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Proceedings of the 15th Annual Conference on the Science of Dissemination and Implementation in Health
Adsul, P., Kanabar, N., Davis, M., Rabin, B., Kruse-Diehr, A., Oliveri, J., Dignan, M., Paskett, E., Reuland, D., Ferrari, R., Moore, A., Polite, B., Kim, K., Gupta, S., Castaneda, S., Martinez, M. E., Lance, P., Hatcher, J., Coury, J., ... Mishra, S. (2023). Proceedings of the 15th Annual Conference on the Science of Dissemination and Implementation in Health. Implementation Science, 18(Suppl 3), Article S142. https://doi.org/10.1186/s13012-023-01299-8
Implementing evidence-based interventions such as colorectal cancer screening for population-level benefit can be challenging in resource-limited, primary healthcare settings. Part of the challenge is in identifying and studying strategies that address the multilevel, contextual influences on implementation in these healthcare settings. The purpose of this study was to examine the strategies utilized by multiple research sites, funded through the Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) initiative that studies the implementation of colorectal cancer screening, follow-up, and referral to care, in primary healthcare settings.
Methods
ACCSIS sites completed Excel-based questionnaires within their teams and listed specific activities and approaches used in the implementation of colorectal cancer screening. Each site’s data was reviewed and validated by three implementation science experts that matched these activities to implementation strategies and domains as they have been operationalized and classified in the Experts Recommending Implementation Change (ERIC) study. All matched strategies were then reviewed and confirmed by the research teams, prior to final data analysis. Analyses examined similarities and differences among implementation strategies used by each site and tracked their use across the screening continuum.
Findings
Seven ACCSIS sites participated in this study; collectively, they identified 77 implementation strategies (range: 3-17 per site) that helped implement colorectal cancer screening, follow-up, and referrals in primary healthcare settings and matched the ERIC study. Several similarities were noted across sites, for example, four sites developed and distributed educational materials, while three used facilitation as an implementation strategy. Of the nine domains under which the ERIC strategies are classified, most strategies used by the ACCSIS sites fell under the domain of using evaluative and iterative strategies (e.g., conducting a local need assessment), followed by training and education (e.g. provider education). All sites used strategies focused on screening while six sites used strategies to ensure follow-up of screening, and only one site used strategies focused on access to treatment.
Implications for D&I Research
Collating strategies across ACCSIS sites enables the development of an evidence-base specifically focused on strategies that address the multi-level influences on colorectal cancer screening and follow-up. Our study findings provide important data to guide real-world implementation efforts, including future scale-up and sustainability.
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