Abstract A15: Using the RE-AIM framework to evaluate a community-based participatory project

Abstract

Abstract Background There are many situations where randomization control trial is not feasible. Interventions that can be adopted, delivered broadly, consistently implemented, and sustained over time are important to public health, as well as population health research. The RE-AIM framework evaluates interventions in five dimensions (reach, efficacy, adoption, implementation, and maintenance) providing an alternation. The purpose of this study was to demonstrate the feasibility of using the RE-AIM framework to evaluate the effectiveness and sustainability of a community-based participatory (CBPR) project to improve the adoption of colorectal cancer (CRC) screening guidelines in seven Asian American (AA) communities. Method This project consisted of three phases. Phase 1 focused on assessing community organizations' capacity and readiness for the project, as well as conducting consumer research (focus group and survey) to understand the adopters. Phase 2 was the implementation of a multilevel and multicomponent intervention. The intervention included using social marketing campaigns at the community level to generate public awareness and the use of community health advisors (CHAs) for social influence at the individual level. All CHAs were received a 6 –hour training course and a 3-hour refreshed course. Phase 3 was to evaluate the effectiveness of the project using the RE-AIM framework. Both quantitative and qualitative data were collected before, during and after the intervention period. Qualitative data were collected through weekly activity logs, site visits notes, focus groups with implementation CHAs and in-depth interviews with organizational level leaderships. Quantitative data were collected through reports and community resident survey. Seven communities (Cambodian, Chinese, Filipino, Korean, Laotian, South Asians and Vietnamese) were involved in Phase 2 and were randomized to two cohorts. A wait-list cross-over random design was used to evaluate the effectiveness of the intervention. Primary outcomes included educational session attendance, Fecal Immunochemical Test (FIT) kits distribution and returned rates. Data were collected over three different time periods. Results Of the eight community-based organizations that joined the project, seven of them agreed to participate in Phase 2. Across the seven communities, ten CHAs reached out to over 2,400 community residents over a 12-week intervention period. No significant deviation or inconsistency of delivery across program components was found during site visits. Project satisfaction rates were high, ranging from 8 to 10 out of a 10 point scale (0=not at all satisfy and 10 = extremely satisfy). Screening rates for cohort 1 and 2 were 63% (93/148) and 57% (58/101), respectively. Community screening rates ranged from 100% in Cambodian, 89% in Vietnamese and 84% in Chinese, to 42% in Korean and Filipinos, and 32% in South Asians. After the 12-week intervention period, significant increase was observed in education session attendance (p = .010), FIT kits distributed (p = .008), and returned (p = .014) compared to baseline data. A cross-over effect was observed. Leaderships reported the project addressed organizations' mission, and aligned with their values and priorities. All sites indicated that they would continue to promote CRC screening as part of their health program. Conclusion The RE-AIM framework is crucial in evaluating community-based projects when randomized control trial is infeasible. Each RE-AIM dimension is an opportunity for future improvement and intervention. Partial or all dimensions can be addressed within a given study, but they are not necessary to be intervened upon. RE-AIM evaluation can increase transparency and help potential adopters to make more informed judgement about the intervention and its applicability. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Karen Kim. Using the RE-AIM framework to evaluate a community-based participatory project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A15.