Abstract 28: Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru
Authors: Jallow Fatou , Orbegozo Andrea Matos , Caruhapoma Maria Del Carmen , Palacios Víctor A. , Montes Milagros , Santos Carlos , Correa-Mendez Margarita , Villalobos Aubrey , Salicrup Alejandro , Jeronimo Jose , Nervi Laura , Gravitt Patti , Gage Julia 
Published: June 2023

Abstract
Purpose: In many countries, implementation planning for delivery of cancer screening services functions as a ‘top-down’ process, often resulting in fragmentation and bottlenecks at points of service delivery. Participatory engagement of health system planners and actors from across cancer screening and treatment continuum involved with implementation, planning, and adaptation is hypothesized to lead to plans that have a higher likelihood of adoption and sustainability. We tested the feasibility of conducting a 4-day series of participatory ‘design workshops’ for implementation of the recently initiated HPV screening program in the DIRIS Lima Norte (DLN) region of Peru.
Methods: The workshop agendas were co-designed by the Peruvian Ministry of Health (MINSA) and the National Cancer Institute (NCI) using principles of participatory action research, implementation science, and systems thinking. The workshop objectives were to clarify the goals and processes of the HPV cervical screening program and reflect on the initial implementation experience. Workshop design was attentive to a) building trust among the health system planners and actors, b) surfacing misconceptions and process bottlenecks, c) equitable representation of perspectives on the process from all levels of the screening system, and d) shared decision-making in actions to improve the system.
Results: Through real-time participatory reflection and process mapping of the screening program, context-specific challenges were rapidly identified. The process maps helped participants gain a shared understanding of the complexity of the screening system and quickly identified how one part of the system can create barriers for proximal and distal parts of the system. Participants mentioned feeling detached from the distal barriers before the workshops but now understood their role in the decision-making and problem-solving processes and demonstrated a willingness to work with the regional director to implement process improvements in the system, specifically to ensure women testing positive received the appropriate follow-up care.
Conclusion: Rapid embedded implementation research using facilitated workshops with broad health system representation to reflect on the processes and procedures was an acceptable quality improvement activity. MINSA plans to replicate this experience in other regions and to continue to create a culture of trust and establishment of learning health systems.
Citation Format: Fatou Jallow, Andrea Matos Orbegozo, Maria Del Carmen Caruhapoma, Víctor A. Palacios, Milagros Montes, Carlos Santos, Margarita Correa-Mendez, Aubrey Villalobos, Alejandro Salicrup, Jose Jeronimo, Laura Nervi, Patti Gravitt, Julia Gage. Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 28.