Abstract C109: Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research
Authors: Correa-Mendez Margarita 
Published: December 2023

Abstract
Background: Improving the adoption and integration of cervical cancer screening programs in resource-limited countries requires engaging with many local health system actors. We hypothesize that participatory design workshops co-developed by researchers, health system practitioners, and policy makers, facilitate rapid engagement to identify context-specific priorities and tailor strategies to improve implementation processes. Methods: With the Peruvian Ministry of Health (MOH), we co-designed a week-long workshop with health system actors (planners, providers, lab technicians) from the North District of Lima city. Through facilitated dialogue, participants engaged in self-reflection to map the cervical cancer screening and follow-up system, visualize system barriers, and identify potential solutions. As research partners, we analyzed findings from the workshop using the Consolidated Framework for Implementation Research, a framework from implementation science that identifies multilevel contextual factors that influence program implementation and guides the tailoring of strategies for improvement. Results: We identified three key context-specific challenges including 1) power hierarchies between specialists and midwives that obstruct the efficiency of screening services, 2) the complexities around communicating screening results, appointments, and referrals, are burdensome for patients and cause loss to follow up, and 3) implementation plans are not adequately matched to resources and workforce capacity. We identified feasible implementation strategies to address these challenges including 1) develop relationships between midwives and specialists through facilitated discussions to surface assumptions and align screening goals, 2) co-create counseling tools to help patients understand results and follow up steps for early detection and treatment of precancerous lesion that also reduce patients’ burden, and 3) Apply design workshops with key actors to develop an implementation plans to guide processes, acceptable adaptations, clinical workflows, and planning (ordering tests, supplies, training human resources, etc.) to align goals to prevention objectives and resources. Conclusions: Engaging with health systems actors through participatory action research is a strategy that enables collective learning, identifying context-specific priorities, and developing tailored implementation strategies that are likely to accelerate integration of sustainable cervical cancer screening programs globally.
Citation Format: Margarita Correa-Mendez. Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research [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 C109.