A mixed method evaluation using the RE-AIM framework of a student-led community-based cardiovascular disease screening clinic in an urban community setting

TL;DR

This study evaluates a student-run heart disease screening clinic using a framework that considers reach, effectiveness, adoption, implementation, and maintenance.

Contribution

The study introduces a comprehensive evaluation of a student-led health initiative using the RE-AIM framework, highlighting both strengths and structural limitations.

Findings

The clinic reached diverse socioeconomic groups but had limited engagement from younger adults.

High rates of modifiable cardiovascular risk factors were detected, with significant improvements in participants' motivation for lifestyle changes.

Strong interpersonal delivery was observed, but referral systems and follow-up procedures were inconsistent.

Abstract

Evaluations of public health interventions often prioritise outcomes while neglecting contextual and implementation factors essential for sustainability. Using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), this study assessed the Young@Heart (Y@H) student-led cardiovascular disease (CVD) screening clinic—a community-based initiative that simultaneously delivers preventive health services and experiential learning for undergraduate pharmacy students.

A concurrent mixed-methods case study was conducted across organisational, service, and individual levels over 12 months. Data sources included semistructured interviews with academic staff, patients, and external stakeholders; focus groups with student volunteers; service-activity data from 1,152 clinic attendees; and 20 fidelity assessments of service delivery. Quantitative and qualitative data were analysed independently, then integrated using the RE-AIM framework to triangulate findings across datasets.

Reach: the clinic attracted 1,152 participants (mean age 53 years), with representation from all socioeconomic deciles and 31% from the most deprived quintiles, demonstrating strong accessibility but limited engagement from younger adults. Effectiveness: High rates of modifiable risk were detected (44% elevated blood pressure, 62% overweight/obese, 36% cholesterol >5 mmol/L). Significant pre-post gains in self-reported motivation for dietary and physical-activity change (p < 0.001) aligned with qualitative reports of increased awareness and intention to act. Adoption: Stakeholders and participants valued the clinic’s dual educational–public health role; however, formal referral rates were low (9%), highlighting weak system integration. Implementation: fidelity checks showed >80% adherence in 18/20 observations, indicating strong interpersonal delivery but procedural inconsistency in referral and signposting practices. Maintenance: participants and stakeholders perceived the model as sustainable if embedded within curricula and supported by stable funding, though absence of follow-up data limited assessment of long-term behavioral maintenance.

Applying the RE-AIM framework provided a comprehensive evaluation of the Y@H clinic, evidencing its accessibility, effectiveness, and educational value. While strong interpersonal delivery and measurable health impact were achieved, structural limitations in referral systems and follow-up impede sustained outcomes. Strengthening cross-sector referral pathways, standardising procedures, and embedding routine evaluation will be essential to ensure scalability, equity, and long-term sustainability of this innovative student-led community health model.