Developing a Co-Production Strategy to Facilitate the Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions for Rural Health Systems: A Pilot Study

Abstract

Background: Evidence-based colorectal cancer screening (CRCS) interventions exist, but have not been broadly adopted in rural primary care settings. Participatory adoption and implementation strategies may be promising in closing this gap through a clinical-academic partnership to guide rural practitioners to locate, select, and implement CRCS interventions that align with local context. We developed a prototype strategy adapted from the National Cancer Institute’s ‘Putting Public Health Evidence in Action’ curriculum in collaboration with two rural clinics to facilitate systems change related to CRCS. This paper describes the process of co-development and delivery of a systems-focused strategy to improve adoption, implementation, and sustainability of CRCS interventions. Methods: We used a bundle of implementation strategies with a core focus on academic-clinical partnership development and Plan-Do-Study-Act cycles to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and systems-change processes that improve CRCS rates. Clinic physicians and staff (n=7) at the rural clinics were asked to evaluate the approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the systems-change process, we conducted key-stakeholder interviews (n=5) to assess feasibility and acceptability on content/delivery format and plans for ongoing implementation of CRCS evidence-based interventions (EBIs). Results: Electronic blueprints for CRCS EBI selection and implementation (8 modules) were developed and followed by an online forum/live-streaming conference to allow for CRCS tailoring. The two clinics used different learning approaches: one completed the modules together while the other completed the modules separately to cover material before a group video conference. Across all modules, participants in both clinics reported positive reactions toward the systems-change modules. Both clinics reported improvements in how they perceived the characteristics of the modules and the participatory approach to tailor selected CRCS EBIs. Through the process both clinics developed a specific EBI implementation plan. Interview participants reported that the approach was feasible and acceptable, and provided suggestions for further improvements on content, delivery, and format of the approach.Conclusions: The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of evidence-based approaches to improve CRCS.