What can RE-AIM tell us about a long-term, community-based smoke alarm installation program?

Operation Installation is a collaborative smoke alarm installation program of the Injury Prevention Center and Dallas Fire-Rescue. It began in 1999 in the 36 census tracts in Dallas, TX with the highest rates of house fire-related deaths and injuries, and has continued to the present. We used the 5 RE-AIM dimensions (Reach, Efficacy, Adoption, Implementation, Maintenance) to determine the impact of Operation Installation. Reach: The program had a 26.5% reach into the target population. Efficacy: The rate of deaths and injuries in program houses were 90% lower than non-program houses for the first 6 years after smoke alarm installation, but minimal efficacy in years 7 through 10. Adoption/Implementation: Only one fire department was recruited to participate in the program; the fire department continued to implement the program throughout the 10-year period, increasing the average number of smoke alarms installed per house from 1.4 in 2000 to 3.0 in 2011. Maintenance: At the setting level, the number of canvassing sessions conducted per year doubled from 5 in 2000 to 10 sessions in 2011, while the number of census tracts canvassed varied by year. At the individual level, 94.5% of smoke alarms installed during the program were still installed and working 2 years following the original installation, but only 22% were still installed and working after 10 years. The RE-AIM model provided insight into areas to focus future activities. We only reached a quarter of the target population. Only 22% of smoke alarms were still installed and functioning 10 years following installation.