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Adsul P, English K, Jim C, Pankratz VS, Edwardson N, Sheche J, Rodman J, Charlie J, Pagett J, Trujillo J, Grisel-Cambridge J, Mora S, Yepa KL, Mishra SI. Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico. Implement Sci Commun 2024; 5:55. [PMID: 38730301 PMCID: PMC11083750 DOI: 10.1186/s43058-024-00591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico's AI communities. METHODS Guided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening. RESULTS The Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers' perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented. CONCLUSIONS Findings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.
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Affiliation(s)
- Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Cheyenne Jim
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - V Shane Pankratz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Edwardson
- University of New Mexico School of Public Administration, Albuquerque, NM, USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - John Pagett
- Kewa Pueblo Health Corporation, Kewa Pueblo, NM, USA
| | | | | | - Steven Mora
- Jemez Health & Human Services, Jemez Pueblo, NM, USA
| | | | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM, 87131, USA.
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM, 87131, USA.
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White A, Sabatino SA, White MC, Vinson C, Chambers DA, Richardson LC. Twenty years of collaborative research to enhance community practice for cancer prevention and control. Cancer Causes Control 2023; 34:1-5. [PMID: 37191768 PMCID: PMC10185931 DOI: 10.1007/s10552-023-01700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) was established in 2002 to conduct applied research and undertake related activities to translate evidence into practice, with a special focus on the unmet needs of populations at higher risk of getting cancer and dying from it. A network of academic, public health and community partners, CPCRN is a thematic research network of the Prevention Research Centers Program at the Centers for Disease Control and Prevention (CDC). The National Cancer Institute's Division of Cancer Control and Population Sciences (DCCPS) has been a consistent collaborator. The CPCRN has fostered research on geographically dispersed populations through cross-institution partnerships across the network. Since its inception, the CPCRN has applied rigorous scientific methods to fill knowledge gaps in the application and implementation of evidence-based interventions, and it has developed a generation of leading investigators in the dissemination and implementation of effective public health practices. This article reflects on how CPCRN addressed national priorities, contributed to CDC's programs, emphasized health equity and impacted science over the past twenty years and potential future directions.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Susan A. Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Mary C. White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Cynthia Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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O'Leary MC, Hassmiller Lich K, Mayorga ME, Hicklin K, Davis MM, Brenner AT, Reuland DS, Birken SA, Wheeler SB. Engaging stakeholders in the use of an interactive simulation tool to support decision-making about the implementation of colorectal cancer screening interventions. Cancer Causes Control 2023; 34:135-148. [PMID: 37147411 PMCID: PMC10689514 DOI: 10.1007/s10552-023-01692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE We aimed to understand how an interactive, web-based simulation tool can be optimized to support decision-making about the implementation of evidence-based interventions (EBIs) for improving colorectal cancer (CRC) screening. METHODS Interviews were conducted with decision-makers, including health administrators, advocates, and researchers, with a strong foundation in CRC prevention. Following a demonstration of the microsimulation modeling tool, participants reflected on the tool's potential impact for informing the selection and implementation of strategies for improving CRC screening and outcomes. The interviews assessed participants' preferences regarding the tool's design and content, comprehension of the model results, and recommendations for improving the tool. RESULTS Seventeen decision-makers completed interviews. Themes regarding the tool's utility included building a case for EBI implementation, selecting EBIs to adopt, setting implementation goals, and understanding the evidence base. Reported barriers to guiding EBI implementation included the tool being too research-focused, contextual differences between the simulated and local contexts, and lack of specificity regarding the design of simulated EBIs. Recommendations to address these challenges included making the data more actionable, allowing users to enter their own model inputs, and providing a how-to guide for implementing the simulated EBIs. CONCLUSION Diverse decision-makers found the simulation tool to be most useful for supporting early implementation phases, especially deciding which EBI(s) to implement. To increase the tool's utility, providing detailed guidance on how to implement the selected EBIs, and the extent to which users can expect similar CRC screening gains in their contexts, should be prioritized.
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Affiliation(s)
- Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria E Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
| | - Karen Hicklin
- Department of Industrial and Systems Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Melinda M Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wangen M, Escoffery C, Fernandez ME, Friedman DB, Hannon P, Ko LK, Maxwell AE, Petagna C, Risendal B, Rohweder C, Leeman J. Twenty years of capacity building across the cancer prevention and control research network. Cancer Causes Control 2023; 34:45-56. [PMID: 37067700 PMCID: PMC10106885 DOI: 10.1007/s10552-023-01690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To improve population health, community members need capacity (i.e., knowledge, skills, and tools) to select and implement evidence-based interventions (EBIs) to fit the needs of their local settings. Since 2002, the Centers for Disease Control and Prevention has funded the national Cancer Prevention and Control Research Network (CPCRN) to accelerate the implementation of cancer prevention and control EBIs in communities. The CPCRN has developed multiple strategies to build community members' capacity to implement EBIs. This paper describes the history of CPCRN's experience developing and lessons learned through the use of five capacity-building strategies: (1) mini-grant programs, (2) training, (3) online tools, (4) evidence academies, and (5) evaluation support for partners' capacity-building initiatives. METHODS We conducted a narrative review of peer-reviewed publications and grey literature reports on CPCRN capacity-building activities. Guided by the Interactive Systems Framework, we developed histories, case studies, and lessons learned for each strategy. Lessons were organized into themes. RESULTS Three themes emerged: the importance of (1) community-engagement prior to and during implementation of capacity-building strategies, (2) establishing and sustaining partnerships, and (3) co-learning at the levels of centers, networks, and beyond. CONCLUSION CPCRN activities have increased the ability of community organizations to compete for external funds to support implementation, increased the use of evidence in real-world settings, and promoted the broad-scale implementation of cancer control interventions across more than eight states. Lessons from this narrative review highlight the value of long-term thematic networks and provide useful guidance to other research networks and future capacity-building efforts.
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Affiliation(s)
- Mary Wangen
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Cam Escoffery
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Maria E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston, Health Promotion and Behavioral Sciences, Houston, TX, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Peggy Hannon
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Linda K Ko
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Annette E Maxwell
- Los Angeles, Fielding School of Public Health and Jonsson, Comprehensive Cancer Center, Health Policy and Management, The University of California, Los Angeles, CA, USA
| | - Courtney Petagna
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Betsy Risendal
- Colorado School of Public Health, Department of Community & Behavioral Health, The University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Watson KS, Tossas KY, San Miguel Y, Gastala N, San Miguel LG, Grumeretz S, Henderson V, Winn R, Jimbo M, Naylor KB, Gregory ME, Molina Y, Hughes AM. Mi-CARE: Comparing Three Evidence-Based Interventions to Promote Colorectal Cancer Screening among Ethnic Minorities within Three Different Clinical Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7049. [PMID: 37998280 PMCID: PMC10671818 DOI: 10.3390/ijerph20227049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Multiple evidence-based interventions (EBIs) have been developed to improve the completion of colorectal cancer (CRC) screening within Federally Qualified Health Centers (FQHCs) and other safety net settings in marginalized communities. Little effort has been made, however, to evaluate their relative effectiveness across different clinical contexts and populations. To this end, we tested the relative effectiveness of three EBIs (mailed birthday cards, lay navigation, and provider-delivered education) among a convenience sample of 1252 patients (aged 50-75 years old, who were due for CRC screening and scheduled for a visit at one of three clinics within a network of Federally Qualified Health Centers (FQHCs) in the United States. To be eligible for the study, patients had to identify as African American (AA) or Latino American (LA). We compared the effects of the three EBIs on CRC screening completion using logistic regression. Overall, 20% of the study population, an increase from a baseline of 13%, completed CRC screening. Clinical demographics appeared to influence the effectiveness of the EBIs. Mailed birthday reminders appeared to be the most effective within the multi-ethnic clinic (p = 0.03), provider-delivered education within the predominantly LA clinic (p = 0.02), and lay navigation within the predominantly AA clinic (p = 0.03). These findings highlight the importance of understanding clinical context when selecting which evidence-based interventions to deploy.
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Affiliation(s)
- Karriem S. Watson
- National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA;
| | - Katherine Y. Tossas
- VCU Massey Comprehensive Cancer Center, 417 N 11th St., Richmond, VA 23219, USA; (K.Y.T.); (R.W.)
| | - Yazmin San Miguel
- Abbott Laboratories, 100 Abbott Park Road, Abbott Park, IL 60064, USA;
| | - Nicole Gastala
- Hospital & Health Sciences Systems Mile Square Health Center, University of Illinois, 1220 S Wood St. M/C 698; Chicago, IL 60612, USA;
| | - Liliana G. San Miguel
- Department of Community Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA; (L.G.S.M.); (Y.M.)
| | - Scott Grumeretz
- Cancer Center, University of Illinois, SRH MC 709, 818 South Wolcott Avenue, Chicago, IL 60612, USA;
| | - Vida Henderson
- Fred Hutchinson Cancer Center, 1100 Fairview Ave. N. M3-B232, Seattle, WA 98109, USA;
| | - Robert Winn
- VCU Massey Comprehensive Cancer Center, 417 N 11th St., Richmond, VA 23219, USA; (K.Y.T.); (R.W.)
| | - Masahito Jimbo
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, 1919 W. Taylor Street, MC 663, Chicago, IL 60612, USA;
| | - Keith B. Naylor
- Department of Clinical Medicine, Division of Gastroenterology and Hepatology, College of Medicine, University of Illinois Chicago, 840 S. Wood St., 718E CSB (MC 716), Chicago, IL 60612, USA;
| | - Megan E. Gregory
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32611, USA;
| | - Yamilé Molina
- Department of Community Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA; (L.G.S.M.); (Y.M.)
| | - Ashley M. Hughes
- Department of Biomedical and Health Information Sciences, School of Applied Health Sciences, University of Illinois Chicago, 1919 W. Taylor Street MC 530, Chicago, IL 60612, USA
- Center for Innovation for Chronic, Complex Healthcare, Edward Hines JR VA Hospital, 5000 South 5th Avenue, Bldg 1, Hines, IL 60141, USA
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Lee RM, Daly JG, Mallick K, Ramanadhan S, Torres CH, Hayes CR, Bertolini A, Nalls R, Emmons KM. Implementation of evidence-based primary cancer prevention interventions in MA community health centers: an explanatory sequential mixed methods study. Implement Sci Commun 2023; 4:101. [PMID: 37620976 PMCID: PMC10463327 DOI: 10.1186/s43058-023-00483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND More than half of cancers could be prevented by employing evidence-based interventions (EBIs), including prevention interventions targeting nutrition, physical activity, and tobacco. Federally qualified health centers (FQHCs) are the primary source of patient care for over 30 million Americans - making them an optimal setting for ensuring evidence-based prevention that advances health equity. The aims of this study are to (1) determine the degree to which primary cancer prevention EBIs are being implemented within Massachusetts FQHCs and (2) describe how these EBIs are implemented internally and via community partnerships. METHODS We used an explanatory sequential mixed methods design to assess the implementation of cancer prevention EBIs. First, we collected 34 quantitative surveys from staff at 16 FQHCs across Massachusetts to determine the frequency of EBI implementation. We followed up with 12 qualitative one-on-one interviews among a sample of staff to understand how the EBIs selected on the survey were implemented. Exploration of contextual influences on implementation and use of partnerships was guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative data were summarized descriptively, and qualitative analyses used reflexive, thematic approaches, beginning deductively with codes from CFIR, then inductively coding additional categories. RESULTS All FQHCs indicated they offered clinic-based tobacco interventions, such as clinician-delivered screening practices and prescription of tobacco cessation medications. Quitline interventions and some diet/physical activity EBIs were available at all FQHCs, but staff perceptions of penetration were low. Only 38% of FQHCs offered group tobacco cessation counseling and 63% referred patients to mobile phone-based cessation interventions. We found multilevel factors influenced implementation across intervention types - including the complexity of intervention trainings, available time and staffing, motivation of clinicians, funding, and external policies and incentives. While partnerships were described as valuable, only one FQHC reported using clinical-community linkages for primary cancer prevention EBIs. CONCLUSIONS Adoption of primary prevention EBIs in Massachusetts FQHCs is relatively high, but stable staffing and funding are required to successfully reach all eligible patients. FQHC staff are enthusiastic about the potential of community partnerships to foster improved implementation-providing training and support to build these relationships will be key to fulfilling that promise.
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Affiliation(s)
- Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - James G Daly
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Kamini Mallick
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Cassidy R Hayes
- Caring Health Center, 1049 Main Street, Springfield, MA, 01103, USA
| | - Alyssa Bertolini
- Caring Health Center, 1049 Main Street, Springfield, MA, 01103, USA
| | - Ra'Shaun Nalls
- Office of Diversity & Inclusion, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Albers B, Auer R, Caci L, Nyantakyi E, Plys E, Podmore C, Riegel F, Selby K, Walder J, Clack L. Implementing organized colorectal cancer screening programs in Europe-protocol for a systematic review of determinants and strategies. Syst Rev 2023; 12:26. [PMID: 36849979 PMCID: PMC9969690 DOI: 10.1186/s13643-023-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND With a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants. METHODS A systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis. DISCUSSION With its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022306580).
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Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Laura Caci
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Emanuela Nyantakyi
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Ekaterina Plys
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Clara Podmore
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Franziska Riegel
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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8
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McClam M, Workman L, Dias EM, Walker TJ, Brandt HM, Craig DW, Gibson R, Lamont A, Weiner BJ, Wandersman A, Fernandez ME. Using cognitive interviews to improve a measure of organizational readiness for implementation. BMC Health Serv Res 2023; 23:93. [PMID: 36707829 PMCID: PMC9881511 DOI: 10.1186/s12913-022-09005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs. METHODS We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey. RESULTS Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means). CONCLUSION Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.
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Affiliation(s)
- Maria McClam
- grid.254567.70000 0000 9075 106XCenter for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren Workman
- grid.254567.70000 0000 9075 106XCenter for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC USA ,grid.254567.70000 0000 9075 106XDepartment of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Emanuelle M. Dias
- grid.267308.80000 0000 9206 2401The University of Texas Health Science Center at Houston School of Public Health, Houston, TX USA
| | - Timothy J. Walker
- grid.267308.80000 0000 9206 2401The University of Texas Health Science Center at Houston School of Public Health, Houston, TX USA
| | - Heather M. Brandt
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Derek W. Craig
- grid.267308.80000 0000 9206 2401The University of Texas Health Science Center at Houston School of Public Health, Houston, TX USA
| | - Robert Gibson
- grid.410427.40000 0001 2284 9329Augusta University, Augusta, GA USA
| | | | - Bryan J. Weiner
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | - Maria E. Fernandez
- grid.267308.80000 0000 9206 2401The University of Texas Health Science Center at Houston School of Public Health, Houston, TX USA
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Kim J, Estabrooks P, Aggarwal A, McMillan A, Alshehri K. Developing a co-production strategy to facilitate the adoption and implementation of evidence-based colorectal cancer screening interventions for rural health systems: a pilot study. Implement Sci Commun 2022; 3:131. [PMID: 36514119 PMCID: PMC9745718 DOI: 10.1186/s43058-022-00375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence-based colorectal cancer screening (CRCS) interventions have not been broadly adopted in rural primary care settings. Co-production of implementation strategies through a bundled approach may be promising in closing this gap by helping rural healthcare practitioners select and implement the best fitting CRCS interventions to the local context. This paper describes the process and outcomes of co-development and delivery of the bundled implementation strategy to improve adoption and implementation of CRCS interventions with two rural clinics. METHODS We used a bundle of implementation strategies with a core focus on academic-clinical partnership development (strategy 1) and Plan-Do-Study-Act cycles (strategy 2) to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and implementation that improves CRCS. We also developed an implementation blueprint for each clinic (strategy 3) through an online blueprinting process based on adapted "Putting Public Health Evidence in Action" (PPHEA) training curriculum. Clinic physicians and staff (n = 7) were asked to evaluate the bundled approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the bundled approach, we collected implementation outcomes and limited intervention effectiveness of the CRCS evidence-based interventions (EBIs) developed through the process. RESULTS Our co-production strategy yielded a prototype online blueprinting process consisting of 8 distance-learning PPHEA modules that guide selection and implementation of EBIs tailored to CRCS. Modules were delivered to clinic participants with minor adaptations, using PDSA cycle to improve quality of module contents and formats. Overall, participants in both clinics reported positive reactions toward the bundled approach. Both clinics reported improvements in how they perceived the characteristics of the innovation (the bundled approach) to tailor selected CRCS EBIs. As a result of the bundled strategies, each clinic selected and adopted specific EBI(s) with the varying degrees of implementation and CRCS outcomes. CONCLUSIONS The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of EBIs to improve CRCS.
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Affiliation(s)
- Jungyoon Kim
- Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, 984350 Nebraska Medical Center, Omaha, NE, 98168, USA.
| | - Paul Estabrooks
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, USA
| | - Alisha Aggarwal
- Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, USA
| | - Analisa McMillan
- College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Khalid Alshehri
- Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, 984350 Nebraska Medical Center, Omaha, NE, 98168, USA
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Sharma KP, DeGroff A, Hohl SD, Maxwell AE, Escoffery NC, Sabatino SA, Joseph DA. Multi-component interventions and change in screening rates in primary care clinics in the Colorectal Cancer Control Program. Prev Med Rep 2022; 29:101904. [PMID: 35864930 PMCID: PMC9294188 DOI: 10.1016/j.pmedr.2022.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/06/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Evidence-based interventions (EBIs) in clinics increase colorectal cancer screening. Even more effective are multi-component interventions (MCIs) vs a single strategy. We examined the effectiveness of MCIs in CDC’s Colorectal Cancer Control Program. Combination of 3–4 EBIs or 2–3 strategies led to significant increase in screening. Some MCIs led up to 7.2 percentage points annual increases.
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Implementation of evidence-based interventions (EBIs) increases CRC screening. The purpose of this analysis is to determine which combinations of EBIs or strategies led to increases in clinic-level screening rates among clinics participating in CDC’s Colorectal Cancer Control Program (CRCCP). Data were collected from CRCCP clinics between 2015 and 2018 and the analysis was conducted in 2020. The outcome variable was the annual change in clinic level CRC screening rate in percentage points. We used first difference (FD) estimator of linear panel data regression model to estimate the associations of outcome with independent variables, which include different combinations of EBIs and intervention strategies. The study sample included 486 unique clinics with 1156 clinic years of total observations. The average baseline screening rate was 41 % with average annual increase of 4.6 percentage points. Only two out of six combinations of any two EBIs were associated with increases in screening rate (largest was 6.5 percentage points, P < 0.001). Any combinations involving three EBIs or all four EBIs were significantly associated with the outcome with largest increase of 7.2 percentage points (P < 0.001). All interventions involving 2–3 strategies led to increases in rate with largest increase associated with the combination of increasing community demand and access (6.1 percentage points, P < 0.001). Clinics implementing combinations of these EBIs, particularly those including three or more EBIs, often were more likely to have impact on screening rate change than those implementing none.
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Affiliation(s)
- Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Sarah D Hohl
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, United States
| | - Annette E Maxwell
- Center for Cancer Prevention and Control Research, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Ngoc Cam Escoffery
- Emory University, Rollins School of Public Health, CDC, Atlanta, GA, United States
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Djenaba A Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
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11
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Watanabe-Galloway S, Kim J, LaCrete F, Samson K, Foster J, Farazi E, LeVan T, Napit K. Cross-sectional survey study of primary care clinics on evidence-based colorectal cancer screening intervention use. J Rural Health 2022; 38:845-854. [PMID: 34784067 PMCID: PMC9108125 DOI: 10.1111/jrh.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to examine differences between urban and rural primary care clinics in the use of colorectal cancer (CRC) screening methods and evidence-based interventions to promote CRC screening. METHODS This was a cross-sectional survey of primary care clinics in Nebraska. Surveys in paper form were sent out and followed up with telephone interviews to nonrespondents. Of the 375 facilities, 263 (70.1%) responded to the survey. FINDINGS Over 30% of urban clinics indicated that 80% or more of their patients were meeting the CRC guidelines compared to 18.3% of rural clinics (P = .03). Rural clinics were more likely than urban clinics to prefer the use of colonoscopy alone or in combination with stool tests (P = .02). The most common interventions for CRC screening included one-on-one patient education and use of computer-based pop-ups to remind providers. CONCLUSIONS In conclusion, we found some important differences between rural and urban primary care clinics in the implementation of CRC screening. Given that there is evidence for differences in preference for CRC screening methods (colonoscopy vs stool-based tests) between rural and urban community members, it is important to assess the effectiveness of different types of CRC screening interventions by comparing rural and urban primary care clinic patient populations.
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Affiliation(s)
| | - Jungyoon Kim
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Frantzlee LaCrete
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaeli Samson
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jason Foster
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Evi Farazi
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tricia LeVan
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Krishtee Napit
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Maxwell AE, DeGroff A, Hohl SD, Sharma KP, Sun J, Escoffery C, Hannon PA. Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015-2018. Prev Chronic Dis 2022; 19:E26. [PMID: 35588522 PMCID: PMC9165474 DOI: 10.5888/pcd19.210258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018. INTERVENTION APPROACH The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers). EVALUATION METHODS Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs. RESULTS In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study. IMPLICATIONS FOR PUBLIC HEALTH Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.
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Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles, Los Angeles, California.,Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900. E-mail:
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Juzhong Sun
- Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Stradtman LR, Carman AL, Vanderpool RC. Resources Used by Federally Qualified Health Center Leadership to Learn About Preventive Care Interventions. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E635-E638. [PMID: 34016905 DOI: 10.1097/phh.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Federally qualified health centers (FQHCs) serve patient populations that commonly have low preventive care utilization rates. Implementation of preventive care interventions (PCIs) may help decrease these care deficiencies. A survey of Kentucky FQHC leaders was conducted in 2019 to determine resources used to learn about PCIs and how leaders decide to implement them. Nineteen of Kentucky's 24 FQHCs completed the survey for a participation rate of 79%. Among participating FQHC leadership, the 3 resources that were very or somewhat likely to be used to learn about PCIs were advice or consultation from peers (100%), professional associations (95%), and nonacademic conferences/meetings (90%). The state primary care association and statewide community health center network were listed as the most helpful resources. These results highlight the types of resources used by FQHC leadership to learn about PCIs. Understanding preferred learning methods can help researchers improve outreach to FQHCs and facilitate dissemination of PCIs.
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Affiliation(s)
- Lindsay R Stradtman
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, Kentucky
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14
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Coury J, Ramsey K, Gunn R, Judkins J, Davis M. Source matters: a survey of cost variation for fecal immunochemical tests in primary care. BMC Health Serv Res 2022; 22:204. [PMID: 35168616 PMCID: PMC8845335 DOI: 10.1186/s12913-022-07576-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Mailed fecal immunochemical tests (FIT) are an effective way to increase CRC screening rates, but is still underutilized. In particular, cost of FIT has not been explored in relation to practice characteristics, FIT selection, and screening outreach approaches. Methods We administered a cross-sectional survey drawing from prior validated measures to 252 primary care practices to assess characteristics and context that could affect the implementation of direct mail fecal testing programs, including the cost, source of test, and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson’s chi-squared test of association and interpreted a low p-value (e.g. < 0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). Results Among the 84 viable practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on FIT costs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significantly different by FIT type. However, practices who received FITs from manufacturer’s vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002). Conclusions Our findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have consequences for implementation of outreach programs that address colorectal cancer screening disparities in primary care practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07576-4.
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Affiliation(s)
- Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA.
| | - Katrina Ramsey
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA
| | | | - Jon Judkins
- Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L222, Portland, Oregon, 97239, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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15
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Leeman J, Askelson N, Ko LK, Rohweder CL, Avelis J, Best A, Friedman D, Glanz K, Seegmiller L, Stradtman L, Vanderpool RC. Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: a qualitative study. Transl Behav Med 2021; 10:394-403. [PMID: 30794725 DOI: 10.1093/tbm/ibz023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) screening is highly effective at reducing cancer-related morbidity and mortality, yet screening rates remain suboptimal. Evidence-based interventions can increase screening rates, particularly when they target multiple levels (e.g., patients, providers, health care systems). However, effective interventions remain underutilized. Thus, there is a pressing need to build capacity to select and implement multilevel CRC screening interventions. We report on formative research aimed at understanding how Federally Qualified Health Center (FQHC) staff select and implement CRC screening interventions, which will inform development of capacity-building strategies. We report the qualitative findings from a study that used a mixed methods design, starting with a quantitative survey followed by a qualitative study. In-depth interviews were conducted with 28 staff from 14 FQHCs in 8 states. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and data analysis. Related to the CFIR process domain, few respondents described conducting formal assessments of factors contributing to low screening rates prior to planning their interventions. Many described engaging champions, implementation leaders, and external change agents. Few described a systematic approach to executing implementation plans beyond conducting plan-do-study-act cycles. Reflection and evaluation consisted primarily of reviewing Uniform Data System performance measures. Findings also include themes related to factors influencing these implementation processes. Although FQHCs are implementing CRC screening interventions, they are not actively targeting the multilevel factors influencing their CRC screening rates. Our findings on gaps in FQHCs' implementation processes will inform development of strategies to build capacity to select and implement multilevel CRC screening interventions.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda K Ko
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Carrboro, NC, USA
| | - Jade Avelis
- Center for Health Behavior Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alicia Best
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Daniela Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Karen Glanz
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Seegmiller
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lindsay Stradtman
- Health, Behavior, & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Robin C Vanderpool
- Health, Behavior, & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
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Friedman DB, Arent MA, Yelton B, Sakhuja M, Haynes VE, Noblet S, Brandt HM, Isenhower WD, Wandersman A, Zona D, New C, Fedrick D, Scaccia J, Bruner L. Development of a Clinical-Academic-Community Collaboration to Improve Health Literacy. J Prim Care Community Health 2021; 11:2150132720957440. [PMID: 32909496 PMCID: PMC7495516 DOI: 10.1177/2150132720957440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Limited health literacy is associated with poor patient health outcomes and
increased hospitalization rates. Patient-provider communication plays an
important role in patient health literacy and the understanding of medical
terminology. This study demonstrates how a collaboration between clinical,
academic, and community partners was instrumental in the design and
implementation of a clinic readiness assessment and a clinic-based pilot
intervention to encourage patient-provider communication and improve patient
health literacy. A state hospital association, academic research team, and
community adult literacy center director collaborated to develop a 60-item
clinic readiness assessment and an evidence-informed pilot intervention. The
clinic readiness assessment captured clinics’ motivation and capacity for pilot
implementation and providers’ current communication strategies. The intervention
centered around AskMe3™ educational materials and involved 2 patient visits
(initial and follow-up visits). Data collection instruments for the intervention
were administered verbally and included questions about patient demographics and
communication needs, and a single-item health literacy measure. Descriptive
statistics (frequencies/percentages) were used to analyze results from the
clinic readiness assessment and pilot intervention. Establishment of the
partnership, and collaborative, iterative development of the clinic readiness
assessment and pilot intervention are described. This pilot project resulted in
important lessons learned which led to critical modifications that will inform
future expansion of the intervention. Collaboration between healthcare leaders,
researchers, and community partners is recommended for developing clinic-based
health literacy initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diana Zona
- South Carolina Hospital Association, Columbia, SC, USA
| | - Cyndi New
- South Carolina Hospital Association, Columbia, SC, USA
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Somayaji D, Melendez M, Kwon M, Lathan C. Access to Cancer Care Resources in a Federally Qualified Health Center: a Mixed Methods Study to Increase the Understanding of Met and Unmet Needs of Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:591-602. [PMID: 31828550 DOI: 10.1007/s13187-019-01669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0-5 years with 17.5% (n = 3), 6-10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.
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Affiliation(s)
- Darryl Somayaji
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA.
| | | | - Misol Kwon
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA
| | - Christopher Lathan
- Dana Farber/Harvard Cancer Center Medicine Department, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
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18
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Davis MM, Schneider JL, Gunn R, Rivelli JS, Vaughn KA, Coronado GD. A qualitative study of patient preferences for prompts and reminders for a direct-mail fecal testing program. Transl Behav Med 2021; 11:540-548. [PMID: 32083287 PMCID: PMC7963281 DOI: 10.1093/tbm/ibaa010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Programs that directly mail fecal immunochemical tests (FIT) to patients can increase colorectal cancer (CRC) screening, especially in low-income and Latino populations. Few studies have explored patient reactions to prompts or reminders that accompany such programs. As part of the Participatory Research to Advance Colon Cancer Prevention pilot study, which tested prompts and reminders to a direct-mail FIT program in a large, urban health center, we conducted telephone interviews among English- and Spanish-speaking participants who were assigned to receive a series of text message prompts, automated phone call reminders, and/or live phone call reminders. We analyzed interviews using a qualitative content analysis approach. We interviewed 41 participants, including 25 responders (61%) and 16 nonresponders (39%) to the direct-mail program. Participants appreciated program ease and convenience. Few participants recalled receiving prompts or automated/live reminders; nevertheless, the vast majority (95%, n = 39) thought reminders were acceptable and helpful and suggested that 2-3 reminders delivered starting 1 week after the mailed FIT would optimally encourage completion. Prompts and reminders used with mailed-FIT programs are accepted by patients, and my help boost response rates.
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Affiliation(s)
- Melinda M Davis
- Oregon Rural Practice-Based Research Network, Department of Family Medicine, and School of Public Health, Oregon Health and Science University, Mail Code, Portland, OR, USA
| | | | - Rose Gunn
- Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer S Rivelli
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Katherine A Vaughn
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Zhan FB, Morshed N, Kluz N, Candelaria B, Baykal-Caglar E, Khurshid A, Pignone MP. Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019. Prev Chronic Dis 2021; 18:E20. [PMID: 33661726 PMCID: PMC7938962 DOI: 10.5888/pcd18.200362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening can reduce morbidity and mortality; however, important disparities exist in CRC uptake. Our study examines the associations of distance to care and frequency of using primary care and screening. METHODS To examine the distribution of screening geographically and according to several demographic features, we used individual patient-level data, dated September 30, 2018, from a large urban safety-net health system in Central Texas. We used spatial cluster analysis and logistic regression adjusted for age, race, sex, socioeconomic status, and health insurance status. RESULTS We obtained screening status data for 13,079 age-eligible patients from the health system's electronic medical records. Of those eligible, 55.1% were female, and 55.9% identified as Hispanic. Mean age was 58.1 years. Patients residing more than 20 miles from one of the system's primary care clinics was associated with lower screening rates (odds ratio [OR], 0.63; 95% CI, 0.43-0.93). Patients with higher screening rates included those who had a greater number of primary care-related (nonspecialty) visits within 1 year (OR, 6.90; 95% CI, 6.04-7.88) and those who were part of the county-level medical assistance program (OR, 1.61; 95% CI, 1.40-1.84). Spatial analysis identified an area where the level of CRC screening was particularly low. CONCLUSION Distance to primary care and use of primary care were associated with screening. Priorities in targeted interventions should include identifying and inviting patients with limited care engagements.
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Affiliation(s)
- F Benjamin Zhan
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, TX 78666.
| | - Niaz Morshed
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Bretta Candelaria
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | | | - Anjum Khurshid
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Michael P Pignone
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
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de Vasconcelos LP, Melo DOD, Stein AT, de Carvalho HB. Even High-Quality CPGs Seldom Include Implementation Strategies. Front Pharmacol 2021; 11:593894. [PMID: 33519455 PMCID: PMC7845482 DOI: 10.3389/fphar.2020.593894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs). Methods: NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy. Results: Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%). Conclusion: Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.
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Affiliation(s)
| | - Daniela Oliveira De Melo
- Department of Pharmaceutical Science, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Airton Tetelbom Stein
- Department of Collective Health, Federal University of Health Sciences of Porto Alegre, São Paulo, Brazil
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Rohweder C, Wangen M, Black M, Dolinger H, Wolf M, O'Reilly C, Brandt H, Leeman J. Understanding quality improvement collaboratives through an implementation science lens. Prev Med 2019; 129S:105859. [PMID: 31655174 PMCID: PMC7138534 DOI: 10.1016/j.ypmed.2019.105859] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Abstract
Quality improvement collaboratives (QICs) have long been used to facilitate group learning and implementation of evidence-based interventions (EBIs) in healthcare. However, few studies systematically describe implementation strategies linked to QIC success. To address this gap, we evaluated a QIC on colorectal cancer (CRC) screening in Federally Qualified Health Centers (FQHCs) by aligning standardized implementation strategies with collaborative activities and measuring implementation and effectiveness outcomes. In 2018, the American Cancer Society and North Carolina Community Health Center Association provided funding, in-person/virtual training, facilitation, and audit and feedback with the goal of building FQHC capacity to enact selected implementation strategies. The QIC evaluation plan included a pre-test/post-test single group design and mixed methods data collection. We assessed: 1) adoption, 2) engagement, 3) implementation of QI tools and CRC screening EBIs, and 4) changes in CRC screening rates. A post-collaborative focus group captured participants' perceptions of implementation strategies. Twenty-three percent of North Carolina FQHCs (9/40) participated in the collaborative. Health Center engagement was high although individual participation decreased over time. Teams completed all four QIC tools: aim statements, process maps, gap and root cause analysis, and Plan-Do-Study-Act cycles. FQHCs increased their uptake of evidence-based CRC screening interventions and rates increased 8.0% between 2017 and 2018. Focus group findings provided insights into participants' opinions regarding the feasibility and appropriateness of the implementation strategies and how they influenced outcomes. Results support the collaborative's positive impact on FQHC capacity to implement QI tools and EBIs to improve CRC screening rates.
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Affiliation(s)
- Catherine Rohweder
- University of North Carolina at Chapel Hill, 200 N. Greensboro St., Suite D-15, Room 212, Carrboro, NC 27510, United States of America.
| | - Mary Wangen
- University of North Carolina at Chapel Hill, 3005 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Molly Black
- American Cancer Society, Inc., 250 Williams St., Atlanta, GA 30303, United States of America.
| | - Heather Dolinger
- American Cancer Society, Inc., 8300 Health Park Suite 10, Raleigh, NC 27615, United States of America.
| | - Marti Wolf
- North Carolina Community Health Center Association, 4917 Waters Edge Drive, Suite 165, Raleigh, NC 27606, United States of America.
| | - Carey O'Reilly
- North Carolina Community Health Center Association, 4917 Waters Edge Drive, Suite 165, Raleigh, NC 27606, United States of America.
| | - Heather Brandt
- University of South Carolina, 915 Greene Street, Discovery Building, Columbia, SC 29208, United States of America.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, 4005 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, United States of America.
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