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

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.