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

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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
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Network Center Map
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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

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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
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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

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• 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

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

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Mammograms Pap smears Colonoscopies HPV
vaccination Smoking cessation Smoke-free home
policy
girls 9-17
women 18-26
Merck Patient Assistance Program
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Local CPCRN Efforts to support Translational
Support Structures

• Ritesh Mistry, PhD
• University of California at Los Angeles
• CPCRN Network Center

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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

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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

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Audiences

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

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NACCDDesigning Chronic Disease Prevention
Programs that Work
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UCLA / California CISUsing What Works Adaptation

• Conducted six 1- to 2-day workshops
• Over 175 individuals trained

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Assess Community Needs and Resources
Assess Modifiable Risks Factors
Evaluate Program
Adopt / Adapt / Design, and Implement Program
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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

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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

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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

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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

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Trainings and Mini-Grant ProgramsUse of
Evidence-Based Strategies

• Michelle Carvalho, MPHc
• Emory University
• CPCRN Network Center

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Designing Prevention Programs that Work
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History of Trainings
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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

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Awarded Sites Programs
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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

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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

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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
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Inventory and Assessment of National Breast and
Cervical Cancer Early Detection Program

• Cam Escoffery, PhD
• Emory University
• CPCRN Network Center

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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

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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

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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)

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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

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Use of Evidence-Based Resources
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Factors Important to Choosing an Activity
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Use of Evidence-based Professional Development
(n242) andRecruitment Strategies (n330)
Breast Cancer or Breast Cancer and Cervical
Cancer Screening Focus
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Barriers to Use of Evidence-based Recruitment
Activities (n44)
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Promising Recruitment Activities conducted by
NBCCEDP that have Insufficient Evidence
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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

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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

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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

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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?

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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

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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

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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

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Partners Program Sources
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Awareness Use of EBP Resources
Note. 80-85 of those who had ever used these
resources rated them as somewhat or very useful
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EBP Resource Use EBP Beliefs
Note. indicates p lt .01
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Partners Training Needs
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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.
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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

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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

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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. 

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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 

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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

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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

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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

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The IDEAL Framework

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

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From Theory to Practice

• IDEAL Framework ? TACTIC
• Theory ? Practice

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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

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TACTIC
Part 1
Part 2
Part 3
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TACTIC - PART 1
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TACTIC PART 2
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TACTIC - PART 3
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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

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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.

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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

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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)

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Next Steps

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

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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

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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

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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

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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.