Abstract
The population-level implementation of innovative, evidence-based medical recommendations for adopting health-behaviors depends on the last link in the translation chain: the users. “User-friendly” medical interventions aimed at engaging users to adopt recommended health behaviors are best developed in a collaborative bio-medical and social sciences setting. In the 1990s, National Breast and Colorectal Cancer Early Detection Programs were launched at the Israeli Department of Community Medicine and Epidemiology. Operating under the largest HMO (Health Maintenance Organization) in Israel (“Clalit Health Services”), the department had direct access to HMO community primary-care clinics’ teams, insured members, and medical records. Academically affiliated, the department engaged in translational research. In a decades-long translational process, this multi-disciplinary unit led a series of interventions built upon basic and applied behavioral/social science phenomena such as framing, “Implementation Intentions,” and “Question-Behavior-Effect”. A heterogeneous team of disciplinary specialists created an integrated scientific environment. In order to enhance screening, the team focused on the establishment of a systematic mechanism actively inviting programs’ “users” (average-risk targeted individuals on the national level), and continuously applied social and health psychology concepts to study individuals’ perceptions, expectations, and needs related to cancer screening. The increase in adherence to screening recommendations was slow and incremental. A decrease in late-stage breast and colorectal cancer diagnoses was observed nationally, but participation was lower than expected. This paper positions screening adherence as a unique challenge and proposes new social and network avenues to enhance future participation.
Highlights
Center worked with the “field”, the development and implementation of a full translation cycle became possible: Clalit Health Services” (CHS) medical teams in primary care neighborhood clinics across the country supported the central cancer screening programs initiated by the department
Using an approach derived from Personal Construct Psychology [22], women waiting for their pre-scheduled mammogram in a radiology clinic provide their reasons to test
An organizational structure facilitated the development of transdisciplinary collaboration, yielding a productive translational-research environment
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In the mid-1990’s, epidemiology experts concluded [1,2,3,4,5,6] that screening for the early detection of breast and colorectal cancers would be advantageous for individuals and target audiences. Diffusing the screening message and achieving participation in breast and colorectal cancer screening presented a challenge Challenge to meet, in light of the known advantages of undergoing screening tests, but reality did not support this assumption. In cancer screening, this gap was and still is wide in many places [7], requiring an explanation.
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