Infrastructure and implementation for policy, systems, and environmental change: Comparing demonstration and traditional comprehensive cancer control programs

Background: Policy, system and environmental (PSE) change strategies may greatly facilitate efforts to address disease burden through primary, secondary, and tertiary prevention. CDC invested in this approach by providing demonstration program funding to 13 of the 65 grantees funded through the National Comprehensive Cancer Control Program (NCCCP), to determine whether this approach would enhance the processes used to develop and implement PSE change strategies.

Methods: As part of a comprehensive, longitudinal, mixed-methods evaluation, we implemented the first of two web surveys of program directors, comparing demonstration programs with traditional NCCCP programs, to determine the impact of program funding on grantees’ capacity, infrastructure, and implementation of PSE change strategies. Analysis was primarily descriptive, employing bivariate statistical methods with tables and graphs for display and summarization.

Results: Demonstration programs were more likely than traditional programs to report high staff competency for PSE work, and to have a Workgroup with skilled members that lead PSE change efforts. Demonstration programs found National Partners’, a cancer control collaborative,  trainings on developing key messages most helpful in building capacity, while traditional programs preferred interaction with other grantees. Demonstration programs’ Workgroups were more likely to address decision makers’ lack of awareness or knowledge, and to identify opponents, try to understand their position, and look for ways to manage opposition to PSE change.

Conclusions: Survey results show enhanced capacity among demonstration program staff and partners to plan and implement PSE change strategies, providing valuable insights into methods used to engage stakeholders who are critical to the implementation process.