ASPO Abstracts
Examining Barriers to Implementing Evidence Based Interventions for Colorectal Cancer Screening in Federally Qualified Health Centers: A Multi-method Approach
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose: To conduct a needs and readiness assessment to identify factors influencing implementation of evidence-based interventions (EBIs) for colorectal cancer screening (CRCS) in federally qualified health centers (FQHCs).Method: As part of the CDC-funded Colorectal Cancer Control Program (CRCCP) in Texas, we worked with 7 clinics (5 rural and 2 urban) from 2 FQHC systems. We used a comprehensive needs and readiness framework to guide data collection. We gathered data on: clinic characteristics, workflow, electronic health records (EHR), use of EBIs (e.g., patient reminders, provider reminders, reducing structural barriers), implementation supports, and organizational readiness defined by the R=MC2 heuristic (Readiness = Motivation x General Capacity x Innovation Specific Capacity). We then used a multi-method approach that included in-depth interviews, clinic-level surveys, and direct workflow observations in each clinic. We used rapid qualitative analysis to analyze qualitative data and a content analysis approach to examine quantitative and observational data. We synthesized findings across data sources to identify implementation barriers and gain a thorough understanding of how they influenced implementation efforts. Results: Findings from the needs and readiness assessments revealed several individual, clinic, and system-level barriers to implementation of CRCS EBIs. Notable barriers at the provider and staff level included- lack of comprehensive knowledge of EHR system, of CRCS modalities available in clinics, and of resources to address barriers. Clinic level barriers included staff turnover and competing priorities (including EHR optimization) and leadership support for system-level changes. System level barriers included lack of funds to update EHR system. Survey results revealed clinics had higher levels of motivation and general capacity for implementation, and lower levels of implementation specific capacity.Conclusions: Results indicate multiple barriers to implementation across levels, that if addressed, could improve implementation efforts. The multi-method approach allowed for a comprehensive understanding of barriers to further inform the development of clinic-specific implementation strategies to accelerate and improve CRCS EBI use.
Keywords: implementation, federally qualified health centers, colorectal cancer, readiness