Assessing factors that affect the implementation of an evidence-based colorectal cancer screening intervention: A report from the CNA Health ACTION Partnership

Screening for colorectal cancer (CRC) can prevent morbidity and mortality; however, screening is sub-optimal despite availability of evidence-based principles for successful programs. There are individual, organizational, and environmental factors that affect the implementation of interventions to improve CRC screening. To understand the impact of these factors, we assessed the implementation of a population-based intervention using the Practical, Robust, Implementation and Sustainability Model (PRISM).

Through a centralized organization, we implemented the System Approach to Tracking and Increasing Screening for Public Health Improvement of Colorectal Cancer intervention in 15 primary care practices. The six-step intervention provided a mechanism to assist practices with screening and an educational component to inform and change the behavior of both patients and clinicians. We used PRISM to guide the development of the intervention and the assessment of its implementation.

Despite some implementation challenges, the intervention was effective. It was adopted by the primary care practices and reached the target patient population. Logistic regression analyses demonstrated that it was effective in increasing CRC screening. The PRISM framework provided a useful tool for assessing factors affecting the intervention's implementation. Such factors included patient's confidence in their clinicians, the ease at which screening was made available, the organization's ability to use electronic medical records, competing interests within the practices, and clinicians recommendation of guideline concordant screening. We disseminated these findings to others wanting to adopt the intervention.

Identifying and learning from these contextual factors using PRISM will help other organizations implement this and similar cancer screening interventions in future settings.