Developing Strategies to Increase Implementation of Evidence-Based Interventions for Colorectal Cancer Screening in Federally Qualified Health Centers: an Implementation Mapping Approach

Authors: Valerio, M., Savas, L.S., Costa, C., Frachiseur, G., Balasubramanian, B.A., Rogith, D., Foxhall, L., Fenton, S.H., Walker, T., Allen, C., McGaha, P., Chenier, R.S., Hines, D., Padilla, J., Fernandez, M.E.

Category: Cancer Health Disparities
Conference Year: 2023

Abstract Body:
Purpose: Low rates of colorectal cancer screening (CRCS) is a major contributing factor to the high incidence and mortality from colorectal cancer (CRC) in Texas and the US. Improved uptake and use of CRCS evidence-based interventions (EBIs) are needed to increase CRCS rates. Methods: We partnered with Texas Federally Qualified Health Centers (FQHCs) to improve the adoption, implementation, and maintenance of four CRCS EBIs: provider assessment and feedback, provider reminders, patient reminders, and reducing structural barriers. We used Implementation Mapping (IM), a systematic evidence-and theory-informed approach, to identify strategies to implement the EBIs. Results: Following the five tasks of IM, at each clinic, we assessed organizational capacity and readiness to implement EBIs (Task 1). This process revealed individual, clinic, and system-level barriers and facilitators of EBI implementation, which then informed EBI selection (Task 2). Program champions, practice facilitation, telementoring, and EHR optimization (implementation strategies) were selected to address identified barriers. and planned evaluation of the implementation and CRCS outcomes in Task 3, including designing tailored implementation plans for selected EBIs using needs assessment results, theoretical frameworks, and stakeholder input. In Task 4, we focused on improving existing workflows, EHR data report templates, and other relevant protocols and materials. Finally, in Task 5, we evaluated program reach, effectiveness, adoption, implementation, and optimized maintenance. Conclusion: Through the application of IM, we developed an implementation plan to facilitate the effective delivery of CRCS interventions within participating FQHCs. A systematic approach was essential for selecting and tailoring implementation strategies helpful to each FQHC to best promote the sustainability of implemented EBIs.

Keywords: Implementation Mapping, Implementation Strategy, Evidence-Based Interventions, Cancer Prevention.