Implementing Strategies at the Workplace Level to Increase Colorectal Cancer Screening Uptake in Public Workers in Argentina: A Controlled Interrupted Time Series Study.

Abstract

BackgroundColorectal cancer (CRC) is the third most common neoplasm and the fourth cause of cancer death worldwide. In Argentina, more than 16,000 cases are diagnosed and 8,700 people die each year. The Immunochemical Faecal Occult Blood Test (iFOBT) is recommended for the prevention and early detection of CRC in people of both sexes, between 50 and 75 years old with average-risk. The worksite setting has great potential to improve adherence to preventive interventions. We aimed to design and evaluate the feasibility, acceptability, and effectiveness of a strategy implemented in the workplace to improve the rate of adherence to the IFOBT screening in employees of the government’s Revenue Agency of the Province of Buenos Aires (ARBA). MethodsWe used a quasi-experimental research design, a controlled interrupted time-series (ITS). The study period was divided into two-time segments: (1) a 51- month pre-intervention period (July 2015 through September 2018); (2) a 5-month post-intervention period (October 2018 through February 2019). We performed an initial formative research using qualitative research methods (semi-structured interviews, focus groups) in order to inform the design of the intervention and adapt it, to ensure that it is both feasible and implementable by the target population. We fitted segmented linear regression models to evaluate changes in the monthly rates per 10,000 of tests done in ARBA employees, and controlling for the proportion of tests done in non-ARBA workers. ResultsA total of 1552 ARBA employees aged 50 or more participated. Overall, iFOBT mean uptake rates were 16 times higher in the intervened during the five-month intervention period, remaining statistically significant after adjusting by the proportion of tests done in the control group (p <0.001). This observed effect was higher in women aged 50 to 59 years. Activities were suspended due to the Covid-19 pandemic lockdown in the country in 2020.ConclusionsA multifaceted workplace-based intervention helped increase the uptake of CRC screening in public sector employees of the province of Buenos Aires, Argentina. Achieving high implementation rates requires building a healthy relationship with the partner organization, adding their values and views, and establishing agreed upon mechanisms and realistic timelines.

Investigación formativa para el diseño e implementación de una estrategia para aumentar el rastreo de cáncer colorrectal en el ámbito laboral en Argentina

“…El estudio utilizó una serie de tiempo interrumpida para evaluar la frecuencia de la realización de los testeos antes y después de la intervención en un grupo expuesto a la misma y en un grupo control. La metodología y resultados de la serie de tiempo interrumpida se publican en otro artículo 19 .…”