Factors influencing implementation of evidence-based practices for cancer prevention and control in community health centers

Background: The Consolidated Framework for Implementation Research (CFIR) is a comprehensive framework of constructs associated with implementation found in a broad array of published theories. The CFIR is intended to facilitate the identification and understanding of constructs relevant to implementation and how they apply to particular contexts in health services research. However, the overall predictive power of CFIR constructs for the implementation of evidence-based practices (EBPs) in primary care settings has not been examined. To improve cancer control efforts in Community Health Centers (CHCs), the Cancer Prevention and Control Research Network's (CPCRN) Federal Qualified Health Center Workgroup developed a comprehensive multi-state survey based on the CFIR to assess factors associated with implementation of EBPs for cancer prevention and control in CHCs. This presentation will describe CFIR-related constructs in relation to the implementation of EBPs in CHCs across 7 states. Methods: A convenience sample of CHC clinics were recruited from 7 states through CPCRN partnerships. The survey is currently administered online and data collection will be completed in April 2013. We expect up to 10 staff in different roles from each clinic to respond to the survey. The unit of analysis is clinic; individual responses will be aggregated within clinics. Levels of implementation of four EBPs recommended by the Community Guide to increase colorectal cancer screening were categorized as: 1) fully and systematically implemented, 2) inconsistently implemented, 3) at an early stage of implementing, 4) planning to implement, and 5) no plan to implement. Intervention-specific CFIR constructs, such as Implementation Climate and Complexity were assessed for each implemented EBP. General CFIR constructs such as Culture, Leadership, Evaluating and Reflecting will also be examined. Results: The association between CFIR constructs and implementation of EBPs for cancer prevention and control in CHCs will be reported. If the data permit, we will also develop a structural model that assesses the major CFIR constructs directly related to implementation of EBPs. The CFIR model of implementation will be evaluated using various fit statistics (χ2, RMSEA, & CFI). Conclusion: This analysis represents the first of its kind to evaluate how CFIR constructs influence implementation of EBPs for cancer prevention and control in Community Health Centers. Findings can inform future intervention development as well as evaluations of the implementation of EBPs.