Evaluating the implementation of active transportation infrastructure during the pandemic: a RE-AIM study

The impact of urban transportation on human health is a critical area of study in public health. The pandemic created a need to re-imagine urban public spaces and trial built environment interventions under expedited timelines. By expanding street space for active transportation during the pandemic, cities aimed to enable access to essential destinations and supported physical and mental health during physical distancing regulations through ‘street reallocation’ interventions. Using the RE-AIM framework, our aim is to evaluate the COVID-19 pandemic street reallocations in the cities of Vancouver, Toronto, and Montréal in Canada. Using a mixed methods approach, we evaluated street reallocation implementation across RE-AIM dimensions (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We conducted a socio-spatial analysis using publicly available data, including cycling infrastructure, area-level sociodemographic characteristics, and measures of accessibility to destinations. To identify barriers and enablers of street reallocation implementation and to add nuance to the socio-spatial analysis, we conducted semi-structured interviews with municipal practitioners in 2022. We coded and analyzed the data using framework analysis. Reach: In Vancouver, Toronto, and Montréal, 39.9%, 21.0%, and 32.9% of the population had access to street reallocations in their census tract. Effectiveness: In Vancouver, most street reallocations were in areas with high accessibility to (i.e., spatial proximity to) employment, and in Toronto and Montréal in areas with high accessibility to parks. Adoption: The majority of street reallocations were implemented near pre-existing cycling infrastructure. Though not targeted as users of the street reallocations, local business owners were important in the decision-making process. Implementation: A facilitator of street reallocation implementation was communication between municipal practitioners and community members, and continuous feedback cycles. Maintenance: Temporary materials used to initially construct street reallocations were high maintenance which resulted in high costs. Sustainability of street reallocation interventions hinges on community support. Our findings help to inform the work of municipal practitioners, public health professionals, and researchers looking to build healthier and more equitable transportation systems. A focus of future implementation science research may be on developing consistent metrics for built environment intervention evaluation.