Title: The CDC Cancer Prevention and Control Research Network: Accelerating the Adoption of EvidenceBased C
1The 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
2CPCRN and National Center Shared Goals
- Kathi Wilson, PhD
- Centers for Disease Control and Prevention
3NCCDPHP 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.
4This 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.
5Network Overview and Accomplishments
- Kurt M. Ribisl, PhD
- University of North Carolina at Chapel Hill
- CPCRN Coordinating Center
6CPCRN Mission
- To accelerate the adoption of evidence-based
cancer prevention and control in communities.
7Vision 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.
8Organization
- 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
9PIs
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
10Network Center Map
11CPCRN 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
12MULTI-CENTER COLLABORATION2 or more centers
13Multi-center Grant Applications(cumulative)
14Network Diagram Multi-center Grants, 2004
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
15Network DiagramMulti-center Grants, 2005
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
16Network Diagram Multi-center Grants, 2006
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
17Network DiagramMulti-center Grants, 2007
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
18Network DiagramMulti-center Grants, 2008
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
19Multi-center Publications (cumulative)
20Network Diagram Multi-center Publications, 2004
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
21Network Diagram Multi-center Publications, 2005
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
22Network Diagram Multi-center Publications, 2006
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
23Network Diagram Multi-center Publications, 2007
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
24Network Diagram Multi-center Publications, 2008
Harvard
UNC
U.Wash
Emory
U.Texas
Morehouse
UCLA
Wash.U
25CPCRN Contributions to Practice and Research
26Increasing 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)
32Local CPCRN Efforts to support Translational
Support Structures
- Ritesh Mistry, PhD
- University of California at Los Angeles
- CPCRN Network Center
33CPCRNs 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
34Capacity 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
35Audiences
- Community-based organizations
- Local and State Health Dept
- State Comprehensive Cancer Plans
- NBCCEDP
- ACS
- Funders and grant applicants
- Students
36NACCDDesigning Chronic Disease Prevention
Programs that Work
37UCLA / California CISUsing What Works Adaptation
- Conducted six 1- to 2-day workshops
- Over 175 individuals trained
38Assess Community Needs and Resources
Assess Modifiable Risks Factors
Evaluate Program
Adopt / Adapt / Design, and Implement Program
39Training 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
40Examples 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
41Examples 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
42Publish 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
43Trainings and Mini-Grant ProgramsUse of
Evidence-Based Strategies
- Michelle Carvalho, MPHc
- Emory University
- CPCRN Network Center
44Designing Prevention Programs that Work
45History of Trainings
46Mini-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
47Awarded Sites Programs
48Program Fit/Adaptation Assessment Tool
- TA Consider how to increase fit
- and whether the program or
- materials can be changed or
- adapted for each factor
49Selected 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
50Adaptation 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
51Inventory and Assessment of National Breast and
Cervical Cancer Early Detection Program
- Cam Escoffery, PhD
- Emory University
- CPCRN Network Center
52Inventory 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
53Purpose 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
54Research 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)
55Methods
- 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
56Use of Evidence-Based Resources
57Factors Important to Choosing an Activity
58Use of Evidence-based Professional Development
(n242) andRecruitment Strategies (n330)
Breast Cancer or Breast Cancer and Cervical
Cancer Screening Focus
59Barriers to Use of Evidence-based Recruitment
Activities (n44)
60Promising Recruitment Activities conducted by
NBCCEDP that have Insufficient Evidence
61Limitations 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
62CPCRN Partners Awareness Use of EBPs and EBP
Resources EBP Resource Inventory Partner Survey
- Peggy A. Hannon, PhD, MPH
- University of Washington
- CPCRN Network Center
63Purpose
- 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
64Key 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?
65EBP 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
66Pilot 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
67Partner 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
68Partners Program Sources
69Awareness Use of EBP Resources
Note. 80-85 of those who had ever used these
resources rated them as somewhat or very useful
70EBP Resource Use EBP Beliefs
Note. indicates p lt .01
71Partners Training Needs
72Conclusion
- 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.
73Development 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
74Purpose
- 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
75Methods
- 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.
76Needs 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
77Methods
- Based on formative work conducted alongside
community partners, the CPCRN developed a
conceptual framework for finding and using EBAs - IDEAL- Identify, Explore, Adapt, Launch
78IDEAL Framework
- 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
79IDEAL Framework
- 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
80The IDEAL Framework
- Used to
- Guide trainings
- Identify areas of needed research and practice
guidelines - Provide feedback to funders and resource sponsors
81From Theory to Practice
- IDEAL Framework ? TACTIC
- Theory ? Practice
82TACTIC
- 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
83TACTIC
Part 1
Part 2
Part 3
84TACTIC - PART 1
85TACTIC PART 2
86TACTIC - PART 3
87TACTIC 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
88TACTIC 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.
89TACTIC 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
90TACTIC 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)
91Next Steps
- Resubmit proposal
- Combine with face-to-face and other types of
training - Explore opportunity that arose for a CPCRN-NCI
CIS collaboration
92CPCRN-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
93The 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
94Adoption 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
95Systematic 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.