Any Questions? Asking the Right Ones for Program Implementation and Evaluation

Adoption, Implementation, and Maintenance of Evidence-Based Colorectal Cancer Screening Interventions among CRCCP Grantees

Authors:

Peggy Hannon (Presenter)
University of Washington

Annette Maxwell, University of California at Los Angeles
Cam Escoffery, Rollins School of Public Health
Thuy Vu, University of Washington
Marlana Kohn, University of Washington
Laurel Dillon-Sumner, University of Washington
Caitlin Mason, University of Washington

Public Health Statement: Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. There are effective CRC screening tests, yet CRC screening is underutilized. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives.

Purpose: CDC’ Colorectal Cancer Control Program (CRCCP) provides a unique opportunity to study EBI adoption, implementation, and maintenance; grantees were encouraged to implement five specific EBIs. Our research questions included assessing: 1) number of grantees implementing EBIs during 2011–2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation.

Methods/Approach: We surveyed CRCCP grantees about EBI implementation with an online survey, in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-end items and coded open-end responses for themes related to reasons for stopping EBI use.

Results: Most grantees implemented small media and client reminders all years. Although fewer grantees reported implementation of system-level EBIs such as reducing structural barriers and provider reminders in 2011, implementation of these EBIS increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees in 2015. Grantees who maintained EBIs rated ease of implementation as either constant or increasingly difficult over time. Reasons for stopping EBI-use included funding ending, competing priorities, or limited staff capacity.

Conclusions/Implications: CRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.

Factors Relating to Use and Non-Use of Direct-Mail Fecal Immunochemical Tests (FIT): Interview Findings from a Diverse FQHC Patient Population

Authors:

Thuy Vu (Presenter)
University of Washington

Allison Cole, University of Washington
Peggy Hannon, University of Washington
Kathryn Kemper, HealthPoint Community Health Centers
Jennifer Moon, AT Still University School of Osteopathic Medicine in Arizona
Gloria Coronado, Kaiser Permanente Northwest
Casey Eastman, Washington State Department of Health
Roxane Waldron, Washington State Department of Health

Public Health Statement: Federally Qualified Health Centers (FQHCs) provide cancer prevention services to underserved populations. FQHC colorectal cancer (CRC) screening rates trail national averages. Clinic-based direct-mail of fecal immunochemical tests (FIT) can improve rates; patient feedback is crucial to optimizing CRC screening efforts among diverse patient populations.

Purpose: A large FQHC explored patient perspectives about their direct-mail FIT program to improve their FIT efforts and completion rates.

Methods/Approach: Semi-structured phone interviews were conducted with patients from 9 sites who had received mailed FIT. Patients were asked about CRC screening barriers, facilitators, and FIT material clarity. Translators facilitated non-English interviews. Two staff coded interviews and identified themes.

Results: Interviews were completed with 43 patients in four languages (22 English, 15 Spanish, 2 Punjabi, and 4 Swahili) over 2 weeks in 2016; 72% completed the FIT. Completers (all language) indicated discussion with clinic staff as facilitators. English-speaking completers indicated avoidance of colonoscopy as reason for FIT completion. Non-English speaking completers endorsed wordless and bi-lingual instructions. All respondents affirmed clarity of instructions. Reasons for non-completing included cost, other health issues, procrastination, and finding the test unpleasant. Non-English speaking non-completers were less likely to recall CRC discussions with clinic staff.

Conclusions/Implications: Translated materials and wordless instructions in mailed FITs are well received by non-English speaking populations. Discussions with clinic staff are an important facilitator of FIT completion. Strategies to ensure discussions with non-English speaking patients may be important to help mailed FIT uptake in these populations. Collection and consideration of diverse patient feedback can improve effectiveness of mailed FIT efforts.

Mixed Methods Study of the Role of Partnerships in Advancing Screening Promotion in the Colorectal Cancer Control Program (CRCCP)

Authors:

Cam Escoffery (Presenter)
Rollins School of Public Health

Michelle Carvalho, Rollins School of Public Health
Anamika Satsangi, CDC
Grace Miskin, Rollins School of Public Health
Shade Owolabi, Rollins School of Public Health
Peggy Hannon, University of Washington
Thuy Vu, University of Washington
Annette Maxwell, University of California, Los Angeles
Caitlin Mason, University of Washington

Public Health Statement: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and screening is recommended for adults ages 50–75 years. In 2009, CDC funded 29 grantees to promote CRC screening by implementing five evidence-based interventions (EBIs) recommended by the Guide to Community Preventive Services. Traditionally, national cancer screening programs have leveraged partnerships to extend their resources and community reach.

Purpose: This study describes the types of CRCCP partnerships and their role in EBI implementation, grantees’ perceptions regarding the success of the partnerships, and the facilitators and barriers to partnerships.

Methods/Approach: We collected data from annual surveys (2012–2013) of all CRCCP grantees and qualitative semi-structured interviews with 14 grantees.

Results: Most grantees reported partnering with organizations to implement small media and client reminders. Fewer grantees reported partnering to reduce structural barriers, to conduct provider assessment and feedback and to implement provider reminders. Grantees reported that their partnerships were somewhat to very successful for screening promotion and easy to form (Means 3.80–4.33, 5=very easy). Most partnerships were formally structured (e.g., MOUs, funding). Challenges to partnerships from the interviews included: time, brokering the relationship, making a business case, aligning goals/missions, turnover, desire for flexibility, infrastructure, training/technical assistance, and data and evaluation sharing. Reported facilitators were building on existing partnerships, working with existing internal programs and shared resources and ongoing communication.

Conclusions/Implications: CRCCP grantees’ partnerships were critical to implementation of EBIs to promote population level screening. Data support the concept that diverse partners are necessary to implement different EBIs.