Dissemination and Implementation of Colon Cancer Screening Program for Latinos Living Near the U.S.-Mexico Border

Saturday, 29 July 2017: 2:10 PM

Laura Szalacha, EdD
College of Nursing, University of Arizona, Tucson, AZ, USA

Background: The recent trends in increased colorectal cancer (CRC) screening test utilization are not mirrored in poor and minority populations. CRC screening rates are particularly low for those who do not identify a primary care provider or clinic and who also have lower levels of education, income, and insurance. We will detail this process of conducting a dissemination and implementation study in the context of our present funded D & I program: Navigation from Community to Clinic to promote CRC Screening in Underserved Populations (Navegantes por Salud).

Purpose: Combing two successful programs of research, we developed and tested a community to clinic tailored navigation intervention using a dissemination (randomized phase) and implementation (non-randomized phase). The final outcome measured was a) clinic attendance and, b) CRC screening. We also examined the roles and responsibilities of the statistician and/or methodologist in a D&I study and how those procedures and practices differ from those in a randomized control trial. This includes the design of a study, appropriate models or theoretical frameworks, frameworks for evaluation (i.e., RE-AIM), measurement issues, concerns of fidelity and re-invention or adaptation of successful interventions and the diffusion of innovation principles.

Methods: We randomized 232 sites to General Education +Tailored Navigation and 116 General Education only. In phase one, all participants received group education on cancer screening and risk. Those in the general education group received up to 5 reminder calls, and those in the navigation group received up to 10 calls from navigators who assisted them with barriers using a tailored message bank. In phase two, all those who attended a clinic received tailored navigation from a trained study navigator, through a combination of in-person meetings and phone calls.

Results: Of the 389 people enrolled, 25% made clinic appointments and of those, 61% complete colon cancer screening. We will frame our discussion with the 5 core values for D & I proposed by the NIH: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge with specific examples from the present D & I study.

Conclusions: As such we have demonstrated that community-engaged cancer screening programs in Arizona are feasibility and acceptability (Reach), are Effective, and that Adaptation is necessary for success.