represents a promising model for community-based health promotion in equity-deserving communities, because the program offerings provided an opportunity for participants to learn information and make informed decisions surrounding their health. Future research should prioritize strategies to enhance long-term maintenance, including longer or tapered intervention sessions over time, address structural participation barriers including transportation, childcare, and conflicting schedules. This study demonstrated that short-term, community-based health promotion programs can produce meaningful impact for an equity-deserving community through gains in self-efficacy and health behaviour framing, even in the absence of immediate, measurable behaviour change.