CPCRN Signature Project: Evidence-Based Approaches to Cancer Control

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CPCRN Signature Project Evidence-Based
Approaches to Cancer Control

• Boston, MAOctober 31 , 2007

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Development of a Training and Planning Tool for
Using Evidence Based Approaches for Cancer Control
Signature Project

• Partnership of all the CPCRNs
• Builds on Dissemination work
• Fills the needs of network partners and the wider
  community
• Furthers a consensus process regarding
  dissementation, adaptation, and implementation

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Our Vision for the EBA Training and Program
Planning Tool
Signature Project

• EBA Training and Planning Tool
• Will support the best use of existing resources
  (Cancer PLANET, The Community Guide, RTIPs, Using
  What Works, etc.) for planning and implementation
  processes
• Will provide training and guide the user through
  the process
• Will provide guidance for adapting evidence-based
  programs to fit community needs.

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Signature Project

• Aims
• Determine factors that influence use of
  evidence-based approaches (EBA), among cancer
  control planners
• Determine community training needs for finding,
  choosing, and adapting evidence-based approaches
  EBA,
• To determine gaps in existing training materials
  on EBA,
• To develop and pilot test a working prototype
• Plan for the full development of the program
•  

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Signature Project

• Needs Assessment
• Summer 2006 EBA Workshops with Texas Cancer
  Control Toolkit Trainings
• Midland, Abilene, San Antonio, McAllen
• Based on Using What Works
• Short survey focus group
• Findings
• Not aware of resources (e.g. Community Guide
  RTIPs)
• Did not know how to find, choose, or adapt an
  evidence-based programs

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Signature Project

• Needs Assessment
• Developed and pilot tested a survey instrument
• Winter 2007 Workshop at Tools for Texans
  Conference
• Spring 2007 TX-CPCRN (LINCC) Face-to-Face Meeting

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Signature Project

• Needs Assessment
• Survey of CDC Cancer Conference attendees
• 67 said ½ all of their job involved planning
  implementing cancer control programs
• 32 agreed EBPs were easy to find/get
• 24 agreed EBPs were easy to adapt
• 55 agreed EBPs didnt come with much information
  about how to implement them
• 80 agreed their funding agencies encouraged the
  use of EBPs

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Signature Project

• Needs Assessment
• Survey of CDC Cancer Conference attendees
• 59 had used The Community Guide
• 72 had never used Cancer PLANET
• 35 had used RTIPS
• Most people who did use the tools found them
  useful or very useful

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Signature Project

• Needs Assessment (planned)
• Survey of CPCRN partners
• 8 centers surveying at least 30 partners each (N
  240)
• Web-based, or paper surveys
• In-depth interviews with program planners
• Identification of Existing Resources
• EBA Resource Inventory The Consumers Guide
  to EBP Planning Resources
• What is there (Using What Works, Cancer Control
  Planet, etc)
• How it performs

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(Partial)
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Replication when there is a Guide recommended
strategy EBPs available
Introduction to EB Interventions?Choosing a risk
factor/cancer type
Adaptation when there is an EBP available, but
insufficient evidence
Decision process for choosing an intervention
goal and strategy, and then finding, reviewing
and assessing programs
Program creation when there are no programs
available
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Signature Project

• Development of the prototype
• Working groups
• Module content area development
• User interface development
• Usability Testing
• Pilot Testing

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Signature Project

• The training and planning tool will accelerate
  the adoption of evidence-based cancer prevention
  and control in communities
• Supports the best use of existing resources
  (Cancer PLANET, The Community Guide, RTIPs, Using
  What Works, etc.)
• Process draws upon the collective experience of
  the CPCRNs and their community partners
• Engaging in the consensus process about issues
  related to dissemination/translation
• Examples
• What constitutes core elements of a program
  that should not be changed?
• Can adaptation include adding objectives/determina
  nts/program elements?

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Activities update Work Session

• Evidence-Based Approaches to Planning Cancer
  Control Programs

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Thanks T eam!
This has truly been a cross-CPCRN group effort.
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Survey Instrument

• Sampling Strategy Completed
• Online Version of Survey Completed
• http//uncodum.qualtrics.com/SE/?SIDSV_3mCd5SNlpX
  Cmt3CSVIDProd
• Paper Version of Survey Completed

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EBA Survey IRB Status (Last Updated 10/25/2007)

• Final IRB Approval Received
• Harvard, Morehouse, SLU, UNC, UT, UW
• UCLA
• IRB approval received, but minor protocol changes
  have been submitted, and were awaiting final
  approval.
• Emory
• IRB requires copies of IRB approval notices from
  ALL other Network Centers. These will be sent
  once UW has resolved a typo in their approval
  letter and passed it on.
• IRB would not accept the official UNC proof of
  CITI human subjects training notices for Rebecca
  Williams and Teresa Edwardsversion from the CITI
  website, these have been sent to Emory.

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EBA Survey IRB Status (Last Updated 10/25/2007)

• CDC
• Once all final IRB approval notices have been
  received from all Network Centers, Rebecca
  Williams will send them and the Coordinating
  Center IRB application to Kathi Wilson for
  submittal to the CDC IRB.

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Module Development Workgroups

• User Interface Development SLU
• SLU is focusing on user interface development and
  will bring the interface to the group for review.

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Module Development Workgroups

• Assessment Dan, Roy, Alexis
• Responsible for content areas 1, 2, 3 of the
  flowchart. This group will be addressing
  community assessment, choosing a risk factor or
  type of cancer, and choosing an intervention goal
  and strategy.

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Introduction to EB Interventions?Choosing a risk
factor/cancer type
Decision process for choosing an intervention
goal and strategy, and then finding, reviewing
and assessing programs
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Content Area 1 Introduction (Overview, Levels of
Evidence)

• Purpose To introduce planners to the concept of
  evidence-based cancer and cancer-related
  interventions and the reasons these types of
  interventions are preferred in planning community
  health promotion programs. This module will
  provide both the conceptual framework for the
  web-based tool and the instructions for its use.
•  
• Learning Objectives 
• Discuss the purpose of the web-based tool
• Recognize the need to employ health promotion
  interventions with demonstrated effectiveness.
• Discuss the usefulness of a tool that will guide
  the selection of an evidence-based intervention
  appropriate for the community of interest.
• Describe the general functions of the web-based
  tool. 
• Utilize the web-based tool effectively 
• Move through the modules and links as appropriate
  for users needs
• Access the Help function as needed.

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Content Area 1 Introduction (Overview, Levels of
Evidence)

• Describe the concept of evidence-based
  interventions 
• Define and differentiate between efficacy and
  effectiveness
• Access the evidence base by using search engines
  (Pubmed etc.), published compendia (Community
  Guide), and websites (Cancer PLANET)
• Describe basic elements of research design
  Question how basic should this be?
• List and describe levels of evidence used by
  Cancer PLANET and the Community Guide as strong,
  sufficient, expert opinion, or insufficient.
• List the factors employed to assess the strength
  of evidence as research design, quality of
  implementation, replication of findings, and
  effect size.

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Content Area 1 Introduction (Overview, Levels of
Evidence)

• Describe the concept of evidence-based
  interventions  (continued)
• Describe issues that one must consider in
  assessing the evidence, such as
• How effective is a public health program in
  achieving its intended disease prevention
  objectives?
• Under what conditions and circumstances have
  program approaches proven effective?
• Does evidence point to ineffective practices that
  consequently cannot be recommended?
• Does the level of effectiveness justify the
  expenditure of resources relative to what was
  achieved?
• Is there a match between the sample in the
  research study and the population that the
  program would be replicated on?
• What is the cost benefit and cost effectiveness
  of the intervention?

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Content Area 2 Choosing a Risk Factor or Cancer
Type

• Purpose To enable planners to choose a cancer
  risk factor or cancer type as the target of a
  health promotion intervention using epidemiologic
  data (e.g. state or federal data) or community
  data to provide a rationale for the choice. In
  the event that a risk factor or cancer type has
  already been chosen, the module will enable the
  planner to assemble the data to defend the
  choice, or will lead the planner to make a
  different choice.
• Learning Objectives 
• Conduct a community health needs assessment with
  particular attention to cancer and cancer-related
  risk factors. 
• Collect cancer-relevant data from secondary
  sources (state or local health department, SEER,
  BRFSS, census, etc.)
• Engage in community entry processes as
  appropriate
• Conduct and interpret key informant interviews
  with community leaders
• Conduct focus groups with targeted audience and
  interpret findings
• Conduct community survey and interpret findings.
• Identify racial, ethnic, and socioeconomic cancer
  disparities.

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Content Area 2 Choosing a Risk Factor or Cancer
Type

• 2. Present findings of community health needs
  assessment to community organizations and groups.
• Create and give presentation appropriate for
  educational and linguistic status of audience.
• Answer questions and obtain feedback from
  audience.
• 3. Select cancer risk factor or cancer type as
  target for intervention. 
• Establish intervention priorities using data from
  community health needs assessment and other data
  sources.
• Incorporate feedback from community audiences
  (Objective 2) into priority selection.
• Present and defend choice or priority list to
  community leaders, political groups, funders,
  public health officials, and medical
  organizations.

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Content Area 3Choosing Intervention Goals
Strategies

• Purpose To enable planners to identify the
  desired outcome of their intervention and select
  a general approach for achieving the outcome.
• Learning Objectives
• Choose an intervention goal
• Formulate goal as specific, measurable,
  achievable, relevant, and time-limited (SMART)
• Identify a feasible goal
• Consider magnitude of problem
• Consider characteristics of intervention
  community
• Access appropriate literature
• Consult with experts
• Consult with experienced health promoters in
  other communities

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Content Area 3Choosing Intervention Goals
Strategies

• Choose an intervention strategy
• Review evidence continuum in Guide to Community
  Preventive Services or other appropriate document
• Consider available resources funds, staff, time
• Enumerate and evaluate strength of existing
  partnerships (agencies, churches, academic
  institutions, community organizations,
  professional societies, healthcare providers)
• Assemble information on existing programs
• Identify programs in RTIPs (Research-Tested
  Intervention Programs)
• Identify programs from other sources health
  promotion literature, presentations at
  professional meetings.
• Review core elements of candidate intervention
  against specifics of priority community

• Race and ethnicity
• Language issues
• Educational level
• Socioeconomic status
• Access to care

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Content Area 3Choosing Intervention Goals
Strategies

• Assemble information on existing programs
• Review core elements of candidate intervention
  against available resources
• Review core elements of candidate intervention
  against capabilities and potential participation
  of partners.
• Meet with partners leadership
• Solicit participation
• Build coalition Question develop a module on
  coalition-building?
•  
• Make decision select/adapt existing program or
  develop new program

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Module Development Workgroups

• Replication Cathy, Vicky, Peggy
• Responsible for content areas 4a, 5a, 6a of the
  flowchart. This group will be addressing the
  pathway regarding what to do when there is both a
  guide recommended strategy and available RTIPs
  assessing fit, replication, implementation and
  monitoring.

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Replication when there is a Guide recommended
strategy EBPs available
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Content Areas 4a, 5a, 6a Replicate an Existing
Program

• Purpose To guide planners through the steps of
  implementing a program that has already been
  developed and successfully tested. The module
  will allow users to learn about the steps to
  replicate a program and how to cope with some of
  the challenges and barriers they may face when
  trying to replicate such a program.
•  
• Learning Objectives 
• Define replication
• Defines replication as implementing an
  evidence-based program as it was originally
  developed/tested.
• Notes any minor modifications (such as listing
  local resources) that can be made and still be
  considered replication. 

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Content Areas 4a, 5a, 6a Replicate an Existing
Program

• Define program fit (how well would an existing
  program have to fit in order to make replication,
  rather than adaptation, the right choice)
   COMMENT This may be covered in Module 3c
• Defines critical fit elements as program
  objectives, methods, and strategies
• Looks for descriptions of what determinants of
  behavior were targeted in the original program
  are these determinants considered important in
  your target community?
• Looks for descriptions of the community/setting
  in which the program was originally developed and
  tested
• Identify key steps to program replication
• Obtaining enough information about the program to
  replicate
• Program materials
• Procedural manuals
• Training for interventionists
• When available, process and other measures

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Content Areas 4a, 5a, 6a Replicate an Existing
Program

• Identify key steps to program replication
  (continued)
• Community/stakeholder engagement and buy-in for
  the program
• Train interventionists to deliver program with
  fidelity
• Develop plan for implementation and evaluation
• Describe how to overcome potential barriers to
  program replication
• Common barriers obtaining program
  materials/procedure manuals (cost or contact
  problems), fidelity in program delivery,
  perceptions that a program delivered and tested
  elsewhere cant work in my community
• Potential solutions finding/connecting with the
  right person to deliver program materials,
  procedure manuals, training methods, and
  implementation advice (to solve getting program
  materials and ensuring fidelity) ownership
  issues dealt with below

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Content Areas 4a, 5a, 6a Replicate an Existing
Program

• Implement strategies to enable agency and
  community stakeholders to experience feelings of
  ownership for a replicated program
• Defines ownership as feeling that the program is
  the work of the community rather than the work of
  outsiders
• Work with agency and community stakeholders to
  develop implementation plan
• Work with agency and community stakeholders to
  evaluate program
• Share credit for program implementation among all
  stakeholders look for opportunities (or obtain
  permission) to brand or co-brand intervention
  materials to identify them with the community
• Develop a plan to establish ownership among key
  stakeholders (identify leaders, allocate funds or
  other resources to keep plan going, etc.)
• Convene stakeholders periodically to share
  implementation and evaluation reports re-assess
  and modify the program if necessary (link to
  Adaptation Module in case of evidence of need for
  adapting program)

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Module Development Workgroups

• Adaptation Maria, Pat, Kay, Sandra, Jennifer,
  Belinda, Michelle C.
• Responsible for content areas 4b, 5b, 6b of the
  flowchart. This group will be addressing the
  pathway regarding what to do when the evidence is
  insufficient and there are available RTIPs for
  adaptation (with emphasis on following guidelines
  for recommended strategies), developing an
  implementation plan, and a plan for monitoring
  program process and outcome.

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Adaptation when there is an EBP available, but
insufficient evidence
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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Purpose To guide planners through the steps in
  adapting a program that only partially fits their
  community context (culture, resources, etc.). The
  module will allow users to both learn about the
  adaptation process and practice actual adaptation
  of an identified program.
•  
• Learning Objectives 
• Defines adaptation
• Defines adaptation as a process of changing
  identified evidence-based programs (or program
  components) to fit the needs and characteristics
  of a community that differs from the one in which
  it was initially tested.
• Defines elements of the adaptation process as
  including activities such as language
  translation, role model matching to community
  racial/ethnic groups, and inclusion of local
  resource information.
• Defines adaptation as ensuring against change in,
  or deletion of, theoretical methods to promote
  change. For example, deleting methods such as
  role modeling, skill-building, practice,
  persuasion to change risk perceptions.

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Identifies core elements of the existing program
  that, if changed, may compromise the expected
  effectiveness.
• Defines core elements of the program as the
  following
• Target populations
• Objectives for change in the behavior of the
  priority population/at-risk groups QUESTION
  Defined how?
• Objectives for change in elements of the
  environment
• Factors targeted for change as determinants of
  priority population behavior
• Factors targeted for change as determinants of
  environmental agents change behavior
• Theoretical change methods and
• Strategies for delivering theoretical change
  methods.
• Describes why changing each specific core element
  would jeopardize the demonstrated effectiveness
  of the program . QUESTIONS Not sure about this
  one- shouldnt we have some kind of objective
  here that questions whether all of the core
  elements need to be maintained e.g. what if
  there was a focus on multiple environmental
  changes (among teachers, parents, etc) but their
  program is only going to focus on parents?

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Describes the main behavioral (and other)
  outcomes of the existing program and compares
  them to their own program goals and objectives.
• Reviews or develops specific behavioral and or
  environmental change objectives for the desired
  program.
• Looks for descriptions of what behavioral or
  environmental change is targeted by the program
  to be adopted. If descriptions do not exist,
  draws assumptions about intended behavioral and
  environmental targets based on program materials
  that are available.
• Compares the desired change in the program to be
  adapted with the change desired by the adopting
  group and decides whether overlap in objectives
  is sufficient.
• If coverage of objectives is not sufficient,
  decides whether another program can be added to
  the program under consideration to expand the
  range of targeted objectives, whether new
  components can be developed to fill the gaps in
  the existing program, or whether another program
  should be considered. QUESTION Can adaptation
  include adding objectives? It seems that this is
  where our model gets fuzzyCan you consider a
  program built from components of other programs
  as program creation? Seems it lies somewhere
  between adaptation and creation.

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Compares determinants addressed in the existing
  program and compares them to the factors
  influencing the behavior in their community.
• Considers what factors may be determining the
  targeted behavior of the priority population, or
  of the environmental change in their community.
• Looks for descriptions of what determinants were
  targeted in the program being considered.
• Compares the determinants considered to be
  important in the community with the determinants
  targeted by the program under consideration.
• If focus on important determinants is not strong
  enough in the program under consideration,
  determines additional components and/or messages
  that should be added to the existing program for
  use in the new community. QUESTIONS Can
  adaptation include adding determinants? Dont
  they first have to be able to define what is
  strong enough ?

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Works with community groups to plan adaptations
  to make program culturally appropriate for the
  new community . QUESTION Just to make it
  culturally appropriate or for all of the other
  questions above as well?
• Defines culture and explains what is meant by
  cultural context.
• Describes elements of culture that are depicted
  in the materials of interest.
• Describe whether behaviors, or determinants,
  covered in the program are different for cultural
  groups in the community.
• Evaluate whether ways individuals are depicted in
  program materials (including those representing
  racial/ethnically defined groups of African
  Americans, Hispanics/Latinos, Asian Americans,
  European Americans and others) are congruent with
  community groups culture including health
  practices, values, relationships, clothing, food,
  recreation, symbols, etc.

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Works with community groups to plan adaptations
  to make program culturally appropriate for the
  new community (Continued)
• Explains whether community members in various
  groups would be receptive to the delivery
  channels and mechanisms required by the program.
  QUESTION Should they explain why vs. whether?
• Works with community members to suggest changes
  to make the program materials more culturally
  relevant.
• Works with community members to increase cultural
  appropriateness of intended delivery to assure
  reach of program.
• Identifies further sources of information and
  help regarding culture, cultural context, and
  cultural fit.

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Proposes change in the existing program that can
  be accomplished to improve chances for program
  adoption, implementation and success
• Identifies program elements that can be changed
  without compromising the programs integrity and
  potential effectiveness.
• Identifies program elements that can be changed
  within program budget.
• Evaluates visual elements of the materials
  (graphics, other images) to determine the
  suitability of materials for the new community.
• Describes how he/she would modify the existing
  program components to fit community context,
  e.g., add role models and cultural elements to
  make program more relevant to the community.
• Evaluates readability/understandability of
  program materials. QUESTION Changes
  readability?
• Slightly modifies program delivery to meet
  communication channels of community residents.

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Describes how to overcome potential barriers to
  adaptation (e.g. production cost, expertise,
  etc.) QUESTIONS What did we have in mind here?
  Perhaps helping the planner begin to think
  creatively about overcoming various
  barrierse.g., finding sponsors to help defray
  costs, accessing university resources (faculty,
  students, etc.) for expert help, and things of
  this nature?
• Implements strategies to enable agency and
  community stakeholders to experience feelings of
  ownership of an adapted program.
• Defines ownership as feelings that the program is
  the work of the community rather than the work of
  outsiders.
• Works with agency and community stakeholders to
  evaluate and adapt program.
• Works with agency and community stakeholders to
  develop a specific community implementation plan

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Content Areas 4b, 5b, 6b Adapt an Existing
Program

• Implements strategies to enable agency and
  community stakeholders to experience feelings of
  ownership of an adapted program. (Continued)
• Shares credit for community adaptation and
  implementation among all stakeholders
• Develops a plan to establish and/or maintain
  ownership among key stakeholders (i.e. assign
  leadership positions, allocate resources, etc.
• Reassesses and modifies plan when necessary.
• Identifies opportunities where the adapted
  program and organization can be co-branded so
  that the adapted program is associated with the
  organization by consumers.

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Module Development Workgroups

• Program Creation Michelle K., Cam, Michelle C.,
  Debbie
• Responsible for content areas 4c, 5c, 6c of the
  flowchart. This group will be addressing the
  pathway regarding what to do when there are no
  RTIPs, but there is a recommended strategy
  creating a new program following guidelines for
  recommended strategies, and developing an
  implementation and outcome evaluation plan.

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Program creation when there are no programs
available
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Content Areas 4c, 5c, 6c Program Creation

• Purpose To guide planners in developing programs
  when an evidence-based strategy is recommended by
  the Community Guide, but no evidence-based
  program is available on RTIPs.
•  
• Learning Objectives 
• Locate alternative sources of evidence-based
  programs for your content area
• Describe alternative sources of evidence-based
  programs, including the following
• Contact scientific experts or local university
  researchers who can provide program information,
  intervention strategies, and/or understand and
  interpret the scientific literature consider
  requesting an ongoing partnership for program
  planning and evaluation assistance
• Locate Model Programs or Best Practices
  recommended by funding agencies
• Obtain descriptions of effective programs
  directly from scientific literature

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Content Areas 4c, 5c, 6c Program Creation

• Locate alternative sources of evidence-based
  programs for your content area (Continued)
• If conducting a literature search to locate
  effective programs
• Use databases such as PubMed, Medline, PsychInfo
  or search engines such as Google Scholar
• Develop a search plan that has the appropriate
  key words/vocabulary for your content area to
  locate articles or reports of relevant programs
• Prioritize articles or reports that describe
  programs that are part of a systematic review
  (e.g., Cochrane), funded by a peer-reviewed
  grant, or published in a peer-reviewed journal
• Examine articles or reports that describe
  effective programs for your content area
• Define effective (positive results) as
  demonstration of behavior change as opposed to
  intentions, attitudes or knowledge
• Determine level of effectiveness for each program
  alternative using evaluation results and/or
  research findings

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Content Areas 4c, 5c, 6c Program Creation

• Examine articles or reports that describe
  effective programs for your content area
  (Continued)
• Examine the audience of interest, methods or
  procedures for the intervention, and determinants
  targeted by the program alternatives
• If applicable, read the discussions to understand
  the strengths and weaknesses of the article
• Determine which program alternatives are
  promising for potential use in your program
  planning based on a match with audience,
  determinants, context and local adaptability
• Identify core program elements from program
  alternatives
• Define core elements and how to identify them
  from a research article
• Across the effective programs, list the program
  components or elements across the interventions
• Create a matrix of programs and their core
  elements for review

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Content Areas 4c, 5c, 6c Program Creation

• Identify core program elements from program
  alternatives (Continued)
• Consider which of these elements may work in your
  community context and population of interest
  keeping in mind the audience of interest,
  behavioral determinants, environmental
  determinants, theoretical strategies, strategies
  for behavior change, and available resources
• Prioritize best possible evidence-based courses
  of action or elements to achieve the most
  important program outcomes
• Identify and engage partners in choosing program
  elements and developing the program
• Design a program with the prioritized core
  elements
• State measurable objectives, including long-term
  (health problem), intermediate (behavioral and
  environmental outcomes), short-term
  (determinants), and process
• List major activities to accomplish each core
  element, associated tasks, and who is responsible
  for implementation
• Identify resources needed for implementation of
  each activity
• Develop a timeline for program implementation

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Content Areas 4c, 5c, 6c Program Creation

• Develop a process and outcome evaluation plan
  6c
• Engage stakeholders to guide evaluation efforts
• Ensure program objectives are measurable
• Develop logic model
• Develop evaluation questions
• Identify indicators to track objectives and
  answer evaluation questions
• Develop data collection tools and/or systems
• Collect data
• Analyze data
• Report results

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Content Areas 4c, 5c, 6c Program Creation

• Questions/Issues for the Larger Group
• There is a gap in the current Flow Chart
  Insufficient evidence according to the Community
  Guide, and no RTIPS.
• When in the process will Users identify major
  determinants of interest (2a or 5c)?
• Is this module/template specific to breast
  cancer, and if so, should examples be specific to
  the Community Guide recommendations on breast
  cancer? In other words, should our examples
  cover small media and client incentives with
  reminders?
• The need to develop an evaluation plan occurs in
  several places (6a, 6b 6c). Can this be just
  one module, and who will lead its development?
• Will the website be maintained and updated so
  that we can include up-to-date links to resources
  such as specific Cochrane reviews or specific
  Best Practices listed by federal agencies?