3.8 Article

Factors That Support Sustainability of Health Systems Change to Increase Colorectal Cancer Screening in Primary Care Clinics: A Longitudinal Qualitative Study

Journal

HEALTH PROMOTION PRACTICE
Volume 24, Issue 4, Pages 755-763

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1177/15248399221091999

Keywords

colorectal cancer screening; evidence-based intervention (EBI); sustainability; primary care clinic; program evaluation; consolidated framework for implementation research (CFIR)

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This study examined the implementation of the Colorectal Cancer Control Program and identified factors that facilitated early implementation and sustainability. The findings highlighted the importance of readiness assessment, funding support, clinic champions, and coordination with existing practices for successful implementation. Key factors for sustainability included ongoing electronic health record support, clinic leadership support, and integration with clinic policies and procedures.
Background. From 2015 to 2020, the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) supported 30 awardees in partnering with primary care clinics to implement evidence-based interventions (EBIs) and supporting activities (SAs) to increase colorectal cancer (CRC) screening. This study identified factors that facilitated early implementation and sustainability within partner clinics. Methods. We conducted longitudinal qualitative case studies of four CRCCP awardees and four of their partner clinics. We used the Consolidated Framework for Implementation Research (CFIR) to frame understanding of factors related to implementation and sustainability. A total of 41 semi-structured interviews were conducted with key staff and stakeholders exploring implementation practices and facilitators to sustainability. Qualitative thematic analysis of interview transcripts identified emerging themes across awardees and clinics. Results. Qualitative themes related to six CFIR inner setting constructs-structural characteristics, readiness for implementation, networks and communication, culture, and implementation climate-were identified. Themes related to early implementation included conducting readiness assessments to tailor implementation, providing moderate funding to clinics, identifying clinic champions, and coordinating EBIs and SAs with existing clinic practices. Themes related to sustainability included the importance of ongoing electronic health record (EHR) support, clinic leadership support, team-based care, and EBI and SA integration with clinic policies, workflows, and procedures. Implications. Findings help to inform future scale-up of and decision-making within CRC screening programs and other chronic disease prevention programs

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