Abstract C112: Implementing a colorectal cancer screening intervention in Texas FQHCs: A qualitative evaluation of provider perceptions
Authors: Ibekwe Lynn N , Cuccaro Paula M , Savas Lara S , Valerio Melissa A , Foxhall Lewis E , Fernandez Maria E 
Published: September 2020

Abstract
Background: Federally qualified health centers (FQHCs) are well positioned to increase colorectal cancer screening (CRCS) in underserved populations who most often have low screening rates, including racial/ethnic minorities, the uninsured, and low SES individuals. To optimize effectiveness and promote sustainability of CRCS programs in FQHCs, we assessed provider/staff perceptions of the facilitators and barriers to implementing the Alliance for Colorectal Cancer Testing (ACT) program in Texas FQHCs, funded by the Cancer Prevention & Research Institute of Texas (CPRIT). Methods: UTHealth School of Public Health research staff conducted in-depth, face-to-face, semi-structured interviews in English with providers/staff at ACT FQHCs. Interviews lasted 30-45 minutes and elicited perceptions about facilitators and barriers to implementation of ACT. They were audio recorded, transcribed, and coded by hand deductively, using thematic content analysis to identify key themes. Results: We interviewed 20 individuals across 5 ACT FQHCs. Most were non-Hispanic white (38%) and female (88%). Years worked at clinic ranged from 11 months to 11 years (mean 6.2 years) and hours worked per week ranged from 12-60 hours (mean 42.2). Participants’ positions ranged from clinic CEO to provider to clerical staff. Seven themes emerged as facilitators to implementation: 1) external support (e.g., large cancer center facilitated implementation); 2) external funding (e.g., covered screening and diagnostic services); 3) patient tracking and monitoring (e.g., patient list review, FIT distribution/follow-up); 4) clinic leadership and staff support (e.g., clinic level prioritization of CRCS, understanding/acceptance of roles, active leadership support); 5) staff training; 6) same day FIT return (e.g., completing FIT at clinic or at home and returning same day); and 7) community outreach (e.g., newsletters, FIT distribution at community events). Four themes emerged as barriers: 1) CRCS completion and return process/structure (e.g., USPS refusal to pickup/deliver samples, patient inability to return FIT, FIT completion errors, lab delays); capacity (e.g., perception that patients and providers lack time); education (e.g., perception of patient lack of understanding of risk); and clinic resources (e.g., need for simple, bilingual educational materials). Conclusion: In addition to maintaining program facilitators, increased CRCS patient education/awareness, simple and bilingual educational materials, processes to support FIT return, a contact person coordinating CRCS tasks, ongoing staff training, and a clinic manual describing all roles/responsibilities are important for improved implementation and sustainability of ACT. Findings from this evaluation will help inform development of strategies to facilitate FQHCs’ implementation of ACT and other intervention strategies to increase CRCS by reducing two key factors, financial and structural barriers.
Citation Format: Lynn N Ibekwe, Paula M Cuccaro, Lara S Savas, Melissa A Valerio, Lewis E Foxhall, Maria E Fernandez. Implementing a colorectal cancer screening intervention in Texas FQHCs: A qualitative evaluation of provider perceptions [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C112.