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Schlueter D, Bermudez Y, Debrot KF, Ross LW, Masud M, Melillo S, Hannon PA, Miller JW. Breast and cervical cancer programs' success in maintaining screening during periods of high COVID-19: A qualitative multi-case study analysis. Heliyon 2024; 10:e29223. [PMID: 38644841 PMCID: PMC11033107 DOI: 10.1016/j.heliyon.2024.e29223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
Objective During the first year of the COVID-19 pandemic, most of the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs (recipients) experienced significant declines in breast and cervical cancer screening volume. However, 6 recipients maintained breast and/or cervical cancer screening volume during July-December 2020 despite their states' high COVID-19 test percent positivity. We led a qualitative multi-case study to explore these recipients' actions that may have contributed to screening volume maintenance. Methods We conducted 22 key informant interviews with recipients, screening provider sites, and partner organizations. Interviews explored organizational and operational changes; screening barriers; actions taken to help maintain screening volume; and support for provider sites to continue screening. We documented contextual factors that may have influenced these actions, including program structures; clinic capacity; and state COVID-19 policies. Results Thematic analysis revealed crosscutting themes at the recipient, provider site, and partner levels. Recipients made changes to administrative processes to reduce burden on provider sites and delivered tailored technical assistance to support safe screening. Provider sites modified clinic protocols to increase patient safety, enhanced patient reminders for upcoming appointments, and increased patient education on the importance of timely screening during the pandemic. Partners worked with provider sites to identify and reduce patients' structural barriers to screening. Conclusion Study findings provide lessons learned to inform emergency preparedness-focused planning and operations, as well as routine operations for NBCCEDP recipient programs, other cancer screening initiatives, primary care clinics, and chronic disease prevention programs.
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Affiliation(s)
- Dara Schlueter
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Yamisha Bermudez
- Totally Joined for Achieving Collaborative Techniques, Atlanta, GA, United States
| | - Karen F. Debrot
- National Association of Chronic Disease Directors, Atlanta, GA, United States
| | - Leslie W. Ross
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Manal Masud
- Health Promotion Research Center, University of Washington School of Public Health, Seattle, WA, United States
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Peggy A. Hannon
- Health Promotion Research Center, University of Washington School of Public Health, Seattle, WA, United States
| | - Jacqueline W. Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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2
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Hammerback K, Strait M, Kohn MJ, Garcia C, Harris JR, Hannon PA. Exploring the Impact of the COVID-19 Pandemic on Employees' Workplace Health Promotion Preferences. Am J Health Promot 2024; 38:238-241. [PMID: 37349879 PMCID: PMC10291210 DOI: 10.1177/08901171231185765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE The COVID-19 pandemic has led to profound changes in the workplace as well as increases in stress, missed preventive care, and other health concerns. There is limited research since the onset of the pandemic on employees' primary health concerns and their willingness to engage with workplace health promotion (WHP) programs to address these needs. We conducted this survey about employees' current health priorities as a first step to exploring whether WHP programs need to evolve to be responsive to employees' needs at this stage of the pandemic. DESIGN National cross-sectional survey. SETTING United States, April 29-May 5, 2022. SUBJECTS 2053 Americans employed part or full time. MEASURES 17-item online survey assessing demographics, health priorities, and impact of the pandemic on health. ANALYSIS Descriptive statistics, SPSS Version 19. RESULTS Employees' most common health concerns included work/life balance and stress (each cited by 55%). Nearly half (46%) said their health or well-being was affected by the pandemic; within this group, the most common concerns were stress (66%), anxiety (61%), sleep (49%), and depression (48%). Almost all (94%) indicated they would be open to receiving support from their employers. CONCLUSION This research is a first step in learning about employees' current health priorities and how they may have changed. WHP researchers and practitioners can determine how their programs align with current priorities. Our future research will explore employees' preferences, heath behaviors, and their current workplace environments in more depth.
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Affiliation(s)
- Kristen Hammerback
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Michelle Strait
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Cinthya Garcia
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Jeffrey R. Harris
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Abdi N, Flores M, Hara-Hubbard KK, Turner AM, Gudino J, Jafry S, Harris JR, Hannon PA, Baquero B, Meischke H. Bridging Culture and Language: Encouraging Bilingual/Multicultural Individuals to Act as Information Navigators for Their Loved-Ones and Communities during the COVID-19 Pandemic. J Health Commun 2024; 29:34-48. [PMID: 37961888 DOI: 10.1080/10810730.2023.2279670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Linguistically diverse communities face barriers to receiving appropriate health information. COVID-19 exacerbated these health-communication inequities. University of Washington researchers surveyed bilingual staff, students, and medical interpreters - desiring training to become effective communicators of COVID-19 information to their social networks and language communities. In response, the COVID-19 Information Navigator Training was developed and pre-tested with professional networks and members of the target audience. The final training comprised three interactive modules and short quizzes. Evaluation surveys measured Information Navigators' confidence in providing COVID-19 information to their social networks. Surveys included questions on the participants' language or cultural community, the perceived value of the training, and their ability to communicate COVID-19 information. Among 393 participants who enrolled in the training, 284 completed the survey. Significant differences in confidence before and after the course were found in detecting COVID misinformation in the news and social media (pre-course mean: 3.83, post-course mean: 4.63; absolute mean difference was 0.82 points higher in the post-evaluation on the 5-point likert scale, 95% CI: 0.70-0.93, p < .01). Training multicultural volunteers to disseminate information to their social networks is a promising strategy for reaching linguistically diverse communities with up-to-date information during health emergencies.
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Affiliation(s)
- Najma Abdi
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Miriam Flores
- School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Anne M Turner
- School of Public Health, University of Washington, Seattle, Washington, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Juan Gudino
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Sheharbano Jafry
- College of Arts and Sciences, University of Washington, Seattle, Washington, USA
| | - Jeffrey R Harris
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Peggy A Hannon
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Barbara Baquero
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Hendrika Meischke
- School of Public Health, University of Washington, Seattle, Washington, USA
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4
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Wheeler SB, Lee RJ, Young AL, Dodd A, Ellis C, Weiner BJ, Ribisl KM, Adsul P, Birken SA, Fernández ME, Hannon PA, Hébert JR, Ko LK, Seaman A, Vu T, Brandt HM, Williams RS. The special sauce of the Cancer Prevention and Control Research Network: 20 years of lessons learned in developing the evidence base, building community capacity, and translating research into practice. Cancer Causes Control 2023; 34:217-239. [PMID: 37354320 PMCID: PMC10689533 DOI: 10.1007/s10552-023-01691-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The Cancer Prevention and Control Research Network (CPCRN) is a national network focused on accelerating the translation of cancer prevention and control research evidence into practice through collaborative, multicenter projects in partnership with diverse communities. From 2003 to 2022, the CPCRN included 613 members. METHODS We: (1) characterize the extent and nature of collaborations through a bibliometric analysis of 20 years of Network publications; and (2) describe key features and functions of the CPCRN as related to organizational structure, productivity, impact, and focus on health equity, partnership development, and capacity building through analysis of 22 in-depth interviews and review of Network documentation. RESULTS Searching Scopus for multicenter publications among the CPCRN members from their time of Network engagement yielded 1,074 collaborative publications involving two or more members. Both the overall number and content breadth of multicenter publications increased over time as the Network matured. Since 2004, members submitted 123 multicenter grant applications, of which 72 were funded (59%), totaling more than $77 million secured. Thematic analysis of interviews revealed that the CPCRN's success-in terms of publication and grant productivity, as well as the breadth and depth of partnerships, subject matter expertise, and content area foci-is attributable to: (1) its people-the inclusion of members representing diverse content-area interests, multidisciplinary perspectives, and geographic contexts; (2) dedicated centralized structures and processes to enable and evaluate collaboration; and (3) focused attention to strategically adapting to change. CONCLUSION CPCRN's history highlights organizational, strategic, and practical lessons learned over two decades to optimize Network collaboration for enhanced collective impact in cancer prevention and control. These insights may be useful to others seeking to leverage collaborative networks to address public health problems.
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Affiliation(s)
- Stephanie B Wheeler
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC, 27599-7411, USA.
| | - Rebecca J Lee
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexa L Young
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam Dodd
- Impact Measurement and Visualization Team, Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charlotte Ellis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC, 27599-7411, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - María E Fernández
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - James R Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Linda K Ko
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Aaron Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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5
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Sears JM, Wickizer TM, Franklin GM, Fulton-Kehoe D, Hannon PA, Harris JR, Graves JM, McGovern PM. Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future. Am J Ind Med 2023; 66:996-1008. [PMID: 37635638 DOI: 10.1002/ajim.23532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Thomas M Wickizer
- Division of Health Services Management and Policy, The Ohio State University, Columbus, Ohio, USA
| | - Gary M Franklin
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Washington State Department of Labor and Industries, Tumwater, Washington, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA
| | - Jeffrey R Harris
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Patricia M McGovern
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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6
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Kava CM, Strait M, Treend K, Vu T, Hannon PA, Harris JR. Opportunities to Improve Tobacco Control for State Agency Employees. J Occup Environ Med 2023; 65:e710-e716. [PMID: 37641188 PMCID: PMC10840754 DOI: 10.1097/jom.0000000000002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The aim of the study is to explore tobacco-related knowledge and perceptions at Washington State (WA) agencies. METHODS The study used a cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data. RESULTS Of employees, only 18% with a history of tobacco use had used their agency's cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts. CONCLUSIONS State agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.
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Affiliation(s)
- Christine M Kava
- From the Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington (C.M.K., M.S., T.V., P.A.H., J.R.H.); and Washington State Department of Health, Tumwater, Washington (K.T.)
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7
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Aschbrenner KA, Oh AY, Tabak RG, Hannon PA, Angier HE, Moore WT, Likumahuwa-Ackman S, Carroll JK, Baumann AA, Beidas RS, Mazzucca-Ragan S, Waters EA, Sadasivam RS, Shelton RC. Integrating a focus on health equity in implementation science: Case examples from the national cancer institute's implementation science in cancer control centers (ISC 3) network. J Clin Transl Sci 2023; 7:e226. [PMID: 38028358 PMCID: PMC10643915 DOI: 10.1017/cts.2023.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute's (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts. Methods HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019-2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains. Results Centers reported a range of approaches focusing on health equity in implementation research and capacity-building efforts, including (1) engaging diverse community partners/settings in making decisions about research priorities and projects; (2) applying health equity within a single TMF applied across projects or various TMFs used in specific projects; (3) evaluating health equity in operationalizing and measuring health and implementation outcomes; (4) building capacity for health equity-focused implementation science among trainees, early career scholars, and partnering organizations; and (5) leveraging varying levels of institutional resources and efforts to engage, include, and support underrepresented scholars. Conclusions Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers' efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.
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Affiliation(s)
- Kelly A. Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - April Y. Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel G. Tabak
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Peggy A. Hannon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heather E. Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - W. Todd Moore
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Erika A. Waters
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajani S. Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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8
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Hohl SD, Maxwell AE, Sharma KP, Sun J, Vu TT, DeGroff A, Escoffery C, Schlueter D, Hannon PA. Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement. Prev Sci 2023:10.1007/s11121-023-01496-3. [PMID: 36952143 PMCID: PMC10034905 DOI: 10.1007/s11121-023-01496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 03/24/2023]
Abstract
Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics' adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.
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Affiliation(s)
- Sarah D Hohl
- Health Promotion Research Center, University of Washington, Seattle, WA, USA.
- Office of Community Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Annette E Maxwell
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Krishna P Sharma
- Totally Joined for Achieving Collaborative Techniques, Atlanta, GA, USA
| | - Juzhong Sun
- Totally Joined for Achieving Collaborative Techniques, Atlanta, GA, USA
| | - Thuy T Vu
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dara Schlueter
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Peggy A Hannon
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
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9
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Kruse GR, Hale E, Bekelman JE, DeVoe JE, Gold R, Hannon PA, Houston TK, James AS, Johnson A, Klesges LM, Nederveld AL. Creating research-ready partnerships: the initial development of seven implementation laboratories to advance cancer control. BMC Health Serv Res 2023; 23:174. [PMID: 36810066 PMCID: PMC9942028 DOI: 10.1186/s12913-023-09128-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND In 2019-2020, with National Cancer Institute funding, seven implementation laboratory (I-Lab) partnerships between scientists and stakeholders in 'real-world' settings working to implement evidence-based interventions were developed within the Implementation Science Centers in Cancer Control (ISC3) consortium. This paper describes and compares approaches to the initial development of seven I-Labs in order to gain an understanding of the development of research partnerships representing various implementation science designs. METHODS In April-June 2021, members of the ISC3 Implementation Laboratories workgroup interviewed research teams involved in I-Lab development in each center. This cross-sectional study used semi-structured interviews and case-study-based methods to collect and analyze data about I-Lab designs and activities. Interview notes were analyzed to identify a set of comparable domains across sites. These domains served as the framework for seven case descriptions summarizing design decisions and partnership elements across sites. RESULTS Domains identified from interviews as comparable across sites included engagement of community and clinical I-Lab members in research activities, data sources, engagement methods, dissemination strategies, and health equity. The I-Labs use a variety of research partnership designs to support engagement including participatory research, community-engaged research, and learning health systems of embedded research. Regarding data, I-Labs in which members use common electronic health records (EHRs) leverage these both as a data source and a digital implementation strategy. I-Labs without a shared EHR among partners also leverage other sources for research or surveillance, most commonly qualitative data, surveys, and public health data systems. All seven I-Labs use advisory boards or partnership meetings to engage with members; six use stakeholder interviews and regular communications. Most (70%) tools or methods used to engage I-Lab members such as advisory groups, coalitions, or regular communications, were pre-existing. Think tanks, which two I-Labs developed, represented novel engagement approaches. To disseminate research results, all centers developed web-based products, and most (n = 6) use publications, learning collaboratives, and community forums. Important variations emerged in approaches to health equity, ranging from partnering with members serving historically marginalized populations to the development of novel methods. CONCLUSIONS The development of the ISC3 implementation laboratories, which represented a variety of research partnership designs, offers the opportunity to advance understanding of how researchers developed and built partnerships to effectively engage stakeholders throughout the cancer control research lifecycle. In future years, we will be able to share lessons learned for the development and sustainment of implementation laboratories.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Erica Hale
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Rachel Gold
- Kaiser Permanente NW Center for Health Research, Portland, OR, USA
- OCHIN, Inc., Portland, OR, USA
| | - Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Thomas K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Aimee S James
- Washington University in St Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Ashley Johnson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Lisa M Klesges
- Washington University in St Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Andrea L Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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10
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Steinman LE, Parrish AT, Kohn MJ, Wu S, Hara-Hubbard KK, Brown L, Imam S, Baquero B, Hannon PA, Snowden MB. Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research. Front Public Health 2023; 10:1079082. [PMID: 36793362 PMCID: PMC9922751 DOI: 10.3389/fpubh.2022.1079082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/29/2022] [Indexed: 02/03/2023] Open
Abstract
Background Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
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Affiliation(s)
- Lesley E. Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States,*Correspondence: Lesley E. Steinman ✉
| | - Amanda T. Parrish
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Sherry Wu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - KeliAnne K. Hara-Hubbard
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Lori Brown
- Southeast Washington Aging and Long-Term Care, Yakima, WA, United States
| | - Syed Imam
- Union for Pan Asian Communities (UPAC) Positive Solutions Program, San Diego, CA, United States
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Mark B. Snowden
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Maxwell AE, DeGroff A, Hohl SD, Sharma KP, Sun J, Escoffery C, Hannon PA. Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015-2018. Prev Chronic Dis 2022; 19:E26. [PMID: 35588522 PMCID: PMC9165474 DOI: 10.5888/pcd19.210258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018. INTERVENTION APPROACH The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers). EVALUATION METHODS Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs. RESULTS In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study. IMPLICATIONS FOR PUBLIC HEALTH Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.
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Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles, Los Angeles, California.,Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900. E-mail:
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Juzhong Sun
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Hohl SD, Melillo S, Vu TT, Escoffery C, DeGroff A, Schlueter D, Ross LW, Maxwell AE, Sharma KP, Boehm J, Joseph D, Hannon PA. Development of a Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions in Primary Care Clinics. Prev Chronic Dis 2022; 19:E25. [PMID: 35550244 PMCID: PMC9109642 DOI: 10.5888/pcd19.210395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Evidence-based interventions, including provider assessment and feedback, provider reminders, patient reminders, and reduction of structural barriers, improve colorectal cancer screening rates. Assessing primary care clinics' readiness to implement these interventions can help clinics use strengths, identify barriers, and plan for success. However, clinics may lack tools to assess readiness and use findings to plan for successful implementation. To address this need, we developed the Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions (Field Guide) for the Centers for Disease Control and Prevention's (CDC's) Colorectal Cancer Control Program (CRCCP). We conducted a literature review of evidence and existing tools to measure implementation readiness, reviewed readiness tools from selected CRCCP award recipients (n = 35), and conducted semi-structured interviews with key informants (n = 8). We sought feedback from CDC staff and recipients to inform the final document. The Field Guide, which is publicly available online, outlines 4 assessment phases: 1) convene team members and determine assessment activities, 2) design and administer the readiness assessment, 3) evaluate assessment data, and 4) develop an implementation plan. Assessment activities and tools are included to facilitate completion of each phase. The Field Guide integrates implementation science and practical experience into a relevant tool to bolster clinic capacity for implementation, increase potential for intervention sustainability, and improve colorectal cancer screening rates, with a focus on patients served in safety net clinic settings. Although this tool was developed for use in primary care clinics for cancer screening, the Field Guide may have broader application for clinics and their partners for other chronic diseases.
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Affiliation(s)
- Sarah D Hohl
- Health Promotion Research Center, University of Washington, Seattle, Washington
- Department of Family Medicine Office of Community Health, University of Wisconsin-Madison,1100 Delaplaine Court, Madison, WI 53715.
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thuy T Vu
- Health Promotion Research Center, University of Washington, Seattle, Washington
| | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dara Schlueter
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leslie W Ross
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Annette E Maxwell
- Fielding School of Public Health, University of California, Los Angeles, California
| | - Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Boehm
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peggy A Hannon
- Health Promotion Research Center, University of Washington, Seattle, Washington
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Kava CM, Ruiz RA, Harris JR, Hannon PA. Worksite tobacco control - a qualitative study on perspectives from employers and employees at small worksites. BMC Public Health 2022; 22:904. [PMID: 35524298 PMCID: PMC9073486 DOI: 10.1186/s12889-022-13346-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) for tobacco control can be implemented in worksite settings to reduce tobacco use. Small worksites are less likely to adopt tobacco control EBIs than large worksites. The purpose of this qualitative study was to 1) explore factors that impact small employers' decisions to offer tobacco control EBIs, and 2) understand employees' perceptions of tobacco control at small worksites. METHODS Working with staff from small worksites (20-250 employees), we analyzed data from 12 semi-structured interviews with employers (via key informants) and four focus groups with employees. We recruited employers and employees through a purchased business list and market research company, respectively. Interview and focus group topics included perceptions of worksite tobacco control; internal and external forces shaping worksite tobacco control implementation; and perceived worksite support for cessation. We conducted thematic data analysis. RESULTS Key themes from the employer interviews included: the local environment played an important role in implementation of tobacco control EBIs; tobacco control was perceived as important but not a priority; and tobacco control decisions were driven by worksite culture. Key themes from the employee focus groups included: perceived employer support for tobacco cessation was limited although there was interest from employees; employees who currently used tobacco were stigmatized for their behavior; and incentives and coaching were considered ideal tobacco control EBIs. CONCLUSIONS Tobacco control has not been prioritized at small worksites, despite employees welcoming additional cessation support. This study contributes important information on contextual factors and employee preferences that could be targeted to improve tobacco control EBI implementation. Worksites should implement comprehensive tobacco-free policies, minimize stigma when promoting cessation, establish equitable break policies, and involve employees in decision-making related to tobacco control.
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Affiliation(s)
- Christine M Kava
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
- Health Promotion Research Center, University of Washington, 3980 15th Avenue NE, Seattle, WA, 98195, USA.
| | - Raymond A Ruiz
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Jeffrey R Harris
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Harris JR, M. Kava C, Gary Chan KC, Kohn MJ, Hammerback K, Parrish AT, Helfrich CD, Hannon PA. Pathways to Employee Outcomes in a Workplace Health Promotion Program. Am J Health Promot 2022; 36:662-672. [PMID: 34983199 PMCID: PMC9012684 DOI: 10.1177/08901171211066898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examined the relationship between employee outcomes and employer implementation of evidence-based interventions (EBIs) for chronic disease prevention. DESIGN Cross-sectional samples collected at 3 time points in a cluster-randomized, controlled trial of a workplace health promotion program to promote 12 EBIs. SETTING King County, WA. SAMPLE Employees of 63 small, low-wage workplaces. MEASURES Employer EBI implementation; 3 types of employee outcomes: perceived implementation of EBIs; perceived employer support for health; and health-related behaviors, perceived stress, depression risk, and presenteeism. ANALYSIS Intent-to-treat and correlation analyses using generalized estimating equations. We tested bivariate associations along potential paths from EBI implementation, through perceived EBI implementation and perceived support for health, to several employee health-related outcomes. RESULTS The intent-to-treat analysis found similar employee health-related behaviors in intervention and control workplaces at 15 and 24 months. Workplaces implemented varying combinations of EBIs, however, and bivariate associations were significant for 4 of the 6 indicators of physical activity and healthy eating, as well as perceived stress, depression risk, and presenteeism. We did not find significant positive associations for cancer screening and tobacco cessation. CONCLUSION Our findings support broader dissemination of EBIs for physical activity and healthy eating, as well as more focus on improving employer support for employee health. They also suggest we need better interventions for cancer screening and tobacco cessation.
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Affiliation(s)
- Jeffrey R. Harris
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Christine M. Kava
- Department of Health Systems and Population Health, University of Washington, Seattle
| | | | - Marlana J. Kohn
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Kristen Hammerback
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Amanda T. Parrish
- Department of Health Systems and Population Health, University of Washington, Seattle
| | | | - Peggy A. Hannon
- Department of Health Systems and Population Health, University of Washington, Seattle
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Sears JM, Edmonds AT, Hannon PA, Schulman BA, Fulton-Kehoe D. Workplace Wellness Program Interest and Barriers Among Workers With Work-Related Permanent Impairments. Workplace Health Saf 2022; 70:348-357. [PMID: 35382639 DOI: 10.1177/21650799221076872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nearly half of U.S. workers have access to workplace wellness programs (WWPs), 58% of workers with access participate. The aim of this study was to assess interest in WWP participation and identify reasons for lack of interest among workers with work-related permanent impairments-a population at elevated risk of adverse health outcomes. METHODS Workers who returned to work after a work-related permanent impairment were interviewed 11 to 15 months after workers' compensation claim closure. Qualitative content analysis methods were used to code open-ended responses. FINDINGS Of 560 respondents, 51.4% expressed interest in WWP participation. Numerous adverse health and economic characteristics were associated with WWP interest, for example, interest was expressed by 63.3% of workers reporting fair/poor health status versus 47.1% reporting good/excellent; 56.9% of workers reporting moderate/severe pain versus 41.4% reporting mild/no pain; 64.7% of workers without health insurance versus 50.1% with health insurance; 69.0% of workers reporting depression versus 47.2% without depression; 70.4% of workers reporting obesity versus 48.0% without obesity; and 63.2% of workers often worried about expenses versus 46.9% reporting sometimes/never worried. Specific participation barriers were described by 34.2% of the 272 workers who were not interested. CONCLUSIONS/APPLICATIONS TO PRACTICE A majority of workers with work-related permanent impairments-particularly those with adverse health and economic characteristics-were interested in WWPs. Many workers who reported no interest cited participation barriers. Further research is needed to determine whether addressing such barriers would enhance equitable access. Those undertaking WWP planning, implementation, and outreach should ensure that WWPs are inclusive and serve workers with disabilities.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington, Seattle
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, Seattle
- Institute for Work and Health, Toronto
| | - Amy T Edmonds
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Peggy A Hannon
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Beryl A Schulman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
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Abstract
Implementation science offers a rigorous set of tools to help mitigate long-standing and worsening gender disparities in academia.
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Affiliation(s)
| | | | - Aimee S James
- Washington University in St. Louis, St. Louis, MO, USA
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17
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Petrescu-Prahova M, Harris JR, Leroux B, Kohn M, Kava CM, Zeliadt SB, Steinman L, Fishleder S, Basia Belza, Gakhar M, Hannon PA. Clinical-community linkages as a strategy for increasing evidence-based program reach: Results of the PT-REFER randomized controlled trial with older adults and YMCA associations. Contemp Clin Trials Commun 2022; 26:100888. [PMID: 35106400 PMCID: PMC8789527 DOI: 10.1016/j.conctc.2022.100888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Most older adults do not meet recommended guidelines for physical activity. Referrals from physical therapists (PTs) to community- and evidence-based physical-activity programs like Enhance®Fitness have potential to address this gap. We tested an intervention intended to increase referrals of older adults to Enhance®Fitness programs offered at YMCAs. Materials and methods We developed a capacity-building intervention that included a structured toolkit and technical-assistance calls. From April 2016 to September 2018, using stratified randomization, we conducted a trial with 20 YMCA Associations randomized into intervention and control arms. The primary outcome was the number of new Enhance®Fitness enrollees during the trial period. Using both quantitative and qualitative methods, we also conducted process and intermediate-outcome evaluations to assess intervention implementation and Association outreach activities, barriers, and facilitators. Results The intervention was implemented as intended, but PT outreach was similar for both intervention and control YMCA Associations. The intervention arm had similar enrollment (1695 new enrollees) to the control arm (1326 new enrollees; 95% confidence interval, −47%–199%, P = 0.61). Interviews revealed that barriers, including lack of staff and time for outreach, limited capacity for Enhance®Fitness program growth, and competing priorities, outweighed facilitators, including existing partnerships, presence of an outreach team, senior leadership support, and infrastructure for referrals. Conclusions YMCA Associations in the intervention arm were unable to increase their outreach to PTs and enrollment in Enhance®Fitness. Our evaluation findings indicate that community organizations that prioritize program growth, have support at all organizational levels, and allocate staff and time for outreach and partnership development may be more successful in creating sustainable linkages with clinical partners and increasing evidence-based-program reach. Physical therapists (PTs) may help older adults increase their physical activity by referring them to physical-activity programs. In a randomized trial, we helped YMCA Associations build capacity to increase referrals by PTs of older adults to YMCA Enhance®Fitness programs. The YMCA Associations encountered barriers and were unable to increase PT outreach and Enhance®Fitness enrollment. We did, however, identify facilitators that may help community organizations create linkages with clinical partners and increase program reach. Facilitators include prioritizing program growth, having senior-leadership support, and setting aside staff and time for outreach.
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Hannon PA, Hammerback K, Kava CM, Bravo-Acevedo P, Strait M, Harris JR. By the Seat of Our Pants: the Experience of Small Businesses in the COVID-19 Pandemic, Washington State, March–October 2020. Prev Chronic Dis 2022; 19:E14. [PMID: 35324423 PMCID: PMC8992682 DOI: 10.5888/pcd19.210366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Most US businesses are small, yet they employ almost half of the nation’s workforce. Literature is limited about how small employers (those with 20–250 employees) have made decisions about operating their businesses during the COVID-19 pandemic. We sought to learn how employers made these decisions, what information sources they used, what information they wanted, and to what extent they worked with or used information from their local health department. Methods We conducted qualitative, semistructured interviews with 26 employers in Washington State, from August through October 2020. Employers were recruited from 7 counties (4 urban and 3 rural) that were experiencing either higher or lower COVID-19 case rates than Washington State overall. Results Employers relied heavily on national government resources to make decisions about how to operate their businesses during the COVID-19 pandemic. Few employers had relationships with or turned to their local health departments for information or support. Employers wanted information about COVID-19 safety that was specific to their business operations and industry. Employers also described the emotional toll of COVID-19 and the challenge of trying to make high-stakes decisions with rapidly evolving information. Conclusion Small employers showed little awareness of their local health departments and the information and assistance they could provide. Local health departments could increase their visibility and build relationships with small employers by partnering with them on value-added services such as workplace health promotion. Establishing these relationships could support more rapid collaboration between local health departments and small employers during future public health crises.
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Affiliation(s)
- Peggy A. Hannon
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Kristen Hammerback
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Christine M. Kava
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Perla Bravo-Acevedo
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Michelle Strait
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Jeffrey R. Harris
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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Kava CM, Strait M, Brown MC, Hammerback K, Harris JR, Alongi J, Hannon PA. Partnerships to expand worksite wellness programs - A qualitative analysis of state and local health department perspectives. Inquiry 2022; 59:469580221092822. [PMID: 35593231 PMCID: PMC9130807 DOI: 10.1177/00469580221092822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the U. S. Because the central mission of state and local health departments (HDs) is to protect, promote, and improve population health, these agencies are well-positioned to address risk behaviors for chronic disease. HD-employer partnerships could enhance worksite wellness programming, but few studies have explored this topic. Building upon previously published findings, the purpose of this qualitative study was to describe the context and environment for HDs' delivery of worksite wellness programs, including interest, barriers, facilitators, and decision-making processes. We conducted 12 interviews with directors of state chronic disease programs, 21 interviews with local directors, and three focus groups with local staff. We performed a thematic analysis of the data. Key themes include the following: (1) worksite wellness programs delivered by HDs were diverse in topic and scope and delivered both internally (at the HD for their agency) and externally (for other employers); (2) decisions made about chronic disease prevention were largely driven by funding priorities, with federal, state, and local entities playing roles in the decision-making process; and (3) HDs expressed potential interest in worksite wellness program delivery, dependent upon staff capacity, available funding, and employer buy-in. Our results suggest that funding should be increased for and reallocated towards chronic disease prevention, including worksite wellness. To overcome HD barriers to program delivery, key funders and stakeholders should prioritize and communicate the importance of worksite wellness.
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Affiliation(s)
- Christine M. Kava
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
| | - Michelle Strait
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
| | - Meagan C. Brown
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
| | - Kristen Hammerback
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
| | - Jeffrey R. Harris
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
| | - Jeanne Alongi
- National Association for Chronic
Disease Directors, Sacramento, CA, USA
| | - Peggy A. Hannon
- Health Promotion Research Center,
Department of Health Systems and Population Health, University of Washington,
Seattle, WA, USA
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Coronado GD, Rawlings AM, Petrik AF, Slaughter M, Johnson ES, Hannon PA, Cole A, Vu T, Mummadi RR. Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial. Cancer Epidemiol Biomarkers Prev 2021; 30:2327-2333. [PMID: 34583969 PMCID: PMC9273475 DOI: 10.1158/1055-9965.epi-20-1793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/17/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Colorectal cancer screening by annual fecal immunochemical test (FIT) with follow-up on abnormal results is a cost-effective strategy to reduce colorectal cancer incidence and mortality. Unfortunately, many patients with abnormal results do not complete a follow-up colonoscopy. We tested whether navigation targeted to patients who are unlikely to complete the procedure may improve adherence and long-term outcomes. METHODS Study participants were patients at a large, integrated health system (Kaiser Permanente Northwest) who were ages 50 to 75 and were due for a follow-up colonoscopy after a recent abnormal FIT result. Probability of adherence to follow-up was estimated at baseline using a predictive risk model. Patients whose probability was 70% or lower were randomized to receive patient navigation or usual care, with randomization stratified by probability category (<50%, 50% < 60%, 60% < 65%, 65% ≤ 70%). We compared colonoscopy completion within 6 months between the navigation and usual care groups using Cox proportional hazards regression. RESULTS Participants (n = 415; 200 assigned to patient navigation, 215 to usual care) had a mean age of 62 years, 54% were female, and 87% were non-Hispanic white. By 6 months, 76% of the patient navigation group had completed a colonoscopy, compared with 65% of the usual care group (HR = 1.35; 95% confidence interval, 1.07-1.72; log-rank P value = 0.027). CONCLUSIONS In this randomized trial, patient navigation led to improvements in follow-up colonoscopy adherence. IMPACT More research is needed to assess the value of precision-directed navigation programs.
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Affiliation(s)
- Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
| | - Andreea M Rawlings
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Matthew Slaughter
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Eric S Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
- Northwest Permanente Medicine, Portland, Oregon
| | - Peggy A Hannon
- University of Washington School of Public Health, Seattle, Washington
| | - Allison Cole
- University of Washington School of Public Health, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Thuy Vu
- University of Washington School of Public Health, Seattle, Washington
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Brown MC, Kava C, Bekemeier B, Ornelas IJ, Harris JR, Chan KCG, Robertson M, Hannon PA. Local Health Departments' Capacity for Workplace Health Promotion Programs to Prevent Chronic Disease: Comparison of Rural, Micropolitan, and Urban Contexts. J Public Health Manag Pract 2021; 27:E183-E188. [PMID: 32487926 PMCID: PMC8670205 DOI: 10.1097/phh.0000000000001182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine local health department (LHD) contexts, capacity for, and interest in partnering with employers on workplace health promotion programs (WHPPs) for chronic disease prevention. DESIGN Qualitative interviews with LHD directors. SETTING LHDs from 21 counties in 10 states. PARTICIPANTS Twenty-one LHD directors. MAIN OUTCOME MEASURESS Experiences and perceptions of existing partnerships, decision making, funding, data needs, and organizational capacity for WHPP partnerships with employers. RESULTS We identified 3 themes: (1) LHDs see the value of partnering with employers but lack the capacity to do so effectively; (2) while LHDs base priorities on community need, funding ultimately drives decision making; and (3) rural, micropolitan, and urban LHDs differ in their readiness and capacity to work with employers. CONCLUSIONS Understanding LHDs' partnership capacity and context is essential to the successful implementation of WHPP partnerships with employers. Expanding these partnerships may require additional financial investments, particularly among rural LHDs.
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Affiliation(s)
- Meagan C Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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Sharma KP, DeGroff A, Maxwell AE, Cole AM, Escoffery NC, Hannon PA. Evidence-Based Interventions and Colorectal Cancer Screening Rates: The Colorectal Cancer Screening Program, 2015-2017. Am J Prev Med 2021; 61:402-409. [PMID: 33994253 PMCID: PMC11008572 DOI: 10.1016/j.amepre.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/09/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention administers the Colorectal Cancer Control Program to increase colorectal cancer screening rates among people aged 50-75 years in areas where rates are lower than state or national levels. The aim of this study is to better understand the effectiveness of specific Colorectal Cancer Control Program components. METHODS The study population included clinics enrolled in the Colorectal Cancer Control Program during Years 1 and 2. Clinic data collected by the Centers for Disease Control and Prevention annually from 2015 to 2017 for program evaluation were used. The outcome variable was screening rate change through Program Year 2, and predictor variables were a new implementation or enhancement of evidence-based interventions and other program components. The analysis, conducted in 2020, used ordinary least square and generalized estimating equations regressions and first difference models to estimate the associations of independent variables with the outcome. RESULTS Of the total 336 clinics, 50%-70% newly implemented or enhanced different evidence-based interventions. Among these, client reminders were most highly associated with the increase in screening rates (8.0 percentage points). Provider reminder was not significantly associated with any change in screening rates. Among all program components, having a colorectal cancer screening champion was most highly (8.4 percentage points) associated with screening rate change. Results from different models were slightly different but in agreement. CONCLUSIONS Client reminders, provider assessment and feedback, and colorectal cancer screening champions were associated with increased clinic-level colorectal cancer screening rates. Universal implementation of these strategies can substantially increase colorectal cancer screening rates in the U.S.
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Affiliation(s)
- Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Annette E Maxwell
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Allison M Cole
- School of Medicine, University of Washington, Seattle, Washington
| | | | - Peggy A Hannon
- School of Public Health, University of Washington, Seattle, Washington
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Hammerback K, Kava CM, Passey DG, Hahn J, Huff A, Kohn MJ, Harris JR, Hannon PA. Development and Pilot Test of an Online Training to Engage Managers to Support Workplace Wellness. J Occup Environ Med 2021; 63:794-799. [PMID: 33883530 DOI: 10.1097/jom.0000000000002237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To contribute to a broader understanding of effective implementation strategies to help managers engage employees in workplace wellness. METHODS We beta-tested an online training at four Washington state agencies (two test, two control). We administered a post-training evaluation, re-administered an online manager survey and conducted additional interviews with wellness leads. RESULTS Training participation rate was high. The two test agencies experienced a significant increase in the percentage of managers who: agreed that they received training on employee wellness; agreed their agency's culture supports employee wellness; and encouraged their employees to participate in wellness activities. Approximately 80% of managers who received the training agreed they could apply information learned to support employee wellness. CONCLUSIONS If proven effective, the training could be administered at a low cost and disseminated to improve employee health.
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Affiliation(s)
- Kristen Hammerback
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Ms Hammerback, Dr Kava, Ms Kohn, Dr Harris, and Dr Hannon); University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, Utah (Dr Passey); Washington State Department of Enterprise Services, Olympia, Washington (Mr Hahn); Washington State Health Care Authority, Olympia, Washington (Mr Huff)
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Lewis CC, Hannon PA, Klasnja P, Baldwin LM, Hawkes R, Blackmer J, Johnson A. Optimizing Implementation in Cancer Control (OPTICC): protocol for an implementation science center. Implement Sci Commun 2021; 2:44. [PMID: 33892822 PMCID: PMC8062945 DOI: 10.1186/s43058-021-00117-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) could reduce cervical cancer deaths by 90%, colorectal cancer deaths by 70%, and lung cancer deaths by 95% if widely and effectively implemented in the USA. Yet, EBI implementation, when it occurs, is often suboptimal. This manuscript outlines the protocol for Optimizing Implementation in Cancer Control (OPTICC), a new implementation science center funded as part of the National Cancer Institute Implementation Science Consortium. OPTICC is designed to address three aims. Aim 1 is to develop a research program that supports developing, testing, and refining of innovative, efficient methods for optimizing EBI implementation in cancer control. Aim 2 is to support a diverse implementation laboratory of clinical and community partners to conduct rapid, implementation studies anywhere along the cancer care continuum for a wide range of cancers. Aim 3 is to build implementation science capacity in cancer control by training new investigators, engaging established investigators in cancer-focused implementation science, and contributing to the Implementation Science Consortium in Cancer. METHODS Three cores serve as OPTICC's foundation. The Administrative Core plans coordinates and evaluates the Center's activities and leads its capacity-building efforts. The Implementation Laboratory Core (I-Lab) coordinates a network of diverse clinical and community sites, wherein studies are conducted to optimize EBI implementation, implement cancer control EBIs, and shape the Center's agenda. The Research Program Core conducts innovative implementation studies, measurement and methods studies, and pilot studies that advance the Center's theme. A three-stage approach to optimizing EBI implementation is taken-(I) identify and prioritize determinants, (II) match strategies, and (III) optimize strategies-that is informed by a transdisciplinary team of experts leveraging multiphase optimization strategies and criteria, user-centered design, and agile science. DISCUSSION OPTICC will develop, test, and refine efficient and economical methods for optimizing EBI implementation by building implementation science capacity in cancer researchers through applications with our I-Lab partners. Once refined, OPTICC will disseminate its methods as toolkits accompanied by massive open online courses, and an interactive website, the latter of which seeks to simultaneously accumulate knowledge across OPTICC studies.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Peggy A Hannon
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Rene Hawkes
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Janell Blackmer
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ashley Johnson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Harris JR, Hammerback K, Brown M, Ryan DE, Coe NB, Pike KJ, Santiago PM, Hannon PA. Local Health Jurisdiction Staff Deliver Health Promotion to Small Worksites, Washington. J Public Health Manag Pract 2021; 27:117-124. [PMID: 31738191 PMCID: PMC7220816 DOI: 10.1097/phh.0000000000001105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Worksites can serve as community sites for local health jurisdictions (LHJs) to assist with implementation of evidence-based interventions (EBIs) to prevent and control chronic diseases. OBJECTIVE To assess the feasibility and effectiveness of using LHJ staff to disseminate Connect to Wellness (CtW), an effective dissemination package for increasing implementation of EBIs for chronic disease control by small worksites. DESIGN Single-arm, multisite intervention trial, with measurement at baseline, after 6 months of intervention, and after a maintenance period of 6 months. SETTING Six geographically dispersed counties in Washington State. Target worksites had 20 to 250 employees. PARTICIPANTS Nine staff members from 6 LHJs delivered CtW to 35 worksites. INTERVENTION Connect to Wellness seeks to increase worksites' implementation of 14 EBIs classified as communication, policy, or program approaches to increasing 4 behaviors: cancer screening, healthy eating, physical activity, and tobacco cessation. MAIN OUTCOME MEASURE Evidence-based intervention implementation measured on a scale from 0% to 100%. RESULTS Participating worksites showed a significant increase (P < .001, t test) in total mean implementation scores from baseline (33%) to 6-month follow-up (47%). Increases in implementation for communications, policy, healthy eating, and tobacco EBIs were statistically significant at 6 months and maintained at 12 months. Increased implementation at 6 months of a group physical activity program was not sustained after the program became unavailable, and total implementation scores at 12 months (38%) showed little change from baseline. CONCLUSIONS Local health jurisdiction-delivered CtW increased worksites' implementation of EBIs at 6 months, and increased implementation in communication, policy, healthy eating, and tobacco was maintained at 12 months. This package, delivered by LHJ staff working part-time on CtW, was nearly as successful as prior delivery by staff working full-time on CtW.
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Affiliation(s)
- Jeffrey R. Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Kristen Hammerback
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Meagan Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Daron E. Ryan
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Norma B. Coe
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - K. Joanne Pike
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Patti M. Santiago
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
| | - Peggy A. Hannon
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington (Drs Harris, Coe, and Hannon, Mss Hammerback, Brown, and Ryan); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Coe); Alzheimer's Association, Chicago, Illinois (Dr Pike); and Washington State Department of Health, Tumwater, Washington (Ms Santiago)
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Kava CM, Passey D, Harris JR, Chan KCG, Hannon PA. The Workplace Support for Health Scale: Reliability and Validity of a Brief Scale to Measure Employee Perceptions of Wellness. Am J Health Promot 2020; 35:179-185. [PMID: 32808553 DOI: 10.1177/0890117120949807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the reliability and validity of a brief measure (the Workplace Support for Health [WSH] scale) to assess employees' perceived support for a healthy lifestyle. DESIGN Repeated cross-sectional surveys. SETTING We collected employer- and employee-level survey data from small, low-wage workplaces in King County, WA enrolled in a randomized controlled trial. SAMPLE We analyzed data from 68 workplaces that had 2,820 and 2,640 employees complete surveys at baseline and 15 months, respectively. MEASURES The WSH scale consisted of five items. To assess validity, we examined associations between the WSH scale and employer implementation of evidence-based interventions for health promotion, employee self-rated health, and job satisfaction. ANALYSIS We performed an exploratory factor analysis to assess the unidimensionality of the WSH scale items, and produced Cronbach's alpha coefficients to examine scale reliability. We ran regression models using generalized estimating equations to examine validity. RESULTS The factor analysis indicated one factor, which accounted for 59% of the total variance in the workplace support for health items. The scale had good reliability at baseline (α = 0.82) and 15 months (α = 0.83). Employer evidence-based intervention implementation was positively associated with WSH. WSH was also associated with higher self-rated health and job satisfaction. These associations indicate good concurrent validity. CONCLUSION The WSH scale is a reliable and valid measure of perceived workplace support for health. Employers can use the scale to identify gaps in support and create a plan for improvement.
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Affiliation(s)
- Christine M Kava
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
| | - Debbie Passey
- Division of Epidemiology, Department of Internal Medicine, 49462University of Utah, Salt Lake City, UT, USA
| | - Jeffrey R Harris
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
| | - Kwun C Gary Chan
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
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Brown MC, Harris JR, Hammerback K, Kohn MJ, Parrish AT, Chan GK, Ornelas IJ, Helfrich CD, Hannon PA. Development of a Wellness Committee Implementation Index for Workplace Health Promotion Programs in Small Businesses. Am J Health Promot 2020; 34:614-621. [PMID: 32077300 PMCID: PMC7305966 DOI: 10.1177/0890117120906967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To construct a wellness committee (WC) implementation index and determine whether this index was associated with evidence-based intervention implementation in a workplace health promotion program. DESIGN Secondary data analysis of the HealthLinks randomized controlled trial. SETTING Small businesses assigned to the HealthLinks plus WC study arm. SAMPLE Small businesses (20-200 employees, n = 23) from 6 low-wage industries in King County, Washington. MEASURES Wellness committee implementation index (0%-100%) and evidence-based intervention implementation (0%-100%). ANALYSIS We used descriptive and bivariate statistics to describe worksites' organizational characteristics. For the primary analyses, we used generalized estimating equations with robust standard errors to assess the association between WC implementation index and evidence-based intervention implementation over time. RESULTS Average WC implementation index scores were 60% at 15 months and 38% at 24 months. Evidence-based intervention scores among worksites with WCs were 27% points higher at 15 months (64% vs 37%, P < .001) and 36% points higher at 24 months (55% vs 18%, P < .001). Higher WC implementation index scores were positively associated with evidence-based intervention implementation scores over time (P < .001). CONCLUSION Wellness committees may play an essential role in supporting evidence-based intervention implementation among small businesses. Furthermore, the degree to which these WCs are engaged and have leadership support, a set plan or goals, and multilevel participation may influence evidence-based intervention implementation and maintenance over time.
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Affiliation(s)
- Meagan C. Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jeffrey R. Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kristen Hammerback
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Marlana J. Kohn
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Amanda T. Parrish
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Gary K. Chan
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - India J. Ornelas
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christian D. Helfrich
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Briant KJ, Thompson B, Doody DR, Reyes C, Schwartz SM, Hannon PA, Mendoza JA. Abstract C004: Collecting evidence to drive research that addresses community cancer needs in Western Washington. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: The Fred Hutch/University of Washington Cancer Consortium (Consortium) is a National Cancer Institute-designated comprehensive cancer center located in the Seattle metro area. The Consortium comprises four partnering institutions (Fred Hutchinson Cancer Research Center, University of Washington, Seattle Children's Hospital, and Seattle Cancer Care Alliance [SCCA]) that together address the full spectrum of cancer research and interventions to reduce the burden of cancer among catchment area (CA) residents. The Consortium's CA is thirteen counties in western Washington (WA). In an effort to understand and document ongoing research conducted to address the cancer burden, risk factors, incidence, mortality, and inequities in the CA, we initiated a comprehensive needs assessment.
Methods: We conducted a quantitative and qualitative needs assessment from September 2017 to June 2018. Quantitative assessment included secondary data analyses from multiple sources (Seattle-Puget Sound Surveillance, Epidemiology and End Results cancer registry, Behavioral Risk Factor Surveillance Survey data, and WA State Department of Health data). Qualitative assessment included semistructured interviews (n=32) conducted in person and over the telephone with key informants representing county health departments, clinic/health systems, SCCA network sites, and community-based organizations. Interviews included questions about barriers and facilitators to cancer screening, referrals, services, access to care, and cancer inequities.
Results: The quantitative data analysis identified the top five cancer incidence sites in the CA as breast, prostate, lung, hematologic malignancies and colorectal; the top five mortality sites in the CA are lung, prostate, breast, hematologic malignancies and colorectal. Comparisons of incidence and mortality for the region revealed several inequities: 1) American Indians and Alaska Natives (AIAN) had the most numerous and severe inequities for incidence and mortality of the top cancers; 2) non-Hispanic Blacks had the most severe mortality for prostate cancer; and 3) outlying rural counties had higher incidence and mortality rates than urban areas. Through the qualitative data analysis, we identified seven major themes that influenced cancer prevention and control, including geography, social determinants of health, financial issues, issues around provider trust and communication, issues with agency partnerships/collaboration, and race/ethnicity. Qualitative interviews suggested opportunities for the Consortium to address barriers that underlie several major cancer inequities in the CA.
Conclusion: The Consortium will use the needs assessment as a baseline measure to evaluate future research that addresses the cancer burden in the CA. The Consortium now has information to take an informed approach to engage key stakeholders to collaborate and holistically improve cancer research and outcomes for all CA residents.
Citation Format: Katherine J. Briant, Beti Thompson, David R. Doody, Clara Reyes, Stephen M. Schwartz, Peggy A. Hannon, Jason A. Mendoza. Collecting evidence to drive research that addresses community cancer needs in Western Washington [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C004.
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Affiliation(s)
| | - Beti Thompson
- 1Fred Hutchinson Cancer Research Center, Seattle, WA,
| | | | - Clara Reyes
- 2New Mexico State University, Las Cruces, NM,
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Abstract
Introduction Evidence-based interventions for tobacco control in the US workplace can reach a large audience. The purpose of our study was to explore the prevalence and determinants of type of tobacco use (ie, cigarettes only, e-cigarettes only, or dual use) among adult employees in the United States and to examine type of use by state. Methods We used data from the 2017 Behavioral Risk Factor Surveillance System to examine the prevalence of cigarette use, e-cigarette use, dual use, and quit attempts. We used multinomial logistic regression to examine the relationships between sociodemographic characteristics and type of tobacco product used, and we estimated adjusted prevalence. Results Approximately 17% of respondents were current smokers, 5% were current e-cigarette users, and 2% were dual users. E-cigarette-only and dual use were generally highest among young (aged 18–24), male, and less-educated respondents and lower for respondents who identified as black, Asian/Native Hawaiian/Pacific Islander, or Hispanic than for white respondents. Cigarette-only and dual use were higher for respondents who did not have health care coverage. Prevalence by state of e-cigarette use only ranged from 1.2% (Vermont) to 3.9% (Arkansas), whereas the prevalence of dual use ranged from 0.6% (District of Columbia) to 4.0% (Oklahoma). Conclusion Prevalence of cigarette, e-cigarette, and dual use varied by sociodemographic characteristics and by state. These findings can support targeting of specific populations when designing and implementing evidence-based interventions for tobacco control in workplace settings.
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Affiliation(s)
- Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Box 354804, 1107 NE 45th St, Ste 400, Seattle, WA 98105. E-mail:
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, University of Washington, Seattle, Washington
| | - Jeffrey R Harris
- Health Promotion Research Center, Department of Health Services, University of Washington, Seattle, Washington
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Ko LK, Jang SH, Friedman DB, Glanz K, Leeman J, Hannon PA, Shannon J, Cole A, Williams R, Vu T. An application of the Science Impact Framework to the Cancer Prevention and Control Research Network from 2014-2018. Prev Med 2019; 129S:105821. [PMID: 31479655 PMCID: PMC6925321 DOI: 10.1016/j.ypmed.2019.105821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 01/03/2023]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a strategic collaborative effort focused on accelerating the dissemination and implementation of evidence-based cancer prevention and control interventions to communities. In 2014, the CPCRN Coordinating Center began collecting information in alignment with the Centers for Disease Control and Prevention's (CDC) Science Impact Framework. The Science Impact Framework is a CDC-developed approach to trace and link CDC science to events and/or actions recognized as influential to public health, beyond peer-reviewed publications. The purpose of this paper is to highlight the impact of CPCRN activities using key indicators guided by the CDC's Science Impact Framework. We reviewed annual progress reports submitted by CPCRN centers from 2014 to 2019 to identify the impact indicators. The CPCRN activities were linked to four domains from the Science Impact Framework and its key indicators: Disseminating Science (presentations, training, general communication, and other communication reports), Creating Awareness (requests for expertise, and feedback), Catalyzing Action (grant applications, partnerships and collaborations, research & development, advocacy groups, office practice/point of care changes, and technology creating), and Effecting Change (building public health practice, creation of registries/surveillance, legal/policy changes, and change instilled). Overall, CPCRN activities demonstrate impact beyond peer-reviewed publications and thus should continue building scientific impact to ultimately influence health outcomes.
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Affiliation(s)
- Linda K Ko
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98102, USA; University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA.
| | - Sou H Jang
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
| | - Daniela B Friedman
- University of South Carolina, Department of Health Promotion, Education, and Behavior, 915 Greene Street, Suite 557, Columbia, SC 29208, USA
| | - Karen Glanz
- University of Pennsylvania, Perelman School of Medicine and School of Nursing, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA
| | - Jennifer Leeman
- University of North Carolina, School of Nursing, 120 N. Medical Drive, Chapel Hill, NC 27599-7460, USA
| | - Peggy A Hannon
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
| | - Jackilen Shannon
- Oregon Health and Science University, School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Allison Cole
- University of Washington, Department of Family Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Rebecca Williams
- University of North Carolina, Lineberger Comprehensive Cancer Center, 200 North Greensboro Street, Suite D-15, Carrboro, NC 27510, USA
| | - Thuy Vu
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
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Hannon PA, Hammerback K, Kohn MJ, Kava CM, Gary Chan KC, Parrish AT, Allen C, Helfrich CD, Mayotte C, Beresford SA, Harris JR. Disseminating Evidence-Based Interventions in Small, Low-Wage Worksites: A Randomized Controlled Trial in King County, Washington (2014-2017). Am J Public Health 2019; 109:1739-1746. [PMID: 31622155 DOI: 10.2105/ajph.2019.305313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine whether (1) participating in HealthLinks, and (2) adding wellness committees to HealthLinks increases worksites' evidence-based intervention (EBI) implementation.Methods. We developed HealthLinks to disseminate EBIs to small, low-wage worksites. From 2014 to 2017, we conducted a site-randomized trial in King County, Washington, with 68 small worksites (20-200 employees). We assigned worksites to 1 of 3 arms: HealthLinks, HealthLinks plus wellness committee (HealthLinks+), or delayed control. At baseline, 15 months, and 24 months, we assessed worksites' EBI implementation on a 0% to 100% scale and employees' perceived support for their health behaviors.Results. Postintervention EBI scores in both intervention arms (HealthLinks and HealthLinks+) were significantly higher than in the control arm at 15 months (51%, 51%, and 23%, respectively) and at 24 months (33%, 37%, and 24%, respectively; P < .001). Employees in the intervention arms perceived greater support for their health at 15 and 24 months than did employees in control worksites.Conclusions. HealthLinks is an effective strategy for disseminating EBIs to small worksites in low-wage industries.Public Health Implications. Future research should focus on scaling up HealthLinks, improving EBI maintenance, and measuring impact of these on health behavior.
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Affiliation(s)
- Peggy A Hannon
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Kristen Hammerback
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Marlana J Kohn
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Christine M Kava
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Kwun C Gary Chan
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Amanda T Parrish
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Claire Allen
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Christian D Helfrich
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Caitlin Mayotte
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Shirley A Beresford
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
| | - Jeffrey R Harris
- Peggy A. Hannon, Kristen Hammerback, Marlana J. Kohn, Christine M. Kava, Amanda T. Parrish, Claire Allen, Caitlin Mayotte, and Jeffrey R. Harris are with the Department of Health Services, University of Washington, Seattle. Kwun C. Gary Chan is with the Department of Biostatistics, University of Washington, Seattle. Christian D. Helfrich is with VA Puget Sound Health Care System, Seattle, WA. Shirley A. Beresford is with the Department of Epidemiology, University of Washington, Seattle
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Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis 2019; 16:E139. [PMID: 31603404 PMCID: PMC6795067 DOI: 10.5888/pcd16.180682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose and Objectives Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation. Intervention Approach CDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates. Evaluation Methods We surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation. Results Most grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity. Implications for Public Health CRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.
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Affiliation(s)
- Peggy A Hannon
- University of Washington, Seattle, Washington.,1107 NE 45th St, Ste 200, Seattle, WA 98105.
| | | | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | | | | | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Petrescu-Prahova M, Kohn M, Leroux B, Steinman L, Fishleder S, Pike M, Kava CM, Belza B, Schrodt L, Hannon PA, Harris JR. Building community-clinical linkages to increase older adult physical activity: The PT-REFER trial protocol and participant baseline characteristics. Contemp Clin Trials Commun 2019; 15:100373. [PMID: 31111115 PMCID: PMC6512749 DOI: 10.1016/j.conctc.2019.100373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/17/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022] Open
Abstract
Background Physical activity is important for maintaining older adult health, but a majority of older adults are not meeting recommended physical activity levels. This paper describes the protocol and participant baseline characteristics for a trial (named "PT-REFER") to test an intervention focused on developing community-clinical linkages to increase older adult referrals from physical therapy clinics to an evidence-based group exercise program (Enhance®Fitness) (EF) offered by YMCA associations. Methods We designed a two-arm cluster-randomized controlled trial with YMCA associations. We conducted formative research with YMCA staff and physical therapists to inform intervention format and content. The primary outcome is the number of new participants enrolled in EF over the course of 30 months. We also collect process information on cost and implementation though structured surveys and semi-structured qualitative interviews. Results The PT-REFER intervention creates a learning collaborative for YMCA associations, which are tasked with implementing a number of capacity- and partnership-building activities over the course of seven months, and participating in monthly group technical assistance calls. We recruited 20 YMCA associations from 13 states. At baseline, the average number of EF sites per association was 3.9 and the monthly average number of new EF participants was 3.7. Conclusions This study will test an approach to increasing the capacity of YMCAs for conducting outreach to physical therapy clinics, and evaluate the factors that may influence its implementation. As a result, it has the potential to contribute to our understanding of how to develop viable and sustainable community-clinical linkages for older adult health.
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Affiliation(s)
- Miruna Petrescu-Prahova
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
- Corresponding author. Health Promotion Research Center, University of Washington, Box 354804, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA.
| | - Marlana Kohn
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Brian Leroux
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Lesley Steinman
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Sarah Fishleder
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Maureen Pike
- YMCA of the USA, 101 N Wacker Dr, Chicago, IL, 60606, USA
| | - Christine M. Kava
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Basia Belza
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Lori Schrodt
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC, 28723, USA
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
| | - Jeffrey R. Harris
- Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA
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Linnan LA, Leff MS, Martini MC, Walton AL, Baron S, Hannon PA, Abraham J, Studer M. Workplace health promotion and safety in state and territorial health departments in the United States: a national mixed-methods study of activity, capacity, and growth opportunities. BMC Public Health 2019; 19:291. [PMID: 30866884 PMCID: PMC6417036 DOI: 10.1186/s12889-019-6575-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND State and Territorial Health Departments (SHDs) have a unique role in protecting and promoting workers' health. This mixed-methods study presents the first systematic investigation of SHDs' activities and capacity in both Occupational Safety and Health (OSH) and Workplace Health Promotion (WHP) in the United States (US). METHODS National survey of OSH and WHP practitioners from each of 56 SHDs, followed by in-depth interviews with a subset of survey respondents. We calculated descriptive statistics for survey variables and conducted conventional content analysis of interviews. RESULTS Seventy percent (n = 39) of OSH and 71% (n = 40) of WHP contacts responded to the survey. Twenty-seven (n = 14 OSH, n = 13 WHP) participated in follow-up interviews. Despite limited funding, staffing, or organizational support, SHDs reported a wide array of activities. We assessed OSH and WHP surveillance activities, support that SHDs provided to employers to implement OSH and WHP interventions (implementation support), OSH and WHP services provided directly to workers, OSH follow-back investigations, and OSH standard and policy development. Each of the categories we asked about (excluding OSH standard and policy development) were performed by more than half of responding SHDs. Surveillance was the area of greatest OSH activity, while implementation support was the area of greatest WHP activity. Respondents characterized their overall capacity as low. Thirty percent (n = 9) of WHP and 19% (n = 6) of OSH respondents reported no funds at all for OSH/WHP work, and both groups reported a median 1.0 FTEs working on OSH/WHP at the SHD. Organizational support for OSH and WHP was characterized as "low" to "moderate". To increase SHDs' capacity for OSH and WHP, interview respondents recommended that OSH and WHP approaches be better integrated into other public health initiatives (e.g., infectious disease prevention), and that federal funding for OSH and WHP increase. They also discussed specific recommendations for improving the accessibility and utility of existing funding mechanisms, and the educational resources they desired from the CDC. CONCLUSIONS Results revealed current activities and specific strategies for increasing capacity of SHDs to promote the safety and health of workers and workplaces - an important public health setting for reducing acute injury and chronic disease.
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Affiliation(s)
- Laura A Linnan
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd, CB#7426, Chapel Hill, NC, 27514, USA. .,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Maija S Leff
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd, CB#7426, Chapel Hill, NC, 27514, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Marisa C Martini
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7440, Chapel Hill, NC, 27599, USA
| | - AnnMarie L Walton
- Health Systems and Analytics Division, School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, 65-30 Kissena Blvd, Flushing, NY, 11367, USA
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, 1107 NE 45th St., Suite 400, Box 354804, Seattle, WA, 98105, USA
| | - Jean Abraham
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455, USA
| | - Melanie Studer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC, 27599, USA
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Helfrich CD, Kohn MJ, Stapleton A, Allen CL, Hammerback KE, Chan KCG, Parrish AT, Ryan DE, Weiner BJ, Harris JR, Hannon PA. Readiness to Change Over Time: Change Commitment and Change Efficacy in a Workplace Health-Promotion Trial. Front Public Health 2018; 6:110. [PMID: 29740572 PMCID: PMC5925216 DOI: 10.3389/fpubh.2018.00110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time. Methods We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time. Results Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (-0.39) and interventions sites (-0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites. Discussion Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.
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Affiliation(s)
- Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States
| | - Marlana J Kohn
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Austin Stapleton
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States
| | - Claire L Allen
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Kristen Elizabeth Hammerback
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - K C Gary Chan
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Amanda T Parrish
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Daron E Ryan
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Bryan J Weiner
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Jeffrey R Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Peggy A Hannon
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, WA, United States
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Hammerback K, Hannon PA, Parrish AT, Allen C, Kohn MJ, Harris JR. Comparing Strategies for Recruiting Small, Low-Wage Worksites for Community-Based Health Promotion Research. Health Educ Behav 2018; 45:690-696. [PMID: 29658314 DOI: 10.1177/1090198118769360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND HealthLinks is a workplace health promotion program developed in partnership with the American Cancer Society. It delivers a package of evidence-based interventions and implementation support to small worksites in low-wage industries. As part of a randomized, controlled trial of HealthLinks, we studied approaches to recruiting these worksites. AIMS This study aims to guide future recruitment for community-based worksite health promotion interventions by comparing three approaches, including leveraging relationships with community partners. METHOD We recruited 78 small, low-wage worksites in King County, Washington, to participate in the trial via three approaches: phone calls to companies on a purchased list ("cold"), phone calls to a list of eligible companies provided by a health insurer ("lukewarm"), and personal referrals from local health insurers and brokers ("warm"). Eligible and interested worksites received an in-person visit from researchers and completed additional steps to enroll. RESULTS Of the worksites screened and deemed eligible, 32% of the "cold" worksites enrolled in HealthLinks, as did 48% and 60%, respectively, of the "lukewarm" and "warm" worksites. Compared with "warm" worksites, "cold" worksites were twice as likely to be ineligible. DISCUSSION Two distinct factors help explain why "warmer" worksites were more likely to enroll in HealthLinks. First, eligibility was significantly higher among warmer referrals. Second, most of the warm-referred worksites eligible for the study agreed to meet in person with the project team to hear more about the project. CONCLUSIONS "Warmer" recruitment approaches yielded higher recruitment. Leveraging relationships with community partners can help researchers identify and successfully recruit small, low-wage worksites.
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Passey DG, Hammerback K, Huff A, Harris JR, Hannon PA. The Role of Managers in Employee Wellness Programs: A Mixed-Methods Study. Am J Health Promot 2018; 32:1697-1705. [DOI: 10.1177/0890117118767785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The purpose of this study is to evaluate managers’ barriers and facilitators to supporting employee participation in the Washington State Wellness program. Design: Exploratory sequential mixed methods. Setting: Four Washington State agencies located in Olympia and Tumwater, Washington. Participants: State employees in management positions (executive, middle, and line), whose job includes supervision of subordinates and responsibility for the performance and conduct of a subunit or group. Methods: We interviewed 23 managers and then used the results to create a survey that was fielded to all managers at the 4 agencies. The survey response rate was 65% (n = 607/935). Analysis: We used qualitative coding techniques to analyze interview transcripts and descriptive statistics to summarize survey data. We used the Total Worker Health framework to organize our findings and conclusions. Results: Managers support the wellness program, but they also face challenges with accommodating employees’ participation due to workload, scheduling inflexibility, and self-efficacy to discuss wellness with direct reports. About half the managers receive support from the manager above them, and most have not received training on the wellness program. Conclusion: Our findings point to several strategies that can strengthen managers’ role in supporting the wellness program: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees’ participation.
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Affiliation(s)
- Deborah G. Passey
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kristen Hammerback
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Aaron Huff
- Washington State Health Care Authority, Olympia, WA, USA
| | - Jeffrey R. Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
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Passey DG, Brown MC, Hammerback K, Harris JR, Hannon PA. Managers’ Support for Employee Wellness Programs: An Integrative Review. Am J Health Promot 2018; 32:1789-1799. [DOI: 10.1177/0890117118764856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The aim of this integrative literature review is to synthesize the existing evidence regarding managers’ support for employee wellness programs. Data Source: The search utilized multiple electronic databases and libraries. Study Inclusion and Exclusion Criteria: Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers’ support in the context of a worksite intervention. The final sample included 21 articles for analysis. Data Extraction: Two researchers extracted and described results from each of the included articles using a content analysis. Data Synthesis: Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. Results: Factors that may influence managers’ support include their organization’s management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers’ support may influence the organizational culture, employees’ perception of support, and employees’ behaviors. Conclusions: When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers’ support. Interventions need to include explicit measures of managers’ support as part of the evaluation plan.
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Affiliation(s)
- Deborah G. Passey
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Meagan C. Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kristen Hammerback
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Jeffrey R. Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
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Hannon PA, Vu TT, Santiago PM, Joyner P, Mason C, Harris JR. Prevention Research Center Collaborations With State Departments of Health: Washington State. Am J Prev Med 2017; 52:S246-S249. [PMID: 28215373 DOI: 10.1016/j.amepre.2016.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/11/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022]
Abstract
State health departments and Prevention Research Centers (PRCs) have complementary mandates and expertise important to improving population health. State health departments manage and administer numerous programs with broad population reach. PRCs bridge dissemination and implementation research and public health practice to improve health programming and outcomes. This paper describes the 15-year partnership between the Washington State Department of Health and the PRC at the University of Washington. Through this partnership, the Washington State Department of Health increases their research and evaluation capacity by working with the University of Washington PRC, and the University of Washington PRC receives opportunities to apply evidence in a variety of practice settings, expand the reach of their research-tested programs to new populations, and form new partnerships. The partnership focused initially on improving colorectal cancer screening rates through increased dissemination and implementation of evidence-based interventions. The partnership scope has grown to include small cancer screening projects in worksites and healthcare systems, Washington's Colorectal Cancer Control Program, breast and cervical cancer screening, hypertension control, and worksite health promotion. The partnership yields three main types of outcomes that strengthen practice and science: (1) findings from each major assessment or evaluation activity, published in the peer-reviewed literature when possible; (2) use of the findings to improve public health practice and impact; and (3) training opportunities for employees of local and state health departments and public health students. PRCs, health departments, and the populations they serve have much to gain from this type of partnership.
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Affiliation(s)
- Peggy A Hannon
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, Washington;.
| | - Thuy T Vu
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, Washington
| | | | - Pama Joyner
- Office of Healthy Communities, Washington State Department of Health, Olympia, Washington
| | - Caitlin Mason
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, Washington
| | - Jeffrey R Harris
- Health Promotion Research Center, A CDC Prevention Research Center, Department of Health Services, University of Washington, Seattle, Washington
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Ribisl KM, Fernandez ME, Friedman DB, Hannon PA, Leeman J, Moore A, Olson L, Ory M, Risendal B, Sheble L, Taylor VM, Williams RS, Weiner BJ. Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice. Am J Prev Med 2017; 52:S233-S240. [PMID: 28215371 PMCID: PMC5812747 DOI: 10.1016/j.amepre.2016.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating network center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration is often advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN's multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. This paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control.
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Affiliation(s)
- Kurt M Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Peggy A Hannon
- Department of Health Services, University of Washington, Seattle, Washington
| | - Jennifer Leeman
- Department of Health Care Environments, University of North Carolina School of Nursing, Chapel Hill, North Carolina
| | - Alexis Moore
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsay Olson
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marcia Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M University, College Station, Texas
| | - Betsy Risendal
- Department of Community and Behavioral Health, University of Colorado Denver, Denver, Colorado
| | - Laura Sheble
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vicky M Taylor
- Department of Health Services, University of Washington, Seattle, Washington
| | - Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryan J Weiner
- Department of Health Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hannon PA, Helfrich CD, Chan KG, Allen CL, Hammerback K, Kohn MJ, Parrish AT, Weiner BJ, Harris JR. Development and Pilot Test of the Workplace Readiness Questionnaire, a Theory-Based Instrument to Measure Small Workplaces' Readiness to Implement Wellness Programs. Am J Health Promot 2016; 31:67-75. [PMID: 26389975 DOI: 10.4278/ajhp.141204-quan-604] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs. DESIGN In developing our scale, we first tested items via "think-aloud" interviews. We tested the revised items in a cross-sectional quantitative telephone survey. SETTING The study setting comprised small workplaces (20-250 employees) in low-wage industries. SUBJECTS Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects. MEASURES We generated items for each construct in Weiner's theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs. ANALYSIS We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers' current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change. RESULTS Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75-.88) and was positively associated with wellness program implementation ( p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort. CONCLUSION We developed a new questionnaire to assess small workplaces' readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner's theory of readiness for change.
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Affiliation(s)
- Peggy A Hannon
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Christian D Helfrich
- 2 Northwest Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington.,3 Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - K Gary Chan
- 3 Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Claire L Allen
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristen Hammerback
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Marlana J Kohn
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Amanda T Parrish
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Bryan J Weiner
- 4 Department of Health Policy and Management, UNC Gillings Global School of Public Health, University of North Carolina-Chapel Hill
| | - Jeffrey R Harris
- 1 Health Promotion Research Center (a CDC Prevention Research Center), Department of Health Services, University of Washington School of Public Health, Seattle, Washington
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Chen L, Hannon PA, Laing SS, Kohn MJ, Clark K, Pritchard S, Harris JR. Perceived workplace health support is associated with employee productivity. Am J Health Promot 2016; 29:139-46. [PMID: 25559250 DOI: 10.4278/ajhp.131216-quan-645] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the relationship between perceived workplace health support and employee productivity. DESIGN A quantitative cross-sectional study. SETTING Washington State agencies. SUBJECTS A total of 3528 employees from six state agencies were included in this analysis. MEASURES Perceived workplace health support was assessed by two questions that queried respondents on how often they felt supported by the workplace for healthy living and physical activity. The Work Productivity and Activity Impairment Questionnaire was used to measure health-related absenteeism and presenteeism in the past 7 days. ANALYSIS Multivariate linear regression was used to estimate the mean differences in productivity by levels of perceived health support. RESULTS Most participants were between 45 and 64 years of age and were predominantly non-Hispanic white. Presenteeism varied significantly by the level of perceived workplace health support, with those who felt least supported having higher presenteeism than those who felt most supported. The difference in presenteeism by perceived workplace support remained significant in models adjusting for sociodemographic and health characteristics (mean difference: 7.1% for support for healthy living, 95% confidence interval: 3.7%, 10.4%; 4.3% for support for physical activity, 95% confidence interval: 1.7%, 6.8%). Absenteeism was not associated with perceived workplace health support. CONCLUSION Higher perceived workplace health support is independently associated with higher work productivity. Employers may see productivity benefit from wellness programs through improved perceptions of workplace health support.
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Graves MC, Harris JR, Hannon PA, Hammerback K, Parrish AT, Ahmed F, Zhou C, Allen CL. Promoting Influenza Vaccination to Restaurant Employees. Am J Health Promot 2016; 30:498-500. [PMID: 26305606 PMCID: PMC8281321 DOI: 10.4278/ajhp.131216-arb-643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate an evidence-based workplace approach to increasing adult influenza vaccination levels applied in the restaurant setting DESIGN We implemented an intervention and conducted a pre/post analysis to determine effect on vaccination. SETTING Eleven Seattle-area restaurants. SUBJECTS Restaurants with 25+ employees speaking English or Spanish and over 18 years. INTERVENTION Restaurants received influenza vaccination promotion materials, assistance arranging on-site vaccination events, and free influenza vaccinations for employees. MEASURES Pre/post employee surveys of vaccination status with direct observation and employer interviews to evaluate implementation. ANALYSIS We conducted descriptive analysis of employee survey data and performed qualitative analysis of implementation data. To assess intervention effect, we used a mixed-effects logistic regression model with a restaurant-specific random effect. RESULTS Vaccination levels increased from 26% to 46% (adjusted odds ratio 2.33, 95% confidence interval 1.69, 3.22), with 428 employees surveyed preintervention, 305 surveyed postintervention, and response rates of 73% and 55%, respectively. The intervention was effective across subgroups, but there were restaurant-level differences. CONCLUSION An access-based workplace intervention can increase influenza vaccination levels in restaurant employees, but restaurant-level factors may influence success.
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Affiliation(s)
| | - Jeffrey R Harris
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Health Promotion Research Center, a Centers for Disease Control and Prevention Research Center, Seattle, Washington
| | - Peggy A Hannon
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Health Promotion Research Center, a Centers for Disease Control and Prevention Research Center, Seattle, Washington
| | - Kristen Hammerback
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Health Promotion Research Center, a Centers for Disease Control and Prevention Research Center, Seattle, Washington
| | - Amanda T Parrish
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Health Promotion Research Center, a Centers for Disease Control and Prevention Research Center, Seattle, Washington
| | - Faruque Ahmed
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chuan Zhou
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington
| | - Claire L Allen
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington Health Promotion Research Center, a Centers for Disease Control and Prevention Research Center, Seattle, Washington
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Harris JR, Parrish AT, Kohn M, Hammerback K, McMillan B, Hannon PA. Promoting Employee Health Through an American Cancer Society Program, The CEOs Challenge, Washington State, 2013-2015. Prev Chronic Dis 2015; 12:E223. [PMID: 26679492 PMCID: PMC5241642 DOI: 10.5888/pcd12.150381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Evidence-based practices in the workplace can increase levels of healthy eating, cancer screening, physical activity, and tobacco cessation but are underused, even in large workplaces. This report summarizes an evaluation of the first year of The CEOs Challenge, a program developed by the American Cancer Society to promote implementation and maintenance of health-promoting, evidence-based workplace practices by large companies. Methods Use of 17 evidence-based practices by 17 companies in the Washington State Chapter of the American Cancer Society’s CEOs Against Cancer network was assessed via survey and scored from 0 to 100. Companies received a written report of their baseline performance, followed by at least quarterly consultations with American Cancer Society staff members trained to assist in implementation of these practices. Follow-up performance was measured at 1 year. Results At baseline, implementation scores were 54.8 for cancer screening, 46.5 for healthy eating, 59.8 for physical activity, and 68.2 for tobacco cessation. At follow-up, scores increased by 19.6 for cancer screening, 19.4 for healthy eating, 16.0 for physical activity, and 9.4 points for tobacco cessation. Conclusion The CEOs Challenge is a promising approach to chronic disease prevention via the workplace. It brings together one of the nation’s largest health-promoting voluntary agencies with the nation’s largest employers to promote evidence-based practices targeted at the most common causes of disease and death. The program increased the adoption of these practices and was well-accepted.
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Affiliation(s)
- Jeffrey R Harris
- Health Promotion Research Center, 1107 NE 45th St, Suite 200; Seattle, WA 98105.
| | - Amanda T Parrish
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, Washington
| | - Marlana Kohn
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, Washington
| | - Kristen Hammerback
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, Washington
| | - Becca McMillan
- American Cancer Society Great West Division, Seattle, Washington
| | - Peggy A Hannon
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, Washington
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Allen CL, Hammerback K, Harris JR, Hannon PA, Parrish AT. Feasibility of Workplace Health Promotion for Restaurant Workers, Seattle, 2012. Prev Chronic Dis 2015; 12:E172. [PMID: 26447549 PMCID: PMC4599055 DOI: 10.5888/pcd12.150093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Restaurant workers are a large population at high risk for tobacco use, physical inactivity, and influenza. They are difficult to reach with health care interventions and may be more accessible through workplaces, yet few studies have explored the feasibility of workplace health promotion in this population. This study sought to identify barriers and facilitators to promotion of tobacco cessation, physical activity, and influenza vaccination in restaurants. Methods Moderators conducted 7 focus groups, 3 with restaurant owners and managers, 2 with English-speaking workers, and 2 with Spanish-speaking workers. All groups were recorded, and recordings were transcribed and uploaded to qualitative-analysis software. Two researchers coded each transcript independently and analyzed codes and quotations for common themes. Results Seventy people from the restaurant industry participated. Barriers to workplace health promotion included smoking-break customs, little interest in physical activity outside of work, and misinformation about influenza vaccinations. Facilitators included creating and enforcing equitable break policies and offering free, on-site influenza vaccinations. Spanish-speakers were particularly amenable to vaccination, despite their perceptions of low levels of management support for health promotion overall. Owners required a strong business case to consider investing in long-term prevention for their employees. Conclusion Tobacco cessation and influenza vaccinations are opportunities for health promotion among restaurant workers, whereas physical activity interventions face greater challenges. Promotion of equitable breaks, limited smoking-break policies, and free, on-site influenza vaccinations could improve health for restaurant workers, who often do not have health insurance. Workplace interventions may be particularly important for Hispanic workers who have additional access barriers.
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Affiliation(s)
- Claire L Allen
- Health Promotion Research Center, University of Washington, Department of Health Services, 1107 NE 45th St, Suite 200, Seattle, WA 98105. Telephone: 206-543-5750.
| | | | - Jeffrey R Harris
- School of Public Health, University of Washington, Seattle, Washington
| | - Peggy A Hannon
- School of Public Health, University of Washington, Seattle, Washington
| | - Amanda T Parrish
- School of Public Health, University of Washington, Seattle, Washington
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Hammerback K, Hannon PA, Harris JR, Clegg-Thorp C, Kohn M, Parrish A. Perspectives on Workplace Health Promotion Among Employees in Low-Wage Industries. Am J Health Promot 2015; 29:384-92. [PMID: 25162321 PMCID: PMC5070972 DOI: 10.4278/ajhp.130924-qual-495] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Study goals were to (1) understand the attitudes of employees in low-wage industries toward workplace health promotion, including views on appropriateness of employer involvement in employee health and level of interest in workplace health promotion overall and in specific programs, and (2) determine the potential for extending workplace health promotion to spouses and partners of these employees. APPROACH The study used 42 interviews of 60 to 90 minutes. SETTING Interviews were conducted with couples (married or living together) in the Seattle/King County metropolitan area of Washington State. PARTICIPANTS Study participants were forty-two couples with one or more members working in one of five low-wage industries: accommodation/food services, education, health care/social assistance, manufacturing, and retail trade. METHOD The study employed qualitative analysis of interview transcripts using grounded theory to identify themes. RESULTS Employees consider workplace health promotion both appropriate and desirable and believe it benefits employers through increased productivity and morale. Most have little personal experience with it and doubt their employers would prioritize employee health. Employees are most interested in efforts focused on nutrition and physical activity. Both employees and their partners support extending workplace health promotion to include partners. CONCLUSION Employees and their partners are interested in workplace health promotion if it addresses behaviors they care about. Concern over employer involvement in their personal health decisions is minimal; instead, employees view employer interest in their health as a sign that they are valued.
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Kneeshaw-Price SH, Saelens BE, Sallis JF, Frank LD, Grembowski DE, Hannon PA, Smith NL, Chan KCG. Neighborhood Crime-Related Safety and Its Relation to Children's Physical Activity. J Urban Health 2015; 92:472-89. [PMID: 25801486 PMCID: PMC4456478 DOI: 10.1007/s11524-015-9949-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Crime is both a societal safety and public health issue. Examining different measures and aspects of crime-related safety and their correlations may provide insight into the unclear relationship between crime and children's physical activity. We evaluated five neighborhood crime-related safety measures to determine how they were interrelated. We then explored which crime-related safety measures were associated with children's total moderate-to-vigorous physical activity (MVPA) and MVPA in their neighborhoods. Significant positive correlations between observed neighborhood incivilities and parents' perceptions of general crime and disorder were found (r = 0.30, p = 0.0002), as were associations between parents' perceptions of general crime and disorder and perceptions of stranger danger (r = 0.30, p = 0.0002). Parent report of prior crime victimization in their neighborhood was associated with observed neighborhood incivilities (r = 0.22, p = 0.007) and their perceptions of both stranger danger (r = 0.24, p = 0.003) and general crime and disorder (r = 0.37, p < 0.0001). After accounting for covariates, police-reported crime within the census block group in which children lived was associated with less physical activity, both total and in their neighborhood (beta = -0.09, p = 0.005, beta = -0.01, p = 0.02, respectively). Neighborhood-active children living in the lowest crime-quartile neighborhoods based on police reports had 40 min more of total MVPA on average compared to neighborhood-active children living in the highest crime-quartile neighborhoods. Findings suggest that police reports of neighborhood crime may be contributing to lower children's physical activity.
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Walkinshaw LP, Mason C, Allen CL, Vu T, Nandi P, Santiago PM, Hannon PA. Process evaluation of a regional public health model to reduce chronic disease through policy and systems changes, Washington State, 2010-2014. Prev Chronic Dis 2015; 12:E37. [PMID: 25789498 PMCID: PMC4372158 DOI: 10.5888/pcd12.140446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Although the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state’s 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation. Methods We conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014. Results Challenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training. Conclusion Lessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.
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Affiliation(s)
| | - Caitlin Mason
- Health Promotion Research Center, University of Washington, Department of Health Services, 1107 NE 45th St, Ste 200, Seattle, WA 98105.
| | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | - Paj Nandi
- Washington State Department of Health, Olympia, Washington
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Fernández ME, Melvin CL, Leeman J, Ribisl KM, Allen JD, Kegler MC, Bastani R, Ory MG, Risendal BC, Hannon PA, Kreuter MW, Hebert JR. The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice. Cancer Epidemiol Biomarkers Prev 2014; 23:2512-21. [PMID: 25155759 PMCID: PMC6013073 DOI: 10.1158/1055-9965.epi-14-0097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. METHODS The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. RESULTS We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. CONCLUSIONS The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. IMPACT Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.
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Affiliation(s)
- María E Fernández
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina. Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and
| | - Kurt M Ribisl
- Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer D Allen
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roshan Bastani
- UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Marcia G Ory
- Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, Texas
| | - Betsy C Risendal
- University of Colorado School of Public Health, Denver, Colorado
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St Louis, Missouri
| | - James R Hebert
- Department of Biostatistics and Epidemiology and Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Maxwell AE, Hannon PA, Escoffery C, Vu T, Kohn M, Vernon SW, DeGroff A. Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012. Prev Chronic Dis 2014; 11:E170. [PMID: 25275807 PMCID: PMC4184085 DOI: 10.5888/pcd11.140183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Since 2009, the Centers for Disease Control and Prevention (CDC) has awarded nearly $95 million to 29 states and tribes through the Colorectal Cancer Control Program (CRCCP) to fund 2 program components: 1) providing colorectal cancer (CRC) screening to uninsured and underinsured low-income adults and 2) promoting population-wide CRC screening through evidence-based interventions identified in the Guide to Community Preventive Services (Community Guide). CRCCP is a new model for disseminating and promoting use of evidence-based interventions. If the program proves successful, CDC may adopt the model for future cancer control programs. The objective of our study was to compare the colorectal cancer screening practices of recipients of CRCCP funding (grantees) with those of nonrecipients (nongrantees). METHODS We conducted parallel Web-based surveys in 2012 with CRCCP grantees (N = 29) and nongrantees (N = 24) to assess promotion and provision of CRC screening, including the use of evidence-based interventions. RESULTS CRCCP grantees were significantly more likely than nongrantees to use Community Guide-recommended evidence-based interventions (mean, 3.14 interventions vs 1.25 interventions, P < .001) and to use patient navigation services (eg, transportion or language translation services) (72% vs 17%, P < .001) for promoting CRC screening. Both groups were equally likely to use other strategies. CRCCP grantees were significantly more likely to provide CRC screening than were nongrantees (100% versus 50%, P < .001). CONCLUSION Results suggest that CRCCP funding and support increases use of evidence-based interventions to promote CRC screening, indicating the program's potential to increase population-wide CRC screening rates.
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Affiliation(s)
- Annette E Maxwell
- University of California at Los Angeles, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900. E-mail:
| | | | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | | | - Sally W Vernon
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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