Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009–2015

Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009–2015

IMPLEMENTATION EVALUATION — Volume 16 — October 10, 2019

Peggy A. Hannon, PhD, MPH1; Annette E. Maxwell, DrPH2; Cam Escoffery, PhD, MPH3; Thuy Vu, MPH1; Marlana J. Kohn, MPH1; Lindsay Gressard, MPH, MEd4; Laurel Dillon-Sumner, MA1; Caitlin Mason, PhD1; Amy DeGroff, PhD, MPH4 (View author affiliations)

Suggested citation for this article: Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, et al. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009–2015. Prev Chronic Dis 2019;16:180682. DOI: http://dx.doi.org/10.5888/pcd16.180682external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Purpose and Objectives
• Intervention Approach
• Evaluation Methods
• Results
• Implications for Public Health
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

Colorectal Cancer Control Program (CRCCP) grantees from 2009 through 2015 were encouraged to implement evidence-based interventions (EBIs) to promote colorectal cancer screening.

What is added by this report?

This report studies EBI implementation over a 5-year period in a stable group of grantees.

What are the implications for public health practice?

There was some turnover regarding which EBIs were implemented, and implementation did not get easier over time for EBIs that were sustained. Our findings can be applied to evaluating and supporting EBI implementation in the next CRCCP funding cycle and in the National Breast and Cervical Cancer Early Detection Program as they adopt a similar approach to promoting EBIs and collaborating with health systems.

Abstract

Purpose and Objectives

Colorectal 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 Approach

CDC 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 Methods

We 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.

Results

Most 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 Health

CRCCP 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.