Abstract B04: Using CBPR to develop a systems-level colorectal cancer screening intervention.
Authors: James Aimee , Muthukrishnan Meera , Brown Matthew , Jacob Rebekah , Mueller Nancy , Colditz Graham 
Published: August 2014

Abstract
Introduction: Colorectal cancer (CRC) is a leading cause of cancer death. Despite compelling evidence that screening and early detection reduce CRC incidence and mortality; about 50% of adults are screening adherent. CRC screening rates are low in our region and have been identified by our community partners as a priority. However, many interventions have only moderate impact, at best. In this study, we used a Community-Based Participatory Research (CBPR) approach to collaborate with community health centers to develop and test a systems-level intervention. CBPR assures that those who would benefit from and be affected by research fully participate in and influence decision-making. The resultant intervention is being tested in a cluster randomized controlled trial.
Methods: Using a systematic approach, we reviewed literature for evidence-based recommendations for systems-intervention for CRC screening, and worked with our community partners to select intervention options by assessing acceptability, appropriateness, feasibility, and estimated sustainability. Together, we decided that our intervention would be a “menu” of intervention options, thereby allowing more choice for individual sites. Strategic planning with the health center included organizational assessments and interviews with key personnel of the health center to gauge context factors including current health center practices, capacities, and needs. We used snowball sampling to conduct additional interviews with relevant and knowledgeable personnel at each clinic, as well as presentations to group-provider meetings when possible.
Results: Based on the literature, interventions in the following areas were determined to be effective: patient reminders, provider reminder and recall systems, provider assessment and feedback, and reducing structural barriers. Working with our community partners, we developed an initial intervention “menu” that included the following: instructional checklists for patients, provider checklists for referring colonoscopy, and a variety of cues and reminders for patients. Partners provided input as every stage of development. Research staff assisted the health center in implementing the chosen intervention strategies. The outcome evaluation will measure changes in screening rates but also track which strategies were adopted and how they were implemented as well as short-term maintenance of the change once the study has ended.
Conclusion: Using CBPR to develop intervention content and implementation strategies is novel, and has both benefits and challenges. Challenges include the additional time spent and an increased burden placed on our community partners. However, in addition to tapping the expertise of our community partners, having their input and perspective produced an intervention that may be more sustainable, as it reflects the voice of all stakeholders. Furthermore, the process allowed stakeholders to take ownership of the intervention, enhancing the relevance and utility of the study. Last, such a process may result in a program that is more likely to be disseminated because it reflects, and works within, the reality of providing healthcare in diverse settings. Although the effort was time consuming, building in the extra time for CBPR allowed for meaningful community involvement and resulted in a more relevant intervention product.
Citation Format: Aimee James, Meera Muthukrishnan, Matthew Brown, Rebekah Jacob, Nancy Mueller, Graham Colditz. Using CBPR to develop a systems-level colorectal cancer screening intervention. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B04.