System Stakeholders Research Articles

Development of a Canadian Guidance for Reporting Real-world Evidence for Regulatory and Health-Technology Assessment (HTA) Decision Making

Real-world evidence (RWE) can complement and fill knowledge gaps from randomized controlled trials to assist in health-technology assessment (HTA) for regulatory decision-making. However, the generation of RWE is an intricate process with many sequential decision points, and different methods and approaches may impact the quality and reliability of evidence. Standardization and transparency in reporting these decisions is imperative to appraise RWE and incorporate it into HTA decision-making. A partnership between Canadian health system stakeholders, namely Health Canada and Canada's Drug Agency (formerly the Canadian Agency for Drugs and Technologies in Health (CADTH)), was established to develop a guidance for standardization of reporting of RWE for regulatory and HTA decision-making in Canada. In this article, we describe the methods to develop the Guidance for Reporting Real-World Evidence document and checklist for reporting RWE for regulatory and HTA decision-making in Canada. This guidance can be adapted for other jurisdictions and will have future extensions to incorporate emerging issues with RWE and HTA decision-making.

Reaping what we sow: Centering values in food systems transformations research.

In many transdisciplinary research settings, a lack of attention to the values underpinning project aims can inhibit stakeholder engagement and ultimately slow or undermine project outcomes. As a research collective (The Careoperative), we have developed a set of four shared values through a facilitated visioning process, as central to the way we work together: care, reflexivity, inclusivity, and collectivity. In this paper, we explore the implications of a values-centered approach to collaboration in food system transformation research. The paper presents two cases that illustrate how researchers might approach centering values in practice. Where much research on food system transformation focuses on values of food system stakeholders, we contribute insights into the values of researchers in such transdisciplinary endeavors. Specifically, we argue that researchers working on sustainability transformations need to be better prepared to engage in such reflections and aspire to embody values aligned with the transformations they seek to research.

Nursing students' experiences of professional competence evaluation by Objective Structured Clinical examination method: a qualitative content analysis study.

Clinical education is a significant part of medical education, and paying attention to clinical evaluation is important. One of the challenges in the teaching-learning process is evaluating students' performance. Learners, as the main stakeholders of the educational system, may have different experiences of evaluation quality. Awareness of these experiences is effective in improving the quality of clinical evaluation. Therefore, this study was conducted to "explore the experiences of nursing students for evaluation of professional competence by using the objective structured clinical examination (OSCE)". This study was conducted with a qualitative descriptive research approach and conventional content analysis method in 2022-2024. The participants included 12 undergraduate nursing students at Maragheh University of Medical Sciences, who were selected by purposeful sampling, and their experiences were collected using semi-structured and in-depth interviews until reaching data saturation. The data analysis of the interviews led to the extraction of 268 primary codes, 7 subcategories, 2 categories, and 1 theme: "Credibility and stability". The category "Exam's accuracy in measuring competence " included 3 sub-categories: "Challenges in objective adaptation ", " Communication and organizational challenges for exam preparation " and " Inadequate simulation of stations and exam environment ", and the category " Exam power for repeatability" included 4 sub-categories: " Characteristics of the students ", " Lack of evaluators' skills and mastery ", " Inefficiency of the evaluation tool " and " Disturbance in executive affairs". OSCE can be used in self-evaluation, creating motivation and strengthening different dimensions of students' learning, as well as discovering weaknesses and strengths for planning by managers and faculties. According to the results of this study, many factors such as management before and during the exam, characteristics of the evaluators, prevailing educational conditions in the faculty, and the method of clinical training are effective in achieving the "reliability and sustainability" required in the OSCE.

Voices from the ground: Qualitative perspectives on Ugandan national mental health system strengths, challenges, and recommendations

Mental health capacity building is a growing priority in Ugandan healthcare systems. Despite increased governmental attention to community mental health and mental healthcare needs, no empirical assessments document qualitative perspectives from stakeholders in the Ugandan mental health system. The goal of the current needs assessment study was to systematically explore stakeholders’ perceptions of strengths, challenges, and recommendations for enhancing capacity in the national mental health system in Uganda. Using ethnographic research methods, data were collected from 15 key informant interviews and four community focus groups with a total of 44 stakeholders involved in mental healthcare in Uganda. Thematic analyses of data yielded several themes in each domain, including 1) system strengths reflected in the existing policy and action plan, free medications, growing private sector, and partnerships and collaborations; 2) system challenges including socioeconomic constraints, stigma, and limited family engagement; and 3) recommendations surrounding enhanced education and training, integrating systemic approaches, and policy advocacy. We describe clinical, research, and policy implications that can inform systemic mental health efforts in Uganda and comparable global settings.

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

Interorganizational systems withouthierarchy: immunizationinformation systems.

The 2020-2021 COVID-19 pandemic spurred change across multiple healthcare industries. This study explores how managing vaccination data in the United States of America required cooperation among many different organizations necessitated by an emergency response. We studied how individual states interacted with the federal government to address the need for vaccination-related information during the pandemic. In total, 11 interviews were conducted with individuals responsible for collecting vaccination data and reporting it to the US Federal Government. Seven of those individuals were directors of USA jurisdictional Immunization Information Systems (IIS). Archival data were also combined with the interview responses to inform the analysis and development of guidelines. States across the USA had different ways of tracking and storing immunization data that was heavily influenced by state-level and federal legislation. The lack of a universal patient identifier made cross-state patient identification difficult. Federal requirements for reporting dictated much of how the different state-level entities collected, stored and reported data. This study highlights the importance of data interoperability and data sharing by exploring how a loosely coupled set of entities without direct top-down control or a profit motive can govern data effectively. Our analysis provides greater clarity about the interactions between different stakeholders in a complex system. This study presents primary interviews of 11 individuals, each responsible for tracking and reporting immunization information. Analysis of the data expands existing research on IIS on data sharing, system interoperability and dynamic pandemic responses.

Are EU member states ready for the European Health Data Space? Lessons learnt on the secondary use of health data from the TEHDAS Joint Action.

The proposal for a regulation on the European Health Data Space (EHDS) contains provisions that would significantly change health data management systems in European member states (MS). This article presents results of a country mapping exercise conducted during the Joint Action 'Towards the European Health Data Space' (TEHDAS) in 2022. It presents the state-of-play of health data management systems in 12 MS and their preparedness to comply with the EHDS provisions. The country mapping exercise consisted of virtual or face-to-face semi-structured interviews to a selection of key stakeholders of the health information systems. A semi-quantitative analysis of the reports was conducted and is presented here, focusing on key aspects related to the user journey through the EHDS. This article reveals a heterogenous picture in countries' readiness to comply with the EHDS provisions. There is a need to improve digitalization and quality of health data at source across most countries. Less than half of the countries visited have or are developing a national datasets catalogue. Although the process to access health data varies, researchers can analyse health data in secure processing environments in all countries visited. Most of the countries use a unique personal identifier for health to facilitate data linkage. The study concluded that the current landscape is heterogeneous, and no member state is fully ready yet to comply with the future regulation. However, there is general political will and ongoing efforts to align health data management systems with the provisions in the EHDS legislative proposal.

Photovoltaic Modules’ Cleaning Method Selection for the MENA Region

Photovoltaic (PV) systems are important components of the global shift towards sustainable energy resources, utilizing solar energy to generate electricity. However, the efficiency and performance of PV systems heavily rely on cleanliness, as dust accumulation can significantly obstruct their effectiveness over time. This study undertook a comprehensive literature review and carried out multiple interviews with experts in the PV systems field to propose a map for selecting the optimal PV cleaning method for PV systems within MENA region. These factors, covering meteorological conditions, the local environment, PV system design, module characteristics, dust deposition attributes, exposure time to dust, and socio-economic and environmental considerations, were employed as criteria in a Multi-Criteria Decision-Making (MCDM) model, specifically, an Analytic Network Process (ANP). The results indicate that partially automated cleaning is the most suitable method for existing utility-scale PV projects in the MENA region. The findings provide robust guidelines for PV system stakeholders, aiding informed decision-making and enhancing the sustainability of PV cleaning processes.

A situated analysis of research publication evaluation in Latin countries based on a pluriversal approach

The global knowledge ecosystem is affected by ethnocentrism and witnesses Western monopolies of knowledge that have built hegemonic structures and narratives, especially in scientific and academic publishing. For the design field, the paper proposes a transition from processes of power and control over knowledge to processes of distributed knowledge leadership among the stakeholders of the publishing system (journals, conferences, scientific associations and societies, academic networks). It analyses the publishing ecosystem of Latin American countries as a case study representative of Global South knowledge that is ‘decentring’ scientific design publishing. By problematizing pluriversity, it proposes a practical frameworkon international collaboration, informed evaluation, and distributed processes to promote equity and accessibility. The 8th International Forum of Design as a Process serves as a testbed, showcasing community-led knowledge experimentation targeting the Global South countries. The case study highlights the potential to re-evaluate established structures for more pluriversal design knowledge.

Exploring Key Capacities: Insights from Assessing the Resilience of the Public Health System Before and After the Kahramanmaraş Earthquakes

AbstractThe goal of this mixed-methods study was to identify and compare the key capacity considerations regarding public health system resilience before and after the 2023 Türkiye-Syria earthquakes. Public health system resilience was assessed through online and face-to-face workshops using the United Nations Public Health System Resilience Scorecard. The pre-earthquake evaluation was conducted in Istanbul and Trabzon in 2021; the post-earthquake evaluation took place in Hatay and Kahramanmaraş in 2023, with a total of 41 participants each. The online workshops lasted approximately four days, while the face-to-face workshops lasted one day. The study found a significant decrease in the scores for most scorecard resilience indicators in the post-earthquake assessment. Qualitative analysis showed that this decline was largely due to infrastructure collapse. Additionally, defining the roles of health disciplines in disaster management and having data transmission procedures between public health system stakeholders in disasters were among the main capacity considerations in both the pre-and post-earthquake assessments. The post-earthquake evaluation revealed several capacity gaps that had not been addressed in pre-earthquake assessments in areas such as disaster preparedness of vulnerable populations and logistics. The findings highlight the critical importance of strengthening building stock and infrastructure to establish a disaster-resilient public health system.

Sustainability and dialysis: the 4 main points for a green dialysis

Dialysis represents a big challenge for the environmental sustainability, because it is bound to high consumption of water and electricity, hazardous waste incineration and subsequent greenhouse gas emissions. In recent years, it has been recognized the urgent need to preserve our environment together with the people’s health, starting from making dialysis greener. This awareness has led to a new paradigm in the history of dialysis, the concept of Green Nephrology. The Italian Society of Nephrology published 10 affordable actions in the Position Statement with the aims to increase awareness, propose joint actions and coordinate industrial/social interactions. Starting from these, there are four key points to pave the way for environmental sustainability: 1) Sustainable technologies (i.e., machines, filters, water treatment systems, acid concentrates, lighter materials, electronic patient record); 2) Green dialysis centers; 3) Environmental improvement project, using tools to define targets and their monitoring; 4) Nurse role, as he is the main environmental sustainability promoter. To achieve Green Nephrology it’s necessary a partnership between all the stakeholders of the healthcare system. Since the growing awareness of the problem and the existence of ways to solve it, it’s time to act and the effective way to do it is to implement all the solutions provided in this article in an immediate future.

FinTech business models focus on financing SMEs

ABSTRACT Small and medium-sized enterprises (SMEs) are economically important but are caught in a financing dilemma. Reasons for these financing problems are, among others, information asymmetries. Financial technologies (FinTech), in an intermediary role, could help to solve these information asymmetry problems and in this way solve the financing problems of SMEs. Therefore, FinTech as intermediaries for financing SMEs must develop a unique and enduring business model. Due to less empirical data, we will deductively show some first steps on the way to business model generation for FinTech as a practical guide. We are searching for similarities in the market development of creditworthiness assessment for SMEs, done by FinTech, as we saw it in the past for rating agencies concerning large companies. In particular, we analyze the business model of FinTech in the role of an intermediary in SME financing, with focus on customers, value propositions, key resources, and key activities. Our article contributes a first step in a conceptual but practical outline of business model generation for the ecosystem of FinTech in an intermediary role in solving debt financing restrictions of SMEs. In this overview article, we derive our results from a theoretical point of view but try to contribute meaningful and practical knowledge for all stakeholders in the SME financing system.

Perceived stakeholder benefits of continuously training general practitioners in the same rural or remote practice: interviews exploring the Remote Vocational Training Scheme.

Explore stakeholder perspectives of the benefits of continuously training general practitioners in the same rural or remote practice in distributed locations via the Remote Vocational Training Scheme (RVTS). Online one-hour semi-structured interviews were conducted with 27 RVTS staff, participants and supervisors from all states and territories between 16 October and 24 November 2023. Data were deductively and inductively coded by stakeholder type and the range of benefits, and the findings were informed by insights from a project reference group and a stakeholder advisory group. Questions explored the benefits of the RVTS - a program which supports doctors already working in rural, remote and First Nations communities to train towards general practice or rural generalist fellowship while remaining in the same practice. Perspectives on the nature and spread of benefits. Broad benefits were perceived to flow to four system-level stakeholders: communities, health services, participants and policy makers. Perceived participant and community benefits were doctors staying longer in distributed locations with tailored place-based supports and training, doctors building relationships with patients, and doctors learning through longitudinal care. Health service benefits included reduced reliance on locums, improved continuity of accessible and appropriate services in areas otherwise facing major recruitment and retention issues, and the doctors having more time to contribute to improving service quality and upskilling local staff. Policy-maker benefits were sustaining safe and high quality services for distributed populations with high needs. The RVTS model was perceived to offer diverse benefits for different system stakeholders which could improve quality of learning, service delivery and community care. It also aligned with key policy directions for a distributed and sustainable generalist workforce under the goals of the National Medical Workforce Strategy 2021-2031 and the directions set by the independent review of overseas health practitioner regulatory settings led by Robyn Kruk. However, models like the RVTS largely rely on distribution levers to recruit more doctors to the locations it supports.

Комплексный подход к развитию инфраструктуры сбыта продукции аграрного малого и микро-бизнеса

Small and private subsidiary farms are important members of agricultural community. However, they still lack good infrastructure to market their products because they remain beyond the scope of state interest. The agricultural infrastructure in its present condition neither gives farmers access to co-financing nor allows them to shape the list of services they need. The research featured program documents issued by the Government of the Russian Federation that determine the development of wholesale food markets and aggregators of farm produce. The author generalized the experience of retail chains and agricultural consumer marketing cooperatives, as well as studied the cases of small rural businesses merging into marketing cooperatives in agricultural regions. The bibliographic study covered best foreign practices in shaping infrastructure for small farm produce, which were compared with Russian experience. The author also developed an abstract-logical method of establishing the interaction between stakeholders in a new system of farm produce aggregators. In this research, agricultural regions demonstrated the most acute problems in small business marketing. A good system of agricultural infrastructure supports production in all sectors of small business with growth potential. Today, small businesses are alone in organizing their own sales as wholesale distribution centers are not available to them. These centers work with small suppliers through intermediaries, i.e., aggregators. In the Kemerovo Region, an example of such aggregators is the one created on corporate principles between the Magnit retail chain and the Kalina-Malina agricultural consumer marketing cooperative. The experience demonstrated some advantages and disadvantages. The article introduces conditions for successful financial relations in commodity circulation chains in different distribution systems, including farmers, aggregators, and wholesale distribution centers. This approach reduces prices on consumer markets while increasing the efficiency of small farms.

Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project.

Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutritional quality based on the foods' favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners representing actors involved in the Norwegian food system. This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022-2023). This included Nutri-Score's performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway. A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with qualitative content analysis. The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsistencies between Nutri-Score's classification of foods and national nutrition guidelines and policies. Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsistencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing.

Medicine needs of children not addressed in the National Cancer Strategic Framework: insights from a triangulation study

Aim A better understanding of the scope of the National Cancer Strategic Framework (NCSF) could lead to improvements aiding the framework’s ultimate objective of reducing the burden of cancer. Accordingly, this report evaluates whether the 2017-2022 NCSF adequately addressed issues related to childhood cancer treatment, in particular paediatric oncology medicines. Methods To identify determinants of current access to childhood oncology medicines in South Africa, in-depth interviews were conducted with 29 stakeholders in South Africa’s public and private healthcare sectors. Key health system stakeholders included policy makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers were categorised according to the components of the pharmaceutical value chain, and combined with a health systems approach to acknowledge the linkages of medicines with other building blocks of the health system. Identified barriers were then compared to the limitations and interventions as discussed in the 2017-2022 NCSF to identify areas for improvement in the framework. Findings Three recurrent gaps in the NCSF in relation to childhood cancers were identified, representing a range of issues throughout the pharmaceutical value chain: 1) childhood cancers are neglected compared to adult cancers, in both the policy arena and the organisation of healthcare services; 2) there are particular challenges for childhood cancers due to their rarity, thus requiring targeted interventions (e.g., regulatory incentives, tailored pricing solutions, and customised evidence requirements by decision-making bodies); and 3) children must be accompanied by a caregiver during treatment, causing several social and financial issues for their families. Conclusions There is a pressing need for a strategic cancer plan that makes proper provisions for children. Such an endeavour must commence with acknowledging the areas in which childhood cancers are different from adult cancers, and which demand targeted intervention in an update of the NCSF.

Digital health in your hands: A narrative review of exploring Ayushman Bharat's digital revolution

Background: “The Ayushman Bharat Digital Mission (ABDM)” is a revolutionary initiative started in India in September 2021 that aims to digitalize the country's healthcare industry. Initiatives like Ayushman Bharat Digital Mission, CoWIN App, Aarogya Setu, e-Sanjeevani, and e-Hospital provide healthcare services and facilities that reach every corner of India. This narrative review focuses on the mission's goals, objectives, innovations, significant features, progress, and worldwide scenery for digital health practices—India's healthcare scene by delivering universal health coverage and improving health outcomes. The assessment finds that ABDM is an important step toward a digitalized healthcare system that requires attention and assistance to overcome obstacles and reach its full potential. Methods: The research utilized various databases including Research Gate, PubMed, Google Scholar, and government portals to conduct a comprehensive literature review. This review article provides a critical analysis and offers essential suggestions, ideas, and recommendations for the effective and rapid implementation of the Ayushman Bharat Program. Furthermore, it includes information about the program's ability to transform India's healthcare sector and achieve universal health coverage. Conclusion: The revolutionary Ayushman Bharat Digital Mission (ABDM) aims to digitalize India's healthcare industry. It has made major achievements in improving healthcare access, increasing system effectiveness, improving care quality, and promoting teamwork amongst stakeholders in the healthcare system. By implementing strong data privacy and security protocols and developing infrastructure for India's diverse population, ABDM can play a key role in achieving national health coverage and improving health outcomes. ABDM may be vital in attaining national health coverage and greatly enhancing health outcomes with persistent work and strategic assistance.

Embracing Educational Challenges Through Collaboration

While educators have always experienced challenges in providing leadership and literacy instruction, the COVID-19 pandemic highlighted existing challenges and introduced new ones. This qualitative case study looked at information gathered from four suburban K-8 principals and their literacy teachers to identify the post-pandemic challenges at each of their schools. Data provided through interviews and questionnaires gave insights into the challenges facing schools as to how the systems and structures in place may contribute to those challenges. It is important to identify these challenges and understand what contributes to them so that educators and stakeholders in the school system can effectively reflect on and adapt their practices to increase collaboration within schools.

Abstract A028: Revisiting cancer care inequities in Sub-Saharan Africa: standpoint and recommendations

Abstract Introduction: Cancer is a major global public health concern that claims around 2000 lives per day in Africa alone. Mortality rates are expected to rise in the absence of appropriate interventions. Equity and prioritizing are the main obstacles to cancer care in Africa, as policymakers and other stakeholders in the healthcare system do not give cancer enough attention. All aspects of the cancer care continuum especially these three main levels of cancer care—prevention, diagnosis, and treatment/management—are negatively impacted by this neglect. Addressing concerns of equity and prioritizing is essential to promoting equality in cancer care, as it guarantees that all individuals have an equal opportunity at cancer prevention, early detection, appropriate therapy, and follow-up treatment. Methods: We present an overview of the current status of cancer care in Africa and offer recommendations to bridge the gap using the material currently accessible from recognized databases. Results: Insufficient funding for cancer research, inadequate screening or diagnostic facilities, a lack of a well-organized and efficient cancer registry system and access to care, a shortage of specialized medical staff, high costs for screening, vaccination, and treatment, a lack of technical capacity, poor vaccination response, and late patient presentation for cancer screening are some of the factors that we highlighted as contributing to the disparity in cancer care in Africa. We also offer suggestions on overcoming some of these barriers to achieving fairness in cancer care. Our recommendations are broken down into capacity-based and national-level initiatives. These include improving healthcare budgeting for personnel, supplies, and facilities; encouraging screening and vaccine uptake; raising awareness of cancer health among medical professionals during every hospital visit, gaining knowledge through specialized training, financing cancer research, offering cancer insurance, and putting mobile health technologies to use for telemedicine diagnosis.Conclusion: A comprehensive approach to addressing issues related to cancer equity would increase the chances of cancer patients surviving longer, reduce risk factors for at-risk groups, and guarantee fair access to cancer care across the continent. This report describes the present barriers to achieving equity in cancer care, identifies the African countries' current positions on the matter, and offers recommendations that could have the greatest impact on achieving equity in cancer care. Citation Format: John Oluwafemi Teibo, Olabode Omotoso, Festus Adebayo Atiba, Tolulope Oladimeji, Tomiwa Kehinde Paimo, Farid S. Ataya, Gaber El-Saber Batiha, Athanasios Alexiou. Revisiting cancer care inequities in Sub-Saharan Africa: standpoint and recommendations [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A028.

Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study

Abstract Purpose: The COVID-19 pandemic resulted in a marked decrease in preventative screening services for colorectal cancer, especially for more involved procedures like colonoscopies. Nationally, some health systems turned to more socially distanced options such as fecal immunochemical tests (FIT) and guaiac fecal occult blood tests (gFOBT). This study aimed to examine the effects of pandemic protocols on FIT and gFOBT utilization in a large municipal safety-net setting. Methods: This mixed methods study examined primary care visits in Los Angeles County’s municipal safety-net system. Semi-structured interviews were conducted with key stakeholders at multiple levels of the organization. These insights were combined with analysis of structured Electronic Health Record data on orders and procedure codes for completed colorectal cancer screening, including screening colonoscopies and FIT/gFOBT tests within the Los Angeles County health system’s ambulatory care and hospital-based providers, in order to explore trends in colorectal cancer screening during the pandemic. Results: Pre-pandemic, stool tests such as FIT and gFOBT were already the dominant initial screening modality for colorectal cancer in the health system. Across the system, FIT/gFOBT rates decreased during the initial wave of the pandemic and took significant time to recover to pre- pandemic levels. System stakeholders noted significant challenges with utilization of stool sample modalities as a screening method during the pandemic, including poor return rates and patient hesitancy to come in person to receive or return tests. Efforts were made to improve upon utilization, for example implementing distribution of stool tests like the FIT via mail. Rates of screenings may also have been affected by the increase in use telehealth services during the pandemic, by which providers often communicated with patients to order FIT/gFOBT tests during the period. Conclusion: Socially distanced approaches to colorectal cancer screening were an attractive solution for safety-net health systems looking to continue preventative care efforts in a pandemic setting. Our study highlights unique challenges exacerbated by the pandemic that should be considered in the context of future utilization of these screening modalities. In the post-pandemic term, emphasis on FIT/gFOBT utilization, in combination with lessons learned during the pandemic, could help to overcome delays in screening precipitated by COVID-19 by decreasing barriers to access for vulnerable populations (e.g. transportation access, work flexibility) in comparison to endoscopy. Citation Format: Willow Pastard, Cameron Kaplan, Chun Nok Lam, Laura Solano, Sonali Saluja, Sarah Axeen, John Thacker, Todd Schneberk, Jennifer Tsui. Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A140.