Online Program

Exploring factors influencing implementation of evidence-based practices for cancer prevention and control in FQHCs: A qualitative study

Monday, November 4, 2013 : 11:15 a.m. - 11:30 a.m.

Shuting Liang, MPH, Emory Prevention Research Center, Emory University Rollins School of Public Health, Atlanta, GA
Nicholas Woolf, Ph.D., Henley Business School, The University of Reading, Carpinteria
Michelle Kegler, DrPH, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
Betsy Risendal, Ph.D., Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO
Vicki M. Young, PhD, South Carolina Primary Health Care Association, Columbia, SC
Michelle Carvalho, MPH, CHES, Rollins School of Public Health - Public Health Training Center, Emory University, Atlanta, GA
Andrea Dwyer, MPH, Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO
Dayna Campbell, MS, PhD(c), South Carolina Primary Health Care Association, Columbia, SC
Maria E. Fernandez, PhD, Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX
Background: Community Health Centers (CHCs) serve primarily minority and low SES patients that experience cancer related health disparities. To improve cancer control efforts at Community Health Centers (CHCs), we must understand factors influencing implementation of evidence based practices (EBPs) for cancer prevention and control. Researchers from the Cancer Prevention and Control Research Network's (CPCRN) Federal Qualified Health Center Workgroup conducted a qualitative study to fill this evidence gap. This presentation will describe the methods of this qualitative study and discuss the major findings. Methods: We collaborated with the National Association of Community Health Centers and the National Center for Farmworker Health to recruit leaders and staff of CHCs. We developed focus group and interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and used a modified Appreciative Inquiry approach for the discussion. Data were transcribed and analyzed for themes using a grounded thematic approach. Barriers and facilitators to implementation were identified based on the data and conceptually clustered to form key themes, which were then compared to constructs of the CFIR. Results: Five focus groups and 21 interviews were conducted with 59 leaders and staff from over 25 CHCs in 14 states and Washington DC. Key themes identified from the grounded approach were consistent with several of the constructs in the five CFIR domains. While external pressures related to Uniform Data System requirements and Patient-Centered Medical Home recognition seemed to impact adoption of EBPs, the inner setting constructs, including implementation climate, leadership engagement, and individual characteristics of leaders and implementers, were considered more critical for successful implementation of EBPs. Integrating EBPs into the workflow via Electronic Medical Records, engaged leaders spearheading changes and following up on clinical measures related to the EBPs were major facilitators, while barriers were lack of time and resources, competing priorities, patients' resistance to preventive services, and staff's resistance to change due to increased workload and unfamiliarity with new procedures. Conclusion: Findings will contribute to the understanding of factors influencing implementation and inform the design of interventions to increase use of EBPs in Community Health Centers.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the methods and analytic approach for this qualitative study Identify major constructs of the Consolidated Framework for Implementation Research that influence the implementation of evidence-based practices for cancer prevention and control in Community Health Centers

Keyword(s): Cancer Prevention, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was a Co-Project Director for the CPCRN at University of Texas and have recently moved to Emory CPCRN. I have been coordinating and co-leading this qualitative study in the past 2 years and have been involved in every aspect of this study, including conceptualization, interview guide development, data collection and qualitative analysis. My research interests have been focusing on dissemination and implementation research, system changes and evidence-based practices.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.