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Title: The CDC Cancer Prevention and Control Research Network: Accelerating the Adoption of EvidenceBased C


1
The CDC Cancer Prevention and Control Research
Network Accelerating the Adoption of
Evidence-Based Cancer Prevention and Control in
Communities
  • CDC, Atlanta, GA
  • July 28, 2009

2
CPCRN and National Center Shared Goals
  • Kathi Wilson, PhD
  • Centers for Disease Control and Prevention

3
NCCDPHP Vision/Mission/Priorities
  • Vision
  • All people living healthy lives free from the
    devastation of chronic diseases.
  • Mission
  • To lead efforts that promote health and
    well-being through prevention and control of
    chronic diseases.
  • Strategic Priorities
  • Focus on Well-Being Increase emphasis on
    promoting health and preventing risk factors,
    thereby reducing the onset of chronic health
    conditions.
  • Health Equity Leverage program and policy
    activities, build partner capacities, and
    establish tailored interventions to help
    eliminate health disparities.
  • Research Translation Accelerate the translation
    of scientific findings into community practice to
    protect the health of people where they live,
    work, learn, and play.
  • Policy Promotion Promote social, environmental,
    policy, and systems approaches that support
    healthy living for individuals, families, and
    communities.
  • Workforce Development Develop a skilled,
    diverse, and dynamic public health workforce and
    network of partners to promote health and prevent
    chronic disease at the national, state, and local
    levels.

4
This product is in the public domain. Please cite
this work in this manner The National Center
for Chronic Disease Prevention and Health
Promotion (NCCDPHP) Translation Schematic,
Centers for Disease Control and Prevention,
NCCDPHP Work Group on Translation, July 2, 2008.
Adapted from Wilson K Fridinger F. Focusing on
Public Health A Different Look at Translating
Research to Practice. Journal of Womens Health
200817(2)173-179.
5
Network Overview and Accomplishments
  • Kurt M. Ribisl, PhD
  • University of North Carolina at Chapel Hill
  • CPCRN Coordinating Center

6
CPCRN Mission
  • To accelerate the adoption of evidence-based
    cancer prevention and control in communities.

7
Vision and Mission
  • Conduct research and practice activities that
    span the translation continuum from discovery to
    the dissemination and adoption of effective
    interventions
  • Focus on the Guide to Community Preventive
    Services
  • Disseminate and implement Guide-recommended
    interventions.
  • Add to the evidence-base in the Guide.
  • Go beyond advancing the science of cancer
    prevention and control, we will also influence
    public health and primary care practice. 
  • Be actively engaged in enhancing large-scale
    efforts to reach underserved populations and
    reduce their burden of cancer.

8
Organization
  • One of four Thematic Research Networks in the
    Prevention Research Centers (PRCs)
  • Only Thematic Network focused on dissemination
    and translation
  • Collaboration with two Federal Agencies
  • CDC Division of Cancer Prevention and Control
  • NCI Division of Cancer Control and Population
    Sciences
  • Eight Network Centers at research institutions

9
PIs
Karen Glanz, PhD, MPH
Glorian Sorensen, PhD
Dan Blumenthal, MD, MPH
Roshan Bastani, PhD
Cathy Melvin, PhD Kurt Ribisl, PhD (Coord Ctr)
Maria Fernandez, PhD
Vicky Taylor, MD, MPH
Matthew Kreuter, PhD
10
Network Center Map
11
CPCRN Strengths
  • Advancing science for implementation and
    translation research
  • Community partnerships
  • Focus on underserved populations
  • Broad geographic outreach
  • Research focus that complements CDC
  • Infrastructure funding provides impetus to focus
    beyond discovery

12
MULTI-CENTER COLLABORATION2 or more centers
  • The Value of a Network

13
Multi-center Grant Applications(cumulative)
14
Network Diagram Multi-center Grants, 2004
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
15
Network DiagramMulti-center Grants, 2005
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
16
Network Diagram Multi-center Grants, 2006
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
17
Network DiagramMulti-center Grants, 2007
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
18
Network DiagramMulti-center Grants, 2008
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
19
Multi-center Publications (cumulative)
20
Network Diagram Multi-center Publications, 2004
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
21
Network Diagram Multi-center Publications, 2005
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
22
Network Diagram Multi-center Publications, 2006
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
23
Network Diagram Multi-center Publications, 2007
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
24
Network Diagram Multi-center Publications, 2008
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
25
CPCRN Contributions to Practice and Research
26
Increasing use of evidence-based cancer control
services to eliminate disparitiesA CPCRN
collaboration with United Way 2-1-1 Call Centers
in 8 states
  • Debbie Pfeiffer, MA
  • Washington University in Saint Louis
  • CPCRN Network Center

27
(No Transcript)
28
  • 2-1-1 calls per day, selected markets
  • Houston, TX 1,000
  • Atlanta, GA 900
  • Connecticut 900
  • Virginia 500
  • Indiana 500
  • Denver, CO 350
  • Detroit, MI 350
  • Missouri 300

29
  • Assessing six cancer control actions
  • Mammography
  • Pap testing
  • Colonoscopy
  • HPV vaccination
  • Smoking
  • Smoke-free home policies

30
Mammograms Pap smears Colonoscopies HPV
vaccination Smoking cessation Smoke-free home
policy
girls 9-17
women 18-26
Merck Patient Assistance Program
31
(No Transcript)
32
Local CPCRN Efforts to support Translational
Support Structures
  • Ritesh Mistry, PhD
  • University of California at Los Angeles
  • CPCRN Network Center

33
CPCRNs Role inTranslational Support Structure
  • Increase awareness of resources to locate
    evidence-based and practice-based programs and
    strategies.
  • Build skills and resources necessary to select,
    adapt and implement evaluable evidence-based and
    practice-based programs.
  • Disseminate specific evidence-based and
    practice-based programs and strategies.
  • Develop and test evidence-informed programs
    collaboratively with practicing community
  • Increase communication and effective
    collaborations between research and practice

34
Capacity Building Strategies
  • Symposia
  • Town Hall Meetings
  • Forums
  • Workshops
  • Financial Support (Mini-grants)
  • Technical Assistance
  • Publish data on community needs and promising
    programs
  • Train students and young investigators

35
Audiences
  • Community-based organizations
  • Local and State Health Dept
  • State Comprehensive Cancer Plans
  • NBCCEDP
  • ACS
  • Funders and grant applicants
  • Students

36
NACCDDesigning Chronic Disease Prevention
Programs that Work
37
UCLA / California CISUsing What Works Adaptation
  • Conducted six 1- to 2-day workshops
  • Over 175 individuals trained

38
Assess Community Needs and Resources
Assess Modifiable Risks Factors
Evaluate Program
Adopt / Adapt / Design, and Implement Program
39
Training Funders and Grant Applicants
  • Beach Cities Health Department
  • Trained 3 health dept staff at 2-day training
    (Jan 2007)
  • Trained grant applicants at 1-day training (Mar
    2007)
  • Orange County Komen Foundation Affiliate
  • Trained those invited to submit application for
    community breast cancer program (June 2009)
  • 4 hours, 34 participants

40
Examples of Community Projects
  • Chinese Americans Never and Rarely Screened for
    Breast Cancer
  • Small media Guide Recommended
  • Group discussion Insufficient evidence
  • Pilot in 103 participants
  • Will Submit R01

41
Examples of Community Projects
  • No Smoking Policy in Farm Workers Housing
  • Completed resident survey and report of policy
    implementation
  • Encouraging publications
  • Clínica Monseñor Oscar A. Romero Health Needs
    Assessment
  • Completed survey of 140 community residents
  • Plan to use data for advocacy (building
    additional parks), community participatory
    planning and grant applications

42
Publish Data fromCBO Initiated Projects
  • Pausa para tu salud Integration of exercise
    breaks into workplace organizational routine may
    reduce weight and waistlines
  • Preventing Chronic Disease, 2008 Jan 5 (1), A12
  • Lara A, Yancey AK, Tapia-Conyer R, Flores Y,
    Kuri-Morales P, Mistry R, Subirats E, McCarthy
    WJ.
  • Mexican Ministry of Health
  • Adapting a 1 or Less Milk Campaign for a
    Hispanic/Latino Population The Adelante Con
    Leche Semi-descremada 1 Experience
  • American Journal of Health Promotion, 2008
    Nov/Dec 23(2)108
  • Hinkell AJ, Mistry R, McCarthy WJ, Yancey AK
  • CANFit
  • The Black Barbershop Project An ideal venue for
    screening and educating medically underserved men
    at high risk for CVD
  • In preparation (target journal Prev Chronic Dis)
  • Releford W, McCarthy WJ, Hopkins JM, Auyoung M,
    Yancey AK
  • Diabetes Amputation Prevention Foundation

43
Trainings and Mini-Grant ProgramsUse of
Evidence-Based Strategies
  • Michelle Carvalho, MPHc
  • Emory University
  • CPCRN Network Center

44
Designing Prevention Programs that Work
45
History of Trainings
46
Mini-Grants Programs
  • Application Process
  • Attend full day training
  • Select from menu of RTIPs programs
  • Submit proposal to Emory CPCRN
  • Awards 4000 technical assistance (12-18
    months)
  • Process evaluation aims
  • Assess to what extent the sites implemented
    interventions with fidelity
  • Generate lessons learned to inform potential
  • future mini-grant dissemination activities

47
Awarded Sites Programs
48
Program Fit/Adaptation Assessment Tool
  • TA Consider how to increase fit
  • and whether the program or
  • materials can be changed or
  • adapted for each factor

49
Selected Process Evaluation Findings
  • Implementation Fidelity 93 core elements
    completed 4 of 7 sites completed all core
    elements
  • Maintenance Core elements with least fit are
    less likely to be continued
  • Conclusions/Recommendations
  • Mini-grants/TA - promising dissemination strategy
  • Develop strategic TA using program planning
    models
  • Distinguish program core elements (w/ developers)
  • Valid and reliable fidelity measures are needed

50
Adaptation Examples
MINOR ADAPTATION
From Body Soul and Treatwell 5-A-Day Programs
HIGH FIDELITY
  • Widened audience
  • (broader local community)
  • Added educational materials
  • Concurrent physical activity
  • weight loss events
  • Program goal shifted to
  • physical activity and weight loss
  • Did not complete
  • all core elements

LOW FIDELITY
MAJOR ADAPTATION
51
Inventory and Assessment of National Breast and
Cervical Cancer Early Detection Program
  • Cam Escoffery, PhD
  • Emory University
  • CPCRN Network Center

52
Inventory and Assessment of National Breast and
Cervical Cancer Early Detection Program
  • PI Cam Escoffery, PhD (Emory)
  • CPCRN Participating Centers-Advisory Committee
  • Emory (Glanz, Kegler)
  • Harvard (Sorenson)
  • Morehouse (Blumenthal)
  • SLU/Washington University (Kreuter)
  • UCLA (Bastani)
  • UNC (Porterfield)
  • UT (Fernandez, Mullen)
  • UW (Harris, Taylor)
  • Funder CDC

53
Purpose of Study
  • Inventory NBCCEDP interventions used to recruit
    women for screening and interventions used for
    the professional development of program staff and
    healthcare providers
  • Assess the recruitment and professional
    development interventions used based on their
    application of evidence-based cancer prevention
    practices
  • Disseminate the findings to encourage effective,
    evidence-based interventions for recruiting women
    and the professional development of healthcare
    providers

54
Research Questions
  • What is the use of evidence-based resources for
    increasing cancer screening by NBCCEDP grantees
    (i.e., Community Guide, RTIPS)?
  • To what extent do the recruitment and
    professional development activities match
    evidence-based interventions to increase breast
    and cervical cancer screening?
  • To what extent do NBCCEDP grantees implement
    process steps or core elements from
    evidence-based interventions for their
    recruitment and professional development
    activities? (intervention fidelity)
  • What are interventions perceived to be effective
    by the NBCCEDP? (practice-based evidence)

55
Methods
  • Telephone interviews with NBCCEDP professional
    development and recruitment coordinators
  • Professional Development Recruitment
  • Response rate Response rate 59 of 68
    programs (86.7) 61 of 68 programs (89.7)
  • Activities inventoried (252) Activities
    inventoried (340)
  • 153 Major Activities -- 198
    Major Activities
  • 99 Minor Activities -- 99 Minor Activities

56
Use of Evidence-Based Resources
57
Factors Important to Choosing an Activity
58
Use of Evidence-based Professional Development
(n242) andRecruitment Strategies (n330)
Breast Cancer or Breast Cancer and Cervical
Cancer Screening Focus
59
Barriers to Use of Evidence-based Recruitment
Activities (n44)
60
Promising Recruitment Activities conducted by
NBCCEDP that have Insufficient Evidence
61
Limitations and Conclusions of SIP
  • Limitations
  • Self-reported activities of grantees
  • Descriptions are brief
  • Possible over-estimates of use of evidence-based
    strategies
  • Conclusions
  • More work to be done in implementation research
  • Validity of use of evidence-based strategies and
    program
  • Contextual factors that affect uptake of
    evidence-based strategies/interventions
  • Research needed for evaluation of interventions
    used by the BCCEDP community of practice that as
    insufficient evidence rating by the Community
    Guide

62
CPCRN Partners Awareness Use of EBPs and EBP
Resources EBP Resource Inventory Partner Survey
  • Peggy A. Hannon, PhD, MPH
  • University of Washington
  • CPCRN Network Center

63
Purpose
  • Funders increasingly seek evidence-based
    approaches and programs (EBPs)
  • Many program planners have limited training for
    finding and using EBPs
  • CPCRN seeks to create a training framework and
    interactive tool to facilitate cancer control
    planners use of EBPs

64
Key Questions
  • Do community-based cancer control planners use
    EBPs?
  • Do planners want to use EBPs?
  • What resources are available to support EBP use?
  • Are planners aware of and using these resources?
  • What training and support is needed to enhance
    use of EBPs?

65
EBP Resources Inventory
  • Web-based resources
  • Cancer Control P.L.A.N.E.T
  • Guide to Community Preventive Services
  • Research-Tested Intervention Programs
  • In-person training program
  • Using What Works

66
Pilot Survey CDC Cancer Conference, 2007
  • 63 participated in interactive survey w/
    hand-held devices
  • Use of resources varies
  • 35 (R-TIPs) 72 (P.L.A.N.E.T.)
  • Most find using EBPs challenging
  • 32 agree EBPs easy to find obtain
  • 24 agree EBPs easy to adapt

67
Partner Survey
  • Each CPCRN Center surveyed gt 30 partners
  • Key survey domains
  • Source of their programs
  • Perceptions of EBPs
  • Use of EBP resources
  • Perceived EBP training needs
  • 240 respondents included in analyses

68
Partners Program Sources
69
Awareness Use of EBP Resources
Note. 80-85 of those who had ever used these
resources rated them as somewhat or very useful
70
EBP Resource Use EBP Beliefs
Note. indicates p lt .01
71
Partners Training Needs
72
Conclusion
  • Cancer control planners know and like evidence
    based
  • Majority are not using EBP resources
  • Majority report significant training needs to
    support EBP use

Hannon PA, Fernandez ME, Williams R et al. Cancer
control planners perceptions and use of
evidence-based programs. J Public Health Manag
Pract, in press.
73
Development of a Conceptual Framework to Guide
Use of Evidence Based Cancer Control
Interventions
  • Maria E. Fernandez, PhD
  • University of Texas School of Public Health
  • CPCRN Network Center

74
Purpose
  • The CPCRN sought to
  • describe a conceptual framework to guide the
    systematic search, selection and adaptation of
    EBAs for cancer control
  • use the framework to develop/enhance training and
    technical assistance for community level cancer
    control planners

75
Methods
  • Working alongside community partners the CPCRN
    conducted a task analysis to determine
  • the tacit rules guiding current practices in
    using EBAs for cancer control,
  • steps that community planners take and need to
    take to use EBAs,
  • challenges to using EBAs in community settings,
    and
  • gaps in existing resources and training on EBAs. 

76
Needs assessment
  • Needs assessment included
  • Review and inventory of existing resources,
  • Survey of community partners across eight CPCRN
    network sites,
  • Interviews with community cancer control planners
  • Expert review and consensus informed the
    development of the prototype that was further
    validated with cancer control planners 

77
Methods
  • Based on formative work conducted alongside
    community partners, the CPCRN developed a
    conceptual framework for finding and using EBAs
  • IDEAL- Identify, Explore, Adapt, Launch

78
IDEAL Framework
  • IDentify
  • Explore
  • 1) Confirm or identify the cancer control issue
    in the community or specific population
  • 2) Assess data and information sources available
  • 3) Develop the intervention goal
  • 4) Search for evidence-based intervention
    approaches and specific programs
  • 5) Choose interventions based on the evidence
    base
  • 6) Assess potential fit
  • 7) Obtain materials

79
IDEAL Framework
  • Adapt
  • Launch
  • 6) adapt the chosen program to the community
    context
  • 7) develop an implementation plan
  • 8) develop a plan for monitoring the program
    process and outcome 
  • 9) Implement and evaluate
  • the program

80
The IDEAL Framework
  • Used to
  • Guide trainings
  • Identify areas of needed research and practice
    guidelines
  • Provide feedback to funders and resource sponsors

81
From Theory to Practice
  • IDEAL Framework ? TACTIC
  • Theory ? Practice

82
TACTIC
  • The IDEAL framework formed the basis for the
    design of a computer-based tool intended to
    provide decision support and guide planners
    through the process of selecting and adapting
    evidence-based approaches
  • TACTIC - Technical Assistance for Choosing
    evidence based cancer control Tools In
    Communities

83
TACTIC
Part 1
Part 2
Part 3
84
TACTIC - PART 1
85
TACTIC PART 2
86
TACTIC - PART 3
87
TACTIC Model Validation
  • Five CPCRN Centers conducted nine one-hour
    interviews with selected community partners for
    feedback and suggestions
  • During interviews, the TACTIC conceptual
    prototype was reviewed and discussed in detail

88
TACTIC Model Validation
  • The partners interviewed agreed that TACTIC was a
    good idea and would fill in gaps in resources
    such as Cancer Control P.L.A.N.E.T. and Using
    What Works.
  • Partners also thought TACTIC would help people
    who do training, both to improve their skills and
    as a tool to use with the people they train.

89
TACTIC R25E Proposal
  • Aim I - Produce a Web-based, interactive,
    tailored training and decision support program
    (TACTIC) to increase the use of EBAs to reduce
    breast, cervical, and colorectal cancer
    disparities
  • Aim II - Evaluate the process and impact of
    TACTIC with community-level cancer control
    planners and their organizations
  • Aim III - Disseminate TACTIC nationally through
    multiple NCI- and CDC-sponsored networks

90
TACTIC R25 Proposal
  • Collaboration throughout the CPCRN Consortium
  • Texas Lead (Mullen, Fernandez, Bartholomew)
  • Emory Evaluation (Kegler, Escoffery, Carvalho,
    Swan)
  • Wash U/SLU Interface (Kreuter, Pfeiffer, Ross)
  • Coord Ctr/Mass, Morehouse, UCLA, UNC, UW
    Collaborators, Co-Is (Bowen, Hannon, Glenn,
    Mistry, Reese, Ribisl, Williams)
  • CPCRN Steering Committee PIs Advisory Group
    (Bastani, Blumenthal, Glanz, Melvin, Sorenson,
    Taylor)

91
Next Steps
  • Resubmit proposal
  • Combine with face-to-face and other types of
    training
  • Explore opportunity that arose for a CPCRN-NCI
    CIS collaboration

92
CPCRN-NCI CIS Collaboration
  • Developing a plan to improve training of CPCRN
    and CIS partners on how to use EBAs for cancer
    control
  • Will include participatory development and
    testing with CPCRN and CIS community partners
  • Will make use of Using What Works and other CIS
    and CPCRN training resources
  • Will provide an opportunity to advance the TACTIC
    development
  • Will make training materials available and
    readily accessible while reducing burden on
    trainers

93
The Cancer Prevention and Control Research
Network An Integrated Systems Approach to
Advancing Cancer Control Research and Practice
  • Provides concrete examples of CPCRN partnerships
    and processes needed to improve the rapid uptake
    and use of effective interventions for cancer
    prevention and control
  • Describes lessons learned and progress made by
    the CPCRN that adds to our understanding of the
    ISF as well as other evidence to practice models
    to improve health

94
Adoption and Implementation of Evidence Based
Cancer Control in Communities A Systematic
Approach
  • Describes the development of the IDEAL framework
    (Identify, Explore, Adapt, and Launch) for
    finding, adapting and implementing EBAs in
    communities
  • Reports on preliminary validation of the
    framework with community partners

95
Systematic Review of Provider Behavior Change A
Search for Active Ingredients
  • Systematic review of provider behavior change
  • Purpose To describe core elements of
    interventions within and across categories shown
    to be effective
  • The review found substantial variation in what
    was meant by, or included in, intervention
    categories as depicted in reviews of these
    studies.
  • Recommendations are for researchers and potential
    adopters to identify active ingredients.
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