Grounding Evidence-Based Approaches to Cancer Prevention in the Community

Abstract

When community health planners select an evidencebased intervention that has been developed and tested in one situation and adapt it for use in a different situation or community, best practice suggests needs assessment and formative research in the new setting. Cancer prevention planners who are interested in adopting and adapting evidence-based approaches need to base their choices on a sound understanding of the health or behavioral risk problem in which they mean to intervene. This requires a balancing act of weighing community information against a broader perspective from the scientific literature and using the combination to identify and adapt an evidence-based intervention program that is likely to be effective in the new setting. This report is a case study of a community and organizational assessment conducted as a foundation for selecting and recommending adaptation of an evidence-based intervention for improving mammography appointment attendance. We used an inductive sequential exploratory mixed-methods design to inform this process. The process provides a model for formative research grounding evidence-based practice for cancer control planners. Future studies that incorporate findings from needs assessment into the adaptation of the selected intervention program may promote the effective dissemination of evidence-based programs.

Sistas Inspiring Sistas Through Activity and Support (SISTAS): Study Design and Demographics of Participants

“…In the last decade, some studies targeted research for churches, 14 focus groups, 36 or case studies. 37 The SISTAS program utilized a RCT model as a guide for the intervention adapted for AA women.…”

A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women

“…The PMP intervention program consists of the following components: a financial incentive of $7500 to the clinic for participation; funding for screening mammograms for women with documented financial need; coordination of increased screening within each clinic (the research team has established partnerships with local mobile mammography providers to assist in increasing screening capacity); 8 h of state certified training for staff in the EBI’s reminder phone call protocol [ 20 , 30 , 31 ]; stakeholder review of program adaptation and implementation materials; stakeholder meetings to troubleshoot implementation issues as they arise and to develop and disseminate e-newsletters and reports which highlight success stories and re-inforce desired behaviors; technical support for implementation (implementation manuals, clinic manuals, stakeholder manuals); and assistance in data tracking and reporting and budget impact analysis.…”

“…The uncorrected sample size for a difference in two independent proportions assuming a baseline no-show rate of 35 % reduced to 28 %, an α of 0.05 and a power of 0.9 equals 924 per group. The average no-show rate and expected reduction in no-shows are based on pilot studies [ 20 , 30 ]. The intraclass correlation coefficient (ICC), p , for mammography screening interventions has been shown to range from 0.0009 to 0.22 in community-based trials with an average ICC of 0.06 based on recent systematic reviews [ 33 , 34 ].…”

“…A number of evidence-based intervention programs have been developed to address these barriers, yet disparities in breast cancer outcomes persist for underserved women. One reason for this may be the lack of uptake and use of evidence-based interventions in community and clinical settings that serve these women [ 16 – 20 ].…”

“…Our patient navigation-based breast cancer screening intervention for the underserved is called the Peace of Mind Program (PMP). PMP is an EBI which was adapted from a National Cancer Institute Research tested intervention program and uses a tailored telephone counseling reminder call based on the Transtheoretical Model of Change to counsel patients through barriers to appointment attendance [ 20 , 29 – 31 ]. PMP builds on our previous intervention protocol [ 30 , 31 ] by adding intervention components to specifically support implementation within safety net clinics.…”