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Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

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Abstract

While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0–7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.

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Funding

This research was conducted by the Cancer Prevention and Control Research Network, which is funded by the Centers for Disease Control and Prevention (CDC) Prevention Research Centers and the National Cancer Institute (NCI). This research was supported by the following cooperative agreements from the CDC Prevention Research Centers and the NCI: 3 U48 DP005030-01S5, 3 U48 DP005021-01S4, 3 U48 DP005014-01S2, 3 U48 DP005053-01S1, 3 U48 DP005013-01S1A3, 3 U48 DP005000-01S2, 3 U48 DP005017-01S8.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health & College of Nursing, University of South Carolina, Columbia, SC, USA

    Swann Arp Adams

  2. UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, CB #7424, Carrboro, NC, 27510, USA

    Catherine L. Rohweder

  3. School of Nursing, The University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA

    Jennifer Leeman

  4. Department of Health Promotion, Education, and Behavior & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Daniela B. Friedman

  5. UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, CB #7426, Chapel Hill, NC, 27599, USA

    Ziya Gizlice

  6. Department of Health, Behavior & Society, University of Kentucky College of Public Health, 2365 Harrodsburg Road, Ste. A230, Lexington, KY, 40504, USA

    Robin C. Vanderpool

  7. Department of Community & Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, 100 CPHB, Iowa City, IA, 52242, USA

    Natoshia Askelson

  8. Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA

    Alicia Best

  9. Family Medicine and Epidemiology & Biostatistics, The Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Ave, Suite 402, Cleveland, OH, 44106-7136, USA

    Susan A. Flocke

  10. Department of Biostatistics and Epidemiology, George A. Weiss University Professor, University of Pennsylvania School of Medicine, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA

    Karen Glanz

  11. Department of Health Services, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Ave. N. M3-B232, Seattle, WA, 98109-1024, USA

    Linda K. Ko

  12. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory Prevention Research Center, Emory University, 1518 Clifton Road NE Rm 530, Atlanta, GA, 30322, USA

    Michelle Kegler

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  1. Swann Arp Adams
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  2. Catherine L. Rohweder
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Correspondence to Daniela B. Friedman.

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Adams, S.A., Rohweder, C.L., Leeman, J. et al. Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers. J Community Health 43, 1044–1052 (2018). https://doi.org/10.1007/s10900-018-0520-2

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