Promoting Cancer Screening in Partnership With Health Ministries in 9 African American Churches in South Los Angeles: An Implementation Pilot Study

Abstract

Purpose and ObjectivesWe conducted a pilot study to assess the degree to which an intervention led by community health advisors (CHAs) to promote cancer screening was delivered as intended and to estimate the potential effect of the intervention on receipt of screening. In contrast to previous studies and to maximize its potential public health impact, the intervention targeted 4 screening tests and only participants who were not up to date with screening guidelines for at least 1 cancer. Because CHAs had to both determine baseline adherence and provide counseling on 4 screening tests, the protocol was complex. Complex protocols can reduce implementation fidelity.Intervention ApproachIn partnership with health ministries at 9 African American churches in South Los Angeles, we conducted a 1-group pretest–posttest pilot study to assess the feasibility of implementing the intervention. CHAs recruited and obtained consent from church members aged 50 to 75 years; assessed adherence to national screening guidelines for breast, cervical, colorectal, and prostate cancer; and provided evidence-based strategies (one-on-one counseling, print materials, reminder calls) to encourage screening for tests that were overdue.Evaluation MethodsWe assessed implementation fidelity by reviewing baseline screening assessments and counseling scripts completed by CHAs. We estimated potential effect of the intervention on receipt of screening by using data from 3-month follow-up surveys, conducted by the research team, of participants who were nonadherent at baseline.ResultsFrom June 2016 to June 2018, 44 CHAs conducted baseline assessments of 775 participants, of whom 338 (44%) were nonadherent to national guidelines for 1 or more cancer screening tests. CHAs provided counseling to most nonadherent participants. At follow-up, about one-third of participants reported that they had discussed cancer screening with their provider and a smaller proportion reported receipt of a screening test; 13% of men and 25% of women reported receipt of colorectal cancer screening.Implications for Public HealthThis study demonstrates that with training and ongoing technical assistance, CHAs at African American health ministries can implement complex research protocols with good fidelity.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis

“…Slightly more than half (56%; n = 23) of the studies included only participants aged 50 years and older, while five (12%) included participants starting at age 45 years, three (7%) included participants younger than 45. Twelve of the studies (29.27%) reported demographics specific to African-American men [ 50 , 52 , 56 , 57 , 59 , 60 , 63 , 66 , 71 , 74 , 82 , 84 ]. In the studies aimed at increasing CRC screening uptake among African-American men, the intervention components most frequently employed (among 135 interventions types utilized) were telephone encounters or education (18%; n = 25), mailed or electronically sent educational materials (13%; n = 18), FIT or other CRC stool-based screening kits (mailed or administered in person) (13%; n = 17), patient navigation (10%; n = 13), and printed materials given to individuals in person (12%; n = 16).…”

“…Interventions were most commonly implemented by the study researchers themselves, medical personnel, or public health workers (as was the case among patient navigation interventions). Some studies enlisted the help of local community members, including churches, barbershops, and other local businesses [ 57 , 68 , 78 , 82 ]. Besides the use of patient navigators in general, there was no observed trend in CRC screening uptake related to who implemented the intervention.…”

“…Next, 9 of the studies were classified as quasi-experimental [ 49 , 53 , 67 , 68 , 70 , 72 , 76 , 78 , 82 ]. Although only 2 of these studies contained a control group [ 68 , 76 ], a high bias risk was yielded for the remaining 7 studies.…”

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

“…Because CHWs are not expected to have a health background, the quality of CHW trainings is critical to implementation success. Implementation fidelity may suffer if CHWs are not appropriately trained and supported to deliver health interventions (83). In-person trainings for CHWs that have been delivered in efficacy and effectiveness trials are not always feasible from a scalability perspective; thus other approaches such as asynchronous, self-paced online trainings can be used (62).…”

“…Overall, the work conducted in FBOs highlights aspects of implementation research that can guide efforts in other settings: the importance of the local context, engaging stakeholders, involving CHWs, and providing appropriate training to support EBPP implementation. Ongoing implementation research studies will provide insights about the effectiveness of various strategies and outcomes that can inform future research approaches (82,83).…”