# 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.

## Key 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.