Abstract C132: Multilevel facilitators and barriers to cancer screening programs in federally qualified health centers serving Asian American communities
Authors: Garcia Samantha , Tanjasiri Sora , Lee Cevadne , Train Jaqueline , Tsui Jennifer 
Published: December 2023

Abstract
Purpose: Cancer screening disparities among medically underserved Asian Americans are well documented. Assessing multilevel barriers and facilitators to cancer screening programs within safety-net settings is critical to the implementation of evidence-based strategies to improve cancer screening. This study aims to examine how community and clinic driven priorities and activities can inform multilevel processes for planning of cancer screening programs for Asian American patients within FQHCs. Methods: Academic, clinic and community partners established the Advancing Care Together (ACCT) formal network to increase knowledge, attitudes and screening behaviors among low-income Chinese, Korean and Vietnamese individuals in Orange County, California. ACCT focused on breast, cervical, and colorectal. Over three years, a series of meetings, surveys and interviews were conducted with community and clinic partners before implementing evidence-based strategies (community navigation, educational workshops) to increase cancer screening to address cultural and language barriers. We used the Implementation Research Logic Model to guide our analysis of these data and identify multilevel determinants of cancer screening with input provided by the ACCT network. Using a shared drive to gather formative data, we assembled a codebook in Excel to organize AACT activities and identify barriers and facilitators according to the Consolidated Framework for Implementation Research (CFIR). Results: Our study found barriers and facilitators that represent CFIR domains: i) Community-clinic resources can provide increased awareness of screening services (intervention characteristics); ii) patients had difficulty obtaining a provider with their preferred language (inner setting); iii) transportation issues and cultural stigma around receiving specific cancer education (outer setting); iv) clinic and patient outcomes improved as a result of ACCT activities, payers were unable to establish referrals from federally qualified health centers to comprehensive cancer centers (characteristics of individuals involved in the implementation); and v) staff turnover presented challenges to obtaining electronic medical records to evaluate screening and follow-up services (implementation process). Implications: Community-clinic-academic partnerships can facilitate increasing cancer screening and awareness, including cultural screening barriers and identification of adaptation needs for educational materials, specific to Asian American communities. Barriers identified in the cancer screening process included a lack of motivation to resolve payer-related provider networks to address patient accessibility to specialty care, high turnover among clinic quality improvement teams, and challenges of prioritizing cancer screening throughout the COVID19 pandemic. Successful implementation of evidence-based strategies to increase guideline-adherent care for Asian Americans must overcome longstanding clinic- and community-level barriers, and we believe community-clinic-academic partners hold the key.
Citation Format: Samantha Garcia, Sora Tanjasiri, Cevadne Lee, Jaqueline Train, Jennifer Tsui. Multilevel facilitators and barriers to cancer screening programs in federally qualified health centers serving Asian American communities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C132.