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A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program.

ABSTRACT: BACKGROUND:Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community. METHODS:The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost effectiveness of multicomponent interventions used in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. RESULTS:Process measures to evaluate the implementation of interventions to increase community and patient demand for CRC screening, increase patient access, and increase provider delivery of services are presented. In addition, performance measures are identified to assess implementation processes along the continuum of care for screening, diagnosis, and treatment. Series of intermediate and long-term outcome and cost measures also are presented to evaluate the impact of the interventions. CONCLUSIONS:Understanding the effectiveness of multicomponent, evidence-based interventions and identifying successful approaches that can be replicated in other settings are essential to increase screening and reduce CRC burden. The use of common framework, data elements, and evaluation methods will allow the performance of comparative assessments of the interventions implemented across CRCCP sites to identify best practices for increasing colorectal screening, particularly among underserved populations, to reduce disparities in CRC incidence and mortality.

SUBMITTER: Subramanian S

PROVIDER: S-EPMC6289181 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program.

Subramanian Sujha S Hoover Sonja S Tangka Florence K L FKL DeGroff Amy A Soloe Cynthia S CS Arena Laura C LC Schlueter Dara F DF Joseph Djenaba A DA Wong Faye L FL

Cancer 20181025 21

<h4>Background</h4>Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community.<h4>Methods</h4>The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost e ...[more]

PMID: 30359464

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Project description:ContextThe Community Preventive Services Task Force recently recommended multicomponent interventions to increase breast, cervical, and colorectal cancer screening based on strong evidence of effectiveness. This systematic review examines the economic evidence to guide decisions on the implementation of these interventions.Evidence acquisitionA systematic literature search for economic evidence was performed from January 2004 to January 2018. All monetary values were reported in 2016 US dollars, and the analysis was completed in 2018.Evidence synthesisFifty-three studies were included in the body of evidence from a literature search yield of 8,568 total articles. For multicomponent interventions to increase breast cancer screening, the median intervention cost per participant was $26.69 (interquartile interval [IQI]=$3.25, $113.72), and the median incremental cost per additional woman screened was $147.64 (IQI=$32.92, $924.98). For cervical cancer screening, the median costs per participant and per additional woman screened were $159.80 (IQI=$117.62, $214.73) and $159.49 (IQI=$64.74, $331.46), respectively. Two studies reported incremental cost per quality-adjusted life year gained of $748 and $33,433. For colorectal cancer screening, the median costs per participant and per additional person screened were $36.63 (IQI=$7.70, $139.23) and $582.44 (IQI=$91.10, $1,452.12), respectively. Two studies indicated a decline in incremental cost per quality-adjusted life year gained of $1,651 and $3,817.ConclusionsMulticomponent interventions to increase cervical and colorectal cancer screening were cost effective based on a very conservative threshold. Additionally, multicomponent interventions for colorectal cancer screening demonstrated net cost savings. Cost effectiveness for multicomponent interventions to increase breast cancer screening could not be determined owing to the lack of studies reporting incremental cost per quality-adjusted life year gained. Future studies estimating this outcome could assist implementers with decision making.

Project description:BackgroundGlobal health partnerships (GHP) between high or low-middle income countries are considered one of the best approaches to health systems strengthening. They typically involve highly skilled healthcare workers who volunteer to deliver capacity strengthening projects overseas, often in the form of peer-to-peer support through training and mentoring. Given GHP's strong focus on education and training, a common assumption is that training of trainers (ToT) is a strong predictor of sustainability because of its potential for up-skilling the workforce rapidly, cheaply and exponentially by developing local educators. Our aim is to test this assumption and identify the strengths and limitations of this approach by analysing qualitative data from a set of GHP funded by the UK Department for International Development through the Tropical Health and Education Trust.ResultsOur analysis identifies some of the common features of the ToT model and a number of limitations that can prevent it from being both effective and sustainable. Whilst most GHP strive for the long-term sustainability of the training by focusing on adequate training provision and support of local trainers, the wider issues that can facilitate or prevent the continuation of training are not always considered. We propose a conceptual framework (TRAIN) for ToT interventions to help inform practice and project evaluation. We illustrate the applicability of our framework through five case studies, each chosen to illustrate one aspect of the framework.ConclusionsTRAIN is intended as a starting point for further refinements and discussions about the factors affecting capacity building strategies based on training cascades. Although we envisage its usefulness to GHP as a guidance to design and operationalise ToT, we recognise that in practice it may be difficult to implement it in its entirety. The key message underlying TRAIN is that the sustainability of a cascade depends on a number of factors being present or developing at different operational levels during the course of a project. These are crucial to transform the opportunities that ToT affords to health systems in developing countries into the actual achievement of a training cascade that ultimately upskills the workforce and improves health outcomes in these countries.

Project description:BackgroundScreening for colorectal, breast, and cervical cancer has been shown to reduce mortality; however, not all men and women are screened in the USA. Further, there are disparities in screening uptake by people from racial and ethnic minority groups, people with low income, people who lack health insurance, and those who lack access to care. The Centers for Disease Control and Prevention funds two programs-the Colorectal Cancer Control Program and the National Breast and Cervical Cancer Early Detection Program-to help increase cancer screenings among groups that have been economically and socially marginalized. The goal of this manuscript is to describe how programs and their partners integrate evidence-based interventions (e.g., patient reminders) and supporting activities (e.g., practice facilitation to optimize electronic medical records) across colorectal, breast, and cervical cancer screenings, and we suggest research areas based on implementation science.MethodsWe conducted an exploratory assessment using qualitative and quantitative data to describe implementation of integrated interventions and supporting activities for cancer screening. We conducted 10 site visits and follow-up telephone interviews with health systems and their partners to inform the integration processes. We developed a conceptual model to describe the integration processes and reviewed screening recommendations of the United States Preventive Services Task Force to illustrate challenges in integration. To identify factors important in program implementation, we asked program implementers to rank domains and constructs of the Consolidated Framework for Implementation Research.ResultsHealth systems integrated interventions for all screenings across single and multiple levels. Although potentially efficient, there were challenges due to differing eligibility of screenings by age, gender, frequency, and location of services. Program implementers ranked complexity, cost, implementation climate, and engagement of appropriate staff in implementation among the most important factors to success.ConclusionIntegrating interventions and supporting activities to increase uptake of cancer screenings could be an effective and efficient approach, but we currently do not have the evidence to recommend widescale adoption. Detailed multilevel measures related to process, screening, and implementation outcomes, and cost are required to evaluate integrated programs. Systematic studies can help to ascertain the benefits of integrating interventions and supporting activities for multiple cancer screenings, and we suggest research areas that might address current gaps in the literature.

Project description:BackgroundPrevention of tuberculosis (TB)-related stigma is vital to achieving the World Health Organisation's End TB Strategy target of eliminating TB. However, the process and impact evaluation of interventions to reduce TB-stigma are limited. This literature review aimed to examine the quality, design, implementation challenges, and successes of TB-stigma intervention studies and create a novel conceptual framework of pathways to TB-stigma reduction.MethodWe searched relevant articles recorded in four scientific databases from 1999 to 2022, using pre-defined inclusion and exclusion criteria, supplemented by the snowball method and complementary grey literature searches. We assessed the quality of studies using the Crowe Critical Appraisal Tool, then reviewed study characteristics, data on stigma measurement tools used, and interventions implemented, and designed a conceptual framework to illustrate the pathways to TB-stigma reduction in the interventions identified.ResultsOf 14,259 articles identified, eleven met inclusion criteria, of which three were high quality. TB-stigma reduction interventions consisted mainly of education and psychosocial support targeted predominantly toward three key populations: people with TB, healthcare workers, and the public. No psychosocial interventions for people with TB set TB-stigma reduction as their primary or co-primary aim. Eight studies on healthcare workers and the public reported a decrease in TB-stigma attributed to the interventions. Despite the benefits, the interventions were limited by a dearth of validated stigma measurement tools. Three of eight studies with quantitative stigma measurement questionnaires had not been previously validated among people with TB. No qualitative studies used previously validated methods or tools to qualitatively evaluate stigma. On the basis of these findings, we generated a conceptual framework that mapped the population targeted, interventions delivered, and their potential effects on reducing TB-stigma towards and experienced by people with TB and healthcare workers involved in TB care.ConclusionsInterpretation of the limited evidence on interventions to reduce TB-stigma is hampered by the heterogeneity of stigma measurement tools, intervention design, and outcome measures. Our novel conceptual framework will support mapping of the pathways to impacts of TB-stigma reduction interventions.

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A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program.

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A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program.

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