The Application of the RE-AIM and PRISM Framework to Process Evaluations of Diabetes Self-Management Programs: A Systematic Review and Secondary Analysis of Literature

CHINELO NSOBUNDU^1,2*Yeka Nmadu³Nikita Wagle⁴Oluwafemi Aremu^5,6Allen Eruaga²Ngalula Dolly Mwintshi²Mariam Olamide Salis⁷Margaret J Foster⁸Matthew Lee Smith^1,9Marcia G. Ory^1,10

• ¹Center for Community Health and Aging, Texas A&M University, College Station, United States
• ²St. George's University, St. George's, Grenada
• ³University of Florida, Jacksonville, United States
• ⁴School of Public Health, Texas A&M University, College Station, Texas, United States
• ⁵Independent Researcher, Jacksonville, Florida, United States
• ⁶Ascension Wisconsin Family Health Center, Milwaukee, United States
• ⁷School of Medicine, St. George's University, St. George's, Grenada
• ⁸Texas A and M University, College Station, Texas, United States
• ⁹Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States
• ¹⁰Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States

Background Diabetes self-management programs, often known as DSMPs, are crucial interventions for enhancing clinical and behavioral outcomes in individuals with diabetes. Despite the well-established advantages of these programs, little is known about how they are carried out and maintained in real world environments. This systematic review builds upon a previously published prequel by applying the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and PRISM (Practical, Robust Implementation and Sustainability Model) frameworks to examine the process evaluations of traditional, group-based DSMPs, with the goal of identifying implementation strengths, gaps, and contextual influences. Methods Using five databases, a comprehensive analysis of peer-reviewed literature up to January 2024 was performed. Eligible studies included traditional, group-based DSMPs for adults with type 1 or type 2 diabetes that reported at least one process evaluation outcome. Sixty-eight studies (n=78 articles) met inclusion criteria. Data were extracted and synthesized using RE-AIM and PRISM components, and study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results Sixty-eight studies (k=68; n=78) satisfied the requirements for inclusion. Fewer research addressed Adoption (k=5), Implementation (k=24), and Maintenance (k=26), whereas the majority 2 focused on Reach (k=66) and Effectiveness (k=66). Only four studies found external contextual influences, compared to nineteen that found internal contextual elements. Process-level indicators—such as implementation fidelity, cost, sustainability, and provider engagement—were often underreported, despite consistent evidence of positive clinical and behavioral outcomes. Discussion The review highlights a critical gap between outcome evaluation and implementation reporting in DSMP research. The organizational and contextual elements that affect program scalability and durability were overlooked in favor of patient-level outcomes in most of the studies. When the RE-AIM and PRISM frameworks were used systematically, it was discovered that several process components that are essential for long-term integration were underreported. Resolving these shortcomings can help direct the creation of scalable, context-aware DSMPs that are more adaptable to diverse populations and settings. Conclusion Process evaluations should be thorough, context-sensitive, and theory-driven to improve the implementation, execution, and long-term effects of DSMPs. A more comprehensive analysis of program success is made possible by integrating the RE-AIM and PRISM frameworks, which closes the gap