BackgroundThere have been over 430 publications using the RE-AIM model for planning and evaluation of health programs and policies, as well as numerous applications of the model in grant proposals and national programs. Full use of the model includes use of qualitative methods to understand why and how results were obtained on different RE-AIM dimensions, however, recent reviews have revealed that qualitative methods have been used infrequently. Having quantitative and qualitative methods and results iteratively inform each other should enhance understanding and lessons learned.MethodsBecause there have been few published examples of qualitative approaches and methods using RE-AIM for planning or assessment and no guidance on how qualitative approaches can inform these processes, we provide guidance on qualitative methods to address the RE-AIM model and its various dimensions. The intended audience is researchers interested in applying RE-AIM or similar implementation models, but the methods discussed should also be relevant to those in community or clinical settings.ResultsWe present directions for, examples of, and guidance on how qualitative methods can be used to address each of the five RE-AIM dimensions. Formative qualitative methods can be helpful in planning interventions and designing for dissemination. Summative qualitative methods are useful when used in an iterative, mixed methods approach for understanding how and why different patterns of results occur.ConclusionsIn summary, qualitative and mixed methods approaches to RE-AIM help understand complex situations and results, why and how outcomes were obtained, and contextual factors not easily assessed using quantitative measures.

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Dissemination and Implementation Science (DIS) is a growing research field that seeks to inform how evidence-based interventions can be successfully adopted, implemented, and maintained in health care delivery and community settings. In this article, an overview of DIS and how it has contributed to primary care delivery improvement, future opportunities for its use, and DIS resources for learning are described. Case examples are provided to illustrate how DIS can be used to solve the complex implementation and dissemination problems that emerge in primary care. Research in primary care has highlighted many new developments in the past decade including training programs, scope of care, care teams, treatments, and payment models.1,2 These changes have resulted in advances, opportunities, and challenges. Some of the most recent and ongoing developments in primary care include a focus on patientcentered care, the concept and implementation of the patient-centered medical home 3,4 , the use of electronic medical records and meaningful use standards 5,6 , payment redesign such as the Medicare Access and CHIP Reauthorization Act of 2015 7 and Merit-based Incentive Payment System 8 , Maintenance of Certification requirements 9,10 as well as practice transformation strategies to implement these initiatives. Complicating matters further are new developments in the patient population including aging and the associated increasing burden of chronic illness, health equity and social determinants of health issues, and the coming era of precision medicine. 11-13Primary care practitioners and researchers are in the forefront of making these changes happen. Achieving the goals of these initiatives, however, can be challenging for a multitude of reasons. It is well known that most innovations and evidencebased practices do not make it into practice or, if they do, take an average of 17 years.14 Some of the reasons for this delay or failure in implementation of new initiatives are contextual and include lack of training and policy support, reimbursement issues, and lack of appropriate dissemination infrastructure. The complicated demands being placed on increasingly complex systems require that a new strategy and science be in place to be successful at the dissemination, implementation, and sustainability of evidence-based programs. Dissemination and implementation science (DIS), a relatively new area of health research, shows increasing promise to address many of these issues and bridge the gap between new, efficacious or evidence-based practices, guidelines, policies and interventions, and routine practice. DIS studies how interventions can be designed to work in real-world clinical and community settings, and identifies and evaluates the strategies that produce these results. 15,16 The focus is on designing interventions and identifying implementation strategies that work in real life and across diverse (and especially low resource), complex settings and populations.Although others have provided an introduction of DIS for health...