Abstract
Purpose and ObjectivesColorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation.Intervention ApproachCDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates.Evaluation MethodsWe surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation.ResultsMost grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) 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 (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity.Implications for Public HealthCRCCP 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.
Highlights
Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States [1]
Few grantees reported implementation of evidence-based interventions (EBIs) such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions
Summary
Almost all grantees participated in all 4 of the surveys; grantees (96%) completed the survey in 2011 and 2013, and grantees (100%) completed the survey in 2012 and 2015. We found that most grantees adopted and implemented small media and client reminders early in the study period; most grantees maintained these 2 EBIs through 2015 These client-oriented EBIs are often considered simpler to implement than the provider-oriented EBIs because they do not necessarily require partnerships with health systems or modifications to electronic health records. The pattern of rating implementation as stable or more difficult over time was consistent across years and across EBIs. not all grantees provided open-text data about barriers and facilitators to EBI implementation or their reasons for discontinuing EBIs. Given this, we cannot assess the overall impact of the barriers and facilitators on implementing and maintaining EBIs. This study has several strengths. The findings have implications for the second CRCCP cycle (DP15–1502, 2015–2020) and for the implementation of EBIs in comparable clinical settings
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