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Amboree TL, Damgacioglu H, Sonawane K, Adsul P, Montealegre JR, Deshmukh AA. Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county-level income in the United States, 2000-2019. Int J Cancer 2024; 154:1549-1555. [PMID: 38270521 DOI: 10.1002/ijc.34860] [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: 08/14/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
Early evidence suggests that declining cervical cancer incidence reversed in low-income regions in the United States in recent years; however, it is unclear whether there are distinct patterns by race/ethnicity and stage at diagnosis and if the increase has translated into rising mortality. Using Surveillance, Epidemiology, and End Results data, we evaluated trends in hysterectomy-corrected cervical cancer incidence rates (2000-2019) and mortality rates (2005-2019) by county-level income and race/ethnicity, with further stratification of incidence by stage at diagnosis. Following a period of decline, hysterectomy-corrected cervical cancer incidence increased 1.0%/year (95% CI = 0.1% to 4.5%) among Non-Hispanic White women in low-income counties. Particularly, a statistically significant 4.4%/year (95% CI = 1.7% to 7.5%) increase in distant-stage cancer occurred in this group. Additionally, recent increases in cervical cancer mortality (1.1%/year [95% CI = -1.4% to 3.7%]) were observed among this group and Non-Hispanic Black women in low-income counties (2.9%/year [95% CI = -2.3% to 18.2%]), but trends were not statistically significant. Among Hispanic women in low-income counties, distant-stage cervical cancer incidence increased 1.5%/year (95% CI = -0.6% to 4.1%), albeit not statistically significant. The increasing incidence of distant-stage cervical cancer and mortality in specific racial/ethnic groups suggests that the recent introduction of higher sensitivity screening tests may not explain increasing trends in low-income counties. Our findings suggest that the observed rise in cervical cancer incidence may reflect disruptions along the screening and treatment continuum. Future research to further comprehend these trends and continued enhancements in prevention are crucial to combat rising cervical cancer incidence and mortality in low-income counties in the United States.
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Affiliation(s)
- Trisha L Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Haluk Damgacioglu
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kalyani Sonawane
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Mapaona R, Williams V, Musarapasi N, Kibwana S, Maseko T, Chekenyere R, Gumbo S, Mdluli P, Byarugaba H, Galagedera D, Mafukidze A, Hurtado-de-Mendoza A, Adsul P, Bongomin P, Loffredo C, Dlamini X, Bazira D, Ojoo S, Haumba S. Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen. PLOS Glob Public Health 2024; 4:e0002760. [PMID: 38625931 PMCID: PMC11020862 DOI: 10.1371/journal.pgph.0002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 04/18/2024]
Abstract
This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.
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Affiliation(s)
- Rufaro Mapaona
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Rhinos Chekenyere
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sidumo Gumbo
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Phetsile Mdluli
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Dileepa Galagedera
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Christopher Loffredo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Xolisile Dlamini
- National Cancer Control Program, Ministry of Health, Mbabane, Eswatini
| | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
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3
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Schmitz KH, Chongaway A, Saeed A, Fontana T, Wood K, Gibson S, Trilk J, Adsul P, Baker S. An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology. Support Care Cancer 2024; 32:259. [PMID: 38561546 PMCID: PMC10984878 DOI: 10.1007/s00520-024-08457-8] [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: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow. METHODS For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed. RESULTS Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants' performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility). CONCLUSIONS Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA.
| | - Andrew Chongaway
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Anwaar Saeed
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Toni Fontana
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Kelley Wood
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA
| | - Susan Gibson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Trilk
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Prajakta Adsul
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
- Comprehensive Cancer Center, Cancer Control and Population Sciences Research Program, University of New Mexico, Albuquerque, NM, USA
| | - Stephen Baker
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
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4
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Adsul P, Shelton RC, Oh A, Moise N, Iwelunmor J, Griffith DM. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science. Annu Rev Public Health 2024; 45. [PMID: 38166498 DOI: 10.1146/annurev-publhealth-060922-034822] [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: 01/04/2024]
Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, we synthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA;
- Cancer Control and Population Science Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - April Oh
- National Cancer Institute, Rockville, Maryland, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Juliet Iwelunmor
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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5
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Brandt HM, Footman A, Adsul P, Ramanadhan S, Kepka D. Implementing interventions to start HPV vaccination at age 9: Using the evidence we have. Hum Vaccin Immunother 2023; 19:2180250. [PMID: 36803261 PMCID: PMC10026886 DOI: 10.1080/21645515.2023.2180250] [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: 02/22/2023] Open
Abstract
Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers.
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Affiliation(s)
- Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alison Footman
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deanna Kepka
- Huntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA
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6
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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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Adsul P, Islam J, Chebli P, Kranick J, Nash S, Arem H, Wheeler S, Lopez-Pentecost M, Foster V, Sharma RK, Felder T, Risendal B, Chavarria EA, Kwon S, Hirschey R, Trinh-Shevrin C. Identifying research practices toward achieving health equity principles within the Cancer Prevention and Control Research Network. Cancer Causes Control 2023; 34:15-21. [PMID: 36826623 PMCID: PMC9950692 DOI: 10.1007/s10552-023-01674-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Although there is national recognition for health equity-oriented research, there is limited guidance for researchers to engage partnerships that promote health equity in cancer research. The Cancer Prevention and Control Research Network's (CPCRN) Health Equity Work Group developed a toolkit to guide researchers in equitable collaborations. METHODS The CPCRN's Health Equity Work Group collectively outlined health and racial equity principles guiding research collaborations with partners that include communities, community-based organizations, implementing partners in the clinical setting including providers and health care organizations, and policy makers. Using a network-wide survey to crowdsource information around ongoing practices, we leveraged and integrated the network's experience and collaborations. RESULTS Data from the survey formed the preliminary basis for the toolkit, with a focus on sharing fiscal resources with partners, training and capacity building, collaborative decision-making, community-driven research agenda setting, and sustainability. The final toolkit provides reflection considerations for researchers and collated exemplary resources, supported by the contemporary research. CONCLUSIONS The toolkit provides a guide to researchers at all experience levels wanting to engage in equitable research collaborations. Future efforts are underway to evaluate whether and how researchers within and outside CPCRN are able to incorporate these principles in research collaborations.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
- Cancer Control and Populations Sciences Research Program, Cancer Research Facility (CRF), University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
| | | | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Julie Kranick
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Sarah Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hannah Arem
- MedStar Health Research Institute, Washington, DC, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Victoria Foster
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Betsy Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Enmanuel A Chavarria
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Simona Kwon
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
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8
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Adsul P, Wheeler SB, Young AL, Lee RJ, Brandt HM. Supporting implementation science and health equity in cancer prevention and control through research networks. Cancer Causes Control 2023; 34:35-44. [PMID: 37326779 PMCID: PMC10689544 DOI: 10.1007/s10552-023-01732-9] [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: 04/14/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a national network of academic, public health, and community organizational partners across multiple geographic sites who collaborate to reduce the cancer burden in diverse communities. Given key recommendations that suggest the need for cross-disciplinary collaboration in cancer prevention and control, we sought to explore the historical and contemporary evolution of health equity and disparities research as an area of focus within the CPCRN over time. We conducted 22 in-depth interviews with former and current leaders, co-investigators, and other members of the network. Several key themes emerged from data that were analyzed and interpreted using a constructivist, reflexive, thematic analysis approach. Nearly all participants reported a strong focus on studying health disparities since the inception of the CPCRN, which offered the network a distinct advantage in recent years for incorporating an intentional focus on health equity. Recent law enforcement injustices and the inequities observed during the COVID-19 pandemic have further invigorated network activities around health equity, such as development of a health equity-focused workgroup toolkit, among other cross-center activities. Several participants noted that, in terms of deep, meaningful, and impactful health equity-oriented research, there are still great strides for the network to make, while also acknowledging CPCRN as well-aligned with the national dialogue led by federal agency partners around health equity. Finally, several future directions were mentioned by the participants, including a focus on supporting a diverse workforce and engaging organizational partners and community members in equity-focused research. Findings from these interviews provide direction for the network in advancing the science in cancer prevention and control, with a strengthened focus on health equity.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Cancer Research Facility, Room G11, MSC07 4025, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - 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, 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
| | - Rebecca J Lee
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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Adsul P, Austin JD, Chebli P, Dias EM, Hirschey R, Ravi P, Seaman AT, Vogel R. From study plans to capacity building: a journey towards health equity in cancer survivorship. Cancer Causes Control 2023; 34:7-13. [PMID: 37851185 PMCID: PMC10689513 DOI: 10.1007/s10552-023-01808-6] [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: 11/04/2022] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
This article highlights the importance of pausing and reflecting on one's motivation, capacity, and positionality when engaging in health equity research and encourages researchers to engage in critical self-reflection and contribute to the ongoing dialogue on the ethical conduct of health equity-focused cancer research. In response to the urgent need to address health disparities and improve health equity in cancer survivorship care, the Cancer Prevention and Control Research Network (CPCRN) Survivorship workgroup discussed developing a study focused on understanding how racism impacts patient engagement in cancer survivorship care. However, during the study's development, the workgroup recognized limitations in research team composition and infrastructure. The workgroup engaged in critical self-reflections, individually and collectively, leading to the halting of the research study. Consequently, they redirected their efforts towards strengthening the necessary infrastructure for conducting such research, including diverse investigator representation and equitable partnerships with cancer survivors. The description of this process, along with suggestions for reflection, may be helpful and informative to other researchers and research networks seeking to center marginalized voices and work in partnership to address healthcare and health equity.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Perla Chebli
- Department of Population Health, Grossman School of Medicine, NYU Langone, New York, NY, USA
| | - Emanuelle M Dias
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Priyanka Ravi
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Aaron T Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Rosi Vogel
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Hirschey R, Rohweder C, Zahnd WE, Eberth JM, Adsul P, Guan Y, Yeager KA, Haines H, Farris PE, Bea JW, Dwyer A, Madhivanan P, Ranganathan R, Seaman AT, Vu T, Wickersham K, Vu M, Teal R, Giannone K, Hilton A, Cole A, Islam JY, Askelson N. Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment. Cancer Causes Control 2023; 34:159-169. [PMID: 36840904 PMCID: PMC9959942 DOI: 10.1007/s10552-023-01673-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans. METHODS States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states. RESULTS Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining "rural populations," and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community-academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities. CONCLUSION Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.
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Affiliation(s)
- Rachel Hirschey
- School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Catherine Rohweder
- Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico & University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Heidi Haines
- Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Paige E Farris
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel & Enid Zuckerman, College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Andrea Dwyer
- Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Purnima Madhivanan
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Radhika Ranganathan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Aaron T Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- MPH Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Karen Wickersham
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Maihan Vu
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Randall Teal
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Kara Giannone
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Alison Hilton
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Jessica Y Islam
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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11
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Mishra SI, Adsul P, Leekity S, Rodman J, Sussman AL, Kelly K, Sheche J, Faber T, Shah V. A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico. Cancer Causes Control 2023; 34:855-871. [PMID: 37277513 PMCID: PMC10460346 DOI: 10.1007/s10552-023-01721-y] [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: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Affiliation(s)
- Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Prajakta Adsul
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131 USA
| | - Keith Kelly
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Thomas Faber
- Albuquerque Area Indian Health Service, 4101 Indian School Rd, NE, Albuquerque, NM 87110 USA
| | - Vallabh Shah
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
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Birken SA, Wagi CR, Peluso AG, Kegler MC, Baloh J, Adsul P, Fernandez ME, Masud M, Huang TTK, Lee M, Wangen M, Nilsen P, Bender M, Choy-Brown M, Ryan G, Randazzo A, Ko LK. Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework. Front Health Serv 2023; 3:1142598. [PMID: 37720844 PMCID: PMC10501605 DOI: 10.3389/frhs.2023.1142598] [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] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
Introduction Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework. Methods The process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions. Results Twenty-four experts participated in concept mapping. Based on resulting construct groupings' coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7-13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence). Discussion Organizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.
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Affiliation(s)
- Sarah A. Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cheyenne R. Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Alexandra G. Peluso
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Michelle C. Kegler
- Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jure Baloh
- College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Manal Masud
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Terry T-K Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Matthew Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Wangen
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Miriam Bender
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Mimi Choy-Brown
- College of Education and Human Development, School of Social Work, University of Minnesota, St. Paul, MN, United States
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Aliza Randazzo
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Linda K. Ko
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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13
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Sanchez-Youngman S, Adsul P, Gonzales A, Dickson E, Myers K, Alaniz C, Wallerstein N. Transforming the field: the role of academic health centers in promoting and sustaining equity based community engaged research. Front Public Health 2023; 11:1111779. [PMID: 37457247 PMCID: PMC10345346 DOI: 10.3389/fpubh.2023.1111779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/30/2022] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. This article describes the feasibility and preliminary findings from engaging champion teams from three very different academic health centers. We reflect on the learnings from Engage for Equity PLUS; the adaptation of the intervention design and implementation, including the development of a new institutional assessment using mixed research methods; and our organizational theory of change. In summary, our design and preliminary data from the three academic health centers provide support for new attention to the role of institutional practices and processes needed to sustain equity-based patient and community-engaged research and CBPR and transform the field.
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Affiliation(s)
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Amber Gonzales
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Elizabeth Dickson
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
| | - Katie Myers
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Christina Alaniz
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Nina Wallerstein
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
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14
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Moore JX, Andrzejak SE, Casanova T, Langston ME, Estvold S, Adsul P. Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality. Int J Environ Res Public Health 2023; 20:6120. [PMID: 37372707 DOI: 10.3390/ijerph20126120] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.
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Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control & Population Health Program, Department of Medicine, Augusta University, Augusta, GA 30912, USA
- Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control & Population Health Program, Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Marvin E Langston
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 49305, USA
| | - Søren Estvold
- Department of Family Medicine, Augusta University, Augusta, GA 20912, USA
| | - Prajakta Adsul
- Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM 87131, USA
- Cancer Control and Population Sciences Research Program, Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87131, USA
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15
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Chebli P, Adsul P, Kranick J, Rohweder CL, Risendal BC, Bilenduke E, Williams R, Wheeler S, Kwon SC, Trinh-Shevrin C. Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network. Cancer Causes Control 2023; 34:371-387. [PMID: 36781715 PMCID: PMC9925365 DOI: 10.1007/s10552-023-01668-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023]
Abstract
Reflecting their commitment to advancing health equity, the Cancer Prevention and Control Research Network (CPCRN) established a Health Equity Workgroup to identify and distill guiding principles rooted in health equity, community-engaged participatory research (CBPR), social determinants of health, and racial equity frameworks to guide its collective work. The Health Equity Workgroup utilized a multi-phase, participatory consensus-building approach to: (1) identify recurrent themes in health and racial equity frameworks; (2) capture perspectives on and experiences with health equity research among CPCRN members through an online survey; (3) engage in activities to discuss and refine the guiding principles; and (4) collect case examples of operationalizing equity principles in cancer research. Representatives from all CPCRN centers endorsed nine core principles to guide the Network's strategic plan: (1) Engage in power-sharing and capacity building with partners; (2) Address community priorities through community engagement and co-creation of research; (3) Explore and address the systems and structural root causes of cancer disparities; (4) Build a system of accountability between research and community partners; (5) Establish transparent relationships with community partners; (6) Prioritize the sustainability of research benefits for community partners; (7) Center racial equity in cancer prevention and control research; (8) Engage in equitable data collection, analysis, interpretation, and dissemination practices; and (9) Integrate knowledge translation, implementation, and dissemination into research plans. Dissemination products, such as toolkits and technical assistance workshops, reflecting these principles will foster knowledge transfer to intentionally integrate health and racial equity principles in cancer prevention and control research.
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Affiliation(s)
- Perla Chebli
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA.
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Populations Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Julie Kranick
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy C Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Emily Bilenduke
- Department of Psychology Denver, University of Colorado Denver, Denver, CO, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Simona C Kwon
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
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16
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Pankratz VS, Kanda D, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. Colorectal Cancer Survival Trends in the United States From 1992 to 2018 Differ Among Persons From Five Racial and Ethnic Groups According to Stage at Diagnosis: A SEER-Based Study. Cancer Control 2022; 29:10732748221136440. [PMID: 36264283 PMCID: PMC9597478 DOI: 10.1177/10732748221136440] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction Survival following colorectal cancer (CRC) has improved in the US since 1975, but there is limited information on stage-specific survival trends among racial and ethnic subgroups. Objectives The purpose of this study was to estimate and compare trends in 1- and 5-year CRC cause-specific survival in the United States by both stage and race/ethnicity. Methods We performed a retrospective cohort study of individuals diagnosed with CRC using the 1992-2018 Surveillance, Epidemiology and End Results (SEER) database. We estimated and compared time trends in 1- and 5-year survival for CRC stage by race/ethnicity. Results Data from 399 220 individuals diagnosed with CRC were available. There were significant differences in stage-specific 1-year survival trends by race and ethnicity. Differences were most notable for distant stage CRC: survival probabilities increased most consistently for non-Hispanic American Indian/Alaska Native (AIAN) and Black (NHB) persons, but their trend lines were lower than those of Hispanic, and non-Hispanic Asian/Pacific Islander (API) and White (NHW) persons, whose initially greater gains appear to be slowing. Although the data do not support significant racial/ethnic differences in 5-year CRC survival trends by stage, AIAN and NHB persons have the lowest average survival probabilities for multiple CRC stages, and no racial/ethnic group has 5-year survival probabilities above 20% for distant-stage CRC. Conclusion Although there has been an overall improvement in adjusted CRC-specific survival probabilities since 1992, AIAN and NHB persons continue to experience worse prognosis than those of other races/ethnicities. This highlights the importance of reinvigorating efforts to understand the causes of mortality in CRC, including those which may differ according to an individual’s race or ethnicity.
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Affiliation(s)
- Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Vernon S. Pankratz, PhD, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC 07 4025, Albuquerque, NM 87131-0001, USA.
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shiraz I. Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Adsul P, Hariprasad R, Lott BE, Varon ML. Advancing the Science of Implementation for Resource-Limited Settings through Bidirectional Learning Around Cervical Cancer Screening. Ethn Dis 2022; 32:269-274. [PMID: 36388865 PMCID: PMC9590597 DOI: 10.18865/ed.32.4.269] [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: 12/29/2022] Open
Abstract
In 2020, the highest rates of cervical cancer incidence and mortality were reported in Asian and African regions of the world. Across the globe, growing evidence confirms cancer disparities among racial and ethnic minorities, low socioeconomic status groups, sexual and gender minorities, uninsured individuals, and rural residents. Recognition of these stark disparities has led to increased global efforts for improving screening rates overall and, in medically underserved populations, highlighting the urgent need for research to inform the successful implementation of cervical cancer screening. Implementation science, defined as the study of methods to promote the integration of research evidence into health care practice, is well-suited to address this challenge. With a multilevel, implementation focus, we present key research directions that can help address cancer disparities in resource-limited settings. First, we describe several global feasibility studies that acknowledge the effectiveness of self-sampling as a strategy to improve screening coverage. Second, we highlight Project ECHO as a strategy to improve providers' knowledge through an extended virtual learning community, thereby building capacity for health care settings to deliver screening. Third, we consider community health workers, who are a cornerstone of implementing public health interventions in global communities. Finally, we see tremendous learning opportunities that use contextually relevant strategies to advance the science of community engagement and adaptations that could further enhance the uptake of screening in resource-limited settings. These opportunities provide future directions for bidirectional exchange of knowledge between local and global resource-limited settings to advance implementation science and address disparities.
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Affiliation(s)
- Prajakta Adsul
- Department of Medicine, University of New Mexico, Albuquerque, NM
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | - Breanne E. Lott
- Division of Health Behavior & Implementation Science, Department of Epidemiology & Population Health, Montefiore Einstein Cancer Center, Albert Einstein College of Medicine, NY
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18
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Pankratz VS, Kosich M, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. American Indian/Alaska Native and black colon cancer patients have poorer cause-specific survival based on disease stage and anatomic site of diagnosis. Cancer Epidemiol 2022; 80:102229. [PMID: 35872382 PMCID: PMC9482950 DOI: 10.1016/j.canep.2022.102229] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Studies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic disparities in side- and stage-specific survival, we evaluated 5-year CC cause-specific survival probabilities for five racial/ethnic groups by anatomic site (right or left colon) and stage (local, regional, distant). METHODS We obtained cause-specific survival probability estimates from National Cancer Institute's population-based Surveillance, Epidemiology, and End Results (SEER) for CC patients grouped by five racial/ethnic groups (Non-Hispanic American Indian/Alaska Native [AIAN], Non-Hispanic Asian/Pacific Islander [API], Hispanic, Non-Hispanic Black [NHB], and Non-Hispanic White [NHW]), anatomic site, stage, and other patient and SEER registry characteristics. We used meta-regression approaches to identify factors that explained differences in cause-specific survival. RESULTS Diagnoses of distant-stage CC were more common among NHB and AIAN persons (>22 %) than among NHW and API persons (< 20 %). Large disparities in anatomic site-specific survival were not apparent. Those with right-sided distant-stage CC had a one-year cause-specific survival probability that was 16.4 % points lower (99 % CI: 12.2-20.6) than those with left-sided distant-stage CC; this difference decreased over follow-up. Cause-specific survival probabilities were highest for API, and lowest for NHB, persons, though these differences varied substantially by stage at diagnosis. AIAN persons with localized-stage CC, and NHB persons with regional- and distant-stage CC, had significantly lower survival probabilities across follow-up. CONCLUSIONS There are differences in CC presentation according to anatomic site and disease stage among patients of distinct racial and ethnic backgrounds. This, coupled with the reality that there are persistent survival disparities, with NHB and AIAN persons experiencing worse prognosis, suggests that there are social or structural determinants of these disparities. Further research is needed to confirm whether these CC cause-specific survival disparities are due to differences in risk factors, screening patterns, cancer treatment, or surveillance, in order to overcome the existing differences in outcome.
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Affiliation(s)
- V Shane Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America.
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Nicholas Edwardson
- University of New Mexico, School of Public Administration, the United States of America
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., the United States of America
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, the United States of America; Department of Pediatrics, University of New Mexico Health Sciences Center, the United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, the United States of America
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19
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Adsul P, Schmitz K, Basen-Engquist KM, Rogers LQ. Studying the implementation of exercise oncology interventions: a path forward. Transl J Am Coll Sports Med 2022; 7:1-8. [PMID: 36407802 PMCID: PMC9674226 DOI: 10.1249/tjx.0000000000000208] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction/Purpose Extensive scientific evidence supports exercise benefits after a cancer diagnosis and the field now needs to focus on elucidating effective strategies for implementing exercise evidence-based interventions (EBIs) for cancer survivors. Methods This paper brings together three implementation efforts to describe pragmatic observations and strategies when implementing exercise oncology EBIs in non-research settings. From these projects, we report on common implementation barriers and facilitators. We then mapped these observations and strategies on to the phases and processes described in the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Results The first implementation project used key stakeholders' perspectives to develop a toolkit to implement BEAT Cancer (Better Exercise Adherence after Treatment for Cancer), a self-managed intervention led by fitness professionals. The second project adapted a physical activity behavior change intervention (Active Living after Cancer) for use in the broader community. The third project adapted an in-person exercise intervention in a community setting (Physical Activity and Lymphedema) into an out-patient rehabilitation setting, including home-based intervention elements (Strength After Breast Cancer). We retrospectively collated and operationalized the implementation strategies based on the Experts Recommending Implementation Change (ERIC) study. The most common implementation barriers were related to funding, organizational capacity and training, relationship building, patient referral, and engagement with patients. Conclusions These implementation strategies provide initial starting points for the implementation of exercise oncology EBIs in clinical and community settings while also serving as examples for future implementation research to advance the translation of exercise oncology evidence.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico,
Albuquerque, NM, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College
of Medicine, Hershey, PA, USA
| | - Karen M. Basen-Engquist
- Department of Behavioral Science, The University of Texas
MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Q. Rogers
- Department of Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
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20
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Adewumi K, Nishimura H, Oketch SY, Adsul P, Huchko M. Barriers and Facilitators to Cervical Cancer Screening in Western Kenya: a Qualitative Study. J Cancer Educ 2022; 37:1122-1128. [PMID: 33411253 PMCID: PMC9257902 DOI: 10.1007/s13187-020-01928-6] [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] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
About nine out of 10 cervical cancer deaths occur in low-resource countries, with a particularly high burden in sub-Saharan Africa. The objectives of this study were to assess barriers and facilitators to cervical cancer screening in western Kenya from the perspectives of community members and healthcare providers. We conducted two focus groups with female community members (n = 24) and one with providers (n = 12) in Migori County, Kenya. Discussion guides queried about knowledge and awareness of cervical cancer prevention; structural, social, and personal barriers; and facilitators towards cervical cancer screening uptake. Group discussions were recorded, transcribed, and analyzed for emerging themes. Participants in both groups reported low awareness of HPV and cervical cancer screening in the community, and identified that as a main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that providers' lack of knowledge and discomfort with a sensitive subject were significant barriers. A personal connection to cervical cancer and/or screening was associated with willingness to screen and awareness. Providers reported workload and lack of supplies and trained staff as significant barriers to offering services. Based on these findings, we identified three intervention components to address these facilitators and barriers to screening. They include utilizing existing social networks to expand awareness of cervical cancer risk and screening, training non-physician health workers to meet the demand for screening, and employing female-driven screening techniques such as self-collection of specimens for HPV testing. Cervical cancer prevention programs must take into account the local realities in which they occur. In low-resource areas in particular, identifying low-cost, effective, and culturally appropriate strategies for addressing poor screening uptake is important given limited funding. This study took a formative approach to identify facilitators and barriers to cervical cancer screening based on focus groups and interviews with community members and healthcare providers.
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Affiliation(s)
- Konyin Adewumi
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Holly Nishimura
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Prajakta Adsul
- National Cancer Institute/National Institutes of Health, Bethesda, MD, USA
| | - Megan Huchko
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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21
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Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022. [PMID: 35756657 DOI: 10.3389/fonc.2022.841951:10.3389/fonc.2022.841951] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. METHODS Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. RESULTS A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. CONCLUSION Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
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Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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22
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Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022; 12:841951. [PMID: 35756657 PMCID: PMC9213655 DOI: 10.3389/fonc.2022.841951] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. Methods Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. Results A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. Conclusion Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
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Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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23
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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Baumann AA, Woodward EN, Singh RS, Adsul P, Shelton RC. Assessing researchers' capabilities, opportunities, and motivation to conduct equity-oriented dissemination and implementation research, an exploratory cross-sectional study. BMC Health Serv Res 2022; 22:731. [PMID: 35650573 PMCID: PMC9161573 DOI: 10.1186/s12913-022-07882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A recent paradigm shift has led to an explicit focus on enhancing health equity through equity-oriented dissemination and implementation (D&I) research. However, the integration and bidirectional learning across these two fields is still in its infancy and siloed. This exploratory study aimed to examine participants' perceived capabilities, opportunities, and motivations to conduct equity-oriented D&I research. METHODS We conducted an exploratory cross-sectional survey distributed online from December 2020 to April 2021. Participants were recruited at either D&I or health disparities-oriented conferences, meetings, through social media, or personal outreach via emails. Informed by the Capability, Opportunity, and Motivation Model (COM-B), the survey queried respondents about different aspects of engaging in and conducting equity-oriented D&I research. All analyses were conducted in SPSS Version 27.0. RESULTS A total of 180 participants responded to the survey. Most participants were women (81.7%), white (66.1%), academics (78.9%), and faculty members (53.9%). Many reported they were advanced (36.7%) or advanced beginners (27.8%) in the D&I field, and a substantial proportion (37.8%) reported being novice in D&I research that focused on health equity. Participants reported high motivation (e.g., 62.8% were motivated to apply theories, models, frameworks for promoting health equity in D&I research), but low capability to conduct equity-oriented D&I research (e.g., 5% had the information needed for promoting health equity in D&I research). Most participants (62.2%) reported not having used measures to examine equity in their D&I projects, and for those who did use measures, they mainly used individual-level measures (vs. organizational- or structural-level measures). When asked about factors that could influence their ability to conduct equity-oriented D&I research, 44.4% reported not having the skills necessary, and 32.2% stated difficulties in receiving funding for equity-oriented D&I research. CONCLUSIONS Study findings provide empirical insight into the perspectives of researchers from different backgrounds on what is needed to conduct equity-oriented D&I research. These data suggest the need for a multi-pronged approach to enhance the capability and opportunities for conducting equity-oriented D&I work, such as: training specifically in equity-oriented D&I, collaboration between D&I researchers with individuals with expertise and lived experience with health equity research, funding for equity-oriented D&I research, and recognition of the value of community engaged research in promotion packages.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Eva N. Woodward
- Center for Mental Healthcare and Outcomes Research, U.S. Department of Veterans Affairs, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Rajinder Sonia Singh
- South Central Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, North Little Rock, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY USA
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Adsul P, Myers KJ, Kanda D, Jaffe T, Tawfik B, Wu E, McClain M, Pankratz S, Mishra SI, Nair U, Stimatze T, Madhivanan P, Kano MA. Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5533] [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: 11/20/2022] Open
Abstract
5533 Background: Population-based studies to examine cervical cancer screening (CCS) and prevention among sexual and gender diverse (SGD) individuals have been limited. We conducted a state-wide survey in New Mexico to examine differences in CCS and HPV vaccination uptake based on gender and sexual orientation. Methods: The survey was advertised using mailed flyers, social media, and targeted internet ads across the state. We received a total of 2534 responses, of which 797 respondents were CCS eligible (i.e., between 21-65 years old, had a cervix, and did not have a prior cervical cancer diagnosis) and provided information about CCS and were included in this analysis. Descriptive statistics were conducted using SAS 9.4. Results: Of the 797 respondents, 83% were 21 - 40 years old, 44% were white, 34% reported an annual household income below $50,000, 83% were employed, 81% had health insurance, and 73% reported having a primary care provider. Fourteen percent were transgender men or nonbinary, 86% were cisgender women, 34% were bisexual, 48% were lesbian, and 18% were queer. While there were no statistical differences in self-reported CCS based on gender identity, 31% of cisgender women and 25% of transgender men and nonbinary individuals reported never receiving a Pap test. The top reason for never receiving a Pap test among cisgender women was that their healthcare provider told them they did not need it (17%) and for transgender men and nonbinary individuals the top reasons were that they had an HPV vaccine (21%) or that it was too painful, unpleasant, or embarrassing (21%). There were significant statistical differences based on sexual orientation for receiving a Pap test (p < 0.001) and for being up to date on screening (Pap test in the past 3 years, a co-test, or primary HPV test in the past 5 years) (p = 0.03). Among lesbians, 39% reported never having a Pap test, compared with 17% of bisexuals and 30% of queer individuals. For lesbians, the top reason for not receiving a Pap test was not knowing that Pap tests existed (19%), while the top reason for both bisexual and queer individuals was that their healthcare provider told them they did not need it (17% and 19%, respectively). No significant differences were noted in HPV vaccination uptake among respondents. Conclusions: In order to address sexual orientation differences noted in our study, future research is needed to explore mechanisms through which these differences operate using community-based approaches. Additionally, educational interventions inclusive of different gender identities and sexual orientations are needed to improve motivations for screening uptake among SGD individuals. Finally, specific considerations for SGD individuals should be incorporated into screening recommendations and guidelines and clearly communicated to providers, further enabling them to make recommendations for these populations.
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Affiliation(s)
- Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | | | - Bernard Tawfik
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Emily Wu
- University of New Mexico Cancer Center, Albuquerque, NM
| | | | - Shane Pankratz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Uma Nair
- University of South Florida, Tampa, FL
| | | | - Purnima Madhivanan
- University of Arizona, Department of Health Promotion Sciences, Tucson, AZ
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Kizub DA, Eldridge L, Tittenbrun Z, Cira MK, Duncan K, Hohman K, Given L, Foxhall LE, Adsul P. Exploring country priorities and contextual considerations for implementing national cancer control plans (NCCP) among participants of International Cancer Control Partnership (ICCP) ECHO. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1581] [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: 11/20/2022] Open
Abstract
1581 Background: Promoting NCCP implementation by low- and middle-income countries (LMICs) is key to addressing inequities in cancer outcomes and the global burden of cancer. We explored contextual factors that may influence implementation of NCCP priorities in LMICs. Methods: Seven countries participated in the 2021 International Cancer Control Partnership ECHO (R) geared toward creating a community of practice to inform NCCP implementation. Using qualitative methods, we conducted focus group discussions (FGDs) with country teams who were asked to identify NCCP priorities and provide contextual considerations around implementing these in the 12-months program. FGDs were audio-recorded, transcribed, double-coded, and underwent thematic analysis. Results: Thirty-three participants from 6 Sub-Saharan African countries and 1 country in Asia took part in 7 FGDs, including 14 physicians, 9 non-governmental organizations, 6 Ministry of Health/NCCP and 4 cancer registry representatives. All seven country teams (100%) prioritized cancer early detection, especially for cervical (71%) and breast (57%) cancer, including by educating primary care clinicians (57%) and general population (43%) about cancer signs and symptoms. Related contextual factors included late-stage diagnosis of cancer (43%) and low knowledge about cancer among primary care clinicians and the general population (29% each), respectively. Finding resources for implementation of NCCP priorities was important given lack of funding (57% each). Harmonizing programs and building partnerships for implementation (57%) was prioritized given perceived fragmentation of efforts and benefit of leveraging limited resources (29% each). Improving access to treatment (43%) was a priority given a lack of oncology specialists (29%) and unaffordable treatment (14%). Improving access to palliative care (43%), including by writing guidelines (29%), was prioritized due to late-stage diagnosis and insufficient access to palliative care (14% each). Improving cancer registry data was essential for NCCP program planning (43% each), while cancer research (43%) was key to answering specific questions related to cancer registry data (14%) and program impact (29%). Additional contextual considerations for making progress on these priorities dicussed by country teams included leveraging existing programs (100%) and learning from other countries and ICCP technical experts (57% each). Conclusions: There were similarities in country NCCP priorities and contextual factors affecting implementation. These results allow for future exploration of how LMIC country teams implement NCCPs and examine the value of communities of practice promoted by ICCP and facilitated by ECHO, towards improving cancer outcomes.
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Affiliation(s)
| | - Linsey Eldridge
- Center for Global Health, National Cancer Institute, Rockville, MD
| | | | - Mishka K. Cira
- Center for Global Health, National Cancer Institute, Rockville, MD
| | - Kalina Duncan
- Center for Global Health, National Cancer Institute, Rockville, MD
| | | | | | | | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
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Rodman J, Mishra SI, Adsul P. Improving Comprehensive Cancer Control State Plans for Colorectal Cancer Screening in the Four Corners Region of the United States. Health Promot Pract 2022:15248399211073803. [PMID: 35184614 DOI: 10.1177/15248399211073803] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) disparities continue to persist in the four corners region (states of New Mexico, Arizona, Utah, and Colorado) of the United States. The Comprehensive Cancer Control (CCC) state plans provide a policy and practice snapshot on how a state identifies and addresses its cancer burden. This study critically examines the four state plans to identify gaps and opportunities for cancer prevention and control. Using a conventional content analysis approach, we reviewed the CCC plans for CRC screening-related information, culminating in a conceptual framework that highlights three themes. First, states reported their cancer burden using national data from American Cancer Society, Centers for Disease Control and Prevention, or the NCI's Surveillance, Epidemiology, and End Results. Although these data informed specific goals and objectives, not all plans reported state-level data on CRC differences by specific social determinants of health and other characteristics. Second, it was not clear whether the interventions chosen to address state plan objectives were evidence-based and whether or not clearly described criteria were used for the selection of the interventions. Third, very limited information was provided in terms of state-specific contextual challenges and practical implementation of interventions. Study findings highlight opportunities to improve state-level cancer prevention and control efforts: first, by promoting the selection and adaptation of contextually relevant evidence-based interventions for this unique region; and second, through multidirectional engagement with communities, researchers, and policy and practice stakeholders. Such synergies in research and policies are vital for a coordinated and integrated approach to cancer prevention and control.
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Affiliation(s)
- Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
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Broutet N, Jeronimo J, Kumar S, Almonte M, Murillo R, Huy NVQ, Denny L, Kapambwe S, Bhatla N, Sebitloane M, Zhao F, Gravitt P, Adsul P, Rangaraj A, Dalal S, Newman M, Chowdhury R, Church K, Nakisige C, Diop M, Parham G, Thomson KA, Basu P, Steyn P. Implementation research to accelerate scale-up of national screen and treat strategies towards the elimination of cervical cancer. Prev Med 2022; 155:106906. [PMID: 34896155 DOI: 10.1016/j.ypmed.2021.106906] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 05/03/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem. MAIN BODY New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts. CONCLUSION For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.
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Affiliation(s)
| | - Jose Jeronimo
- Consultant for the US National Cancer Institute, MD, USA
| | | | - Maribel Almonte
- International Agency for Research in Cancer (IARC), Lyon, France
| | | | | | | | | | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Fanghui Zhao
- Chinese Academy of Medical Sciences, Beijing, China
| | - Patti Gravitt
- University of Maryland Baltimore, Baltimore, MD, USA
| | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, USA
| | | | - Shona Dalal
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Mamadou Diop
- Cancer Institute, Le Dantec Hospital, Cheikh Anta Diop University, Senegal
| | - Groesbeck Parham
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry A Thomson
- PATH, Sexual & Reproductive Health Program, Seattle, WA, USA
| | - Partha Basu
- International Agency for Research in Cancer (IARC), Lyon, France
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Wray RJ, Nicks SE, Adsul P, Elliot M, Enard K, Jupka K, Trainer AK, Hansen N, Shahid M, Wright-Jones R, Siddiqui S. Promoting informed prostate cancer screening decision-making for African American men in a community-based setting. Cancer Causes Control 2022; 33:503-514. [PMID: 35091864 DOI: 10.1007/s10552-021-01544-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Current screening guidelines for prostate cancer (PCa) encourage men to make individual screening decisions after consulting with their primary care provider to weigh the risks and benefits of undergoing prostate specific antigen (PSA) testing, but many men at high risk of PCa diagnosis (notably African American men) are more likely to be uninsured and lack a primary care provider. An academic-community partnership redesigned its community-based screening program to ensure access to services for African American men, incorporating a session with a trained clinical educator in community settings, designed to increase knowledge and promote informed decision-making regarding PSA testing. This study evaluated effects of the intervention on decision-making outcomes. METHODS To evaluate program efficacy, 88 men completed pre- and post-test surveys assessing outcomes of interest. RESULTS Participants' knowledge, beliefs, attitudes, anxiety levels, and self-efficacy all improved from pre- to post-test at a statistically significant level. Most notably participants' awareness that PCa is often not life-threatening, and watchful waiting is a reasonable treatment option increased after the encounter. More than half of the study sample felt they had received enough knowledge to make an informed decision about whether the PSA test was right for them. CONCLUSION Our findings show the program had positive effects on men's ability to make informed decisions about PCa screening and demonstrate that educational outreach programs with an emphasis on informed decision-making can effectively balance screening guidelines with the needs of underserved populations in community settings to improve outcomes.
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Affiliation(s)
- Ricardo J Wray
- Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO, USA
| | - Shannon E Nicks
- Center for Health Equity, Dayton Children's Hospital, Dayton, OH, USA.
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Michael Elliot
- Department of Epidemiology and Biostatistics, Saint Louis University, St. Louis, MO, USA
| | - Kimberly Enard
- Department of Health Management and Policy, Saint Louis University, St. Louis, MO, USA
| | - Keri Jupka
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | | | - Natasha Hansen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
| | | | | | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
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Adsul P, Quezada K, Myers K, Jaffe T, Tawfik B, Wu E, McClain M, Mishra S, Kano M. Abstract PO-080: Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-080] [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
Purpose Despite about 5% of the US population identifying as Sexual and Gender Diverse (SGD), there is limited research on cancer prevention and control disparities in this population. In New Mexico (NM), population-level data from the Department of Health show differences in cervical and breast cancer screening uptake based on sexual orientation, but these data do not document disparities based on gender identity and for other types of cancer, prompting us to assess cancer prevention practices among NM SGD communities. SGD communities have consistently been considered “hard to reach” and much of the extant SGD studies have been conducted in large urban cities. We present findings on how to implement innovative, multi-pronged, and systematic recruitment strategies to engage SGD communities in NM, a state that is both largely rural and racially classified as “majority-minority” state. Methods Our recruitment efforts focused on four strategies: (1) Every Door Direct Mail program (by the United States Postal Services) was used to mail flyers across targeted (based on residential areas, income below $30,000, and between ages 30-71) mailing routes across NM. (2) These routes were also targeted for study-related ads via Google, Twitter, and Facebook. (3) Email outreach was conducted with SGD-friendly businesses, state cancer coalitions, and the University of New Mexico Comprehensive Cancer Center's Office of Community Outreach and Engagement. (4) Flyers were displayed at clinical and community settings across NM. All flyers, ads, and emails contained QR codes for a pre-survey that determined eligibility for participation in the main survey (i.e. 21-80 years old, NM resident, member of SGD community). Questions on the online survey, provided in both English and Spanish, inquired about the participant's demographics, body organs, physical health, vaccination history, healthcare access, and cancer screening practices. Results A total of 27,369 flyers were distributed and 436,177 impressions were made on social media, resulting in 5,080 surveys from eligible participants. Approximately 68% heard about the study from social media, 17% from email, 16% through friends or family, and 12% from flyers. All eligible participants were then emailed three times and, in a few cases, mailed a survey. This resulted in 3,115 completed surveys. Half of respondents were between 31-40 years, 38% were Black, Hispanic, or American Indian/Alaskan Native, and 48% had an annual household income below $50,000. Eighteen percent identified as lesbian, 30% gay, 28% bisexual, and 18% queer, while 48% were cisgender men, 32% cisgender women, and 13% transgender. Approximately 44% reported residing in rural areas and responses were received from 172 unique NM zip codes. Conclusion To reach state-wide SGD communities and engage them in population-based research, innovative and systematic efforts are needed. Social media and postal flyers may provide successful recruitment opportunities with potential to use these methods for future public health interventions for these populations.
Citation Format: Prajakta Adsul, Karen Quezada, Katie Myers, Talya Jaffe, Bernard Tawfik, Emily Wu, Molly McClain, Shiraz Mishra, Miria Kano. Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-080.
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Affiliation(s)
| | | | | | | | | | - Emily Wu
- 1University of New Mexico, Albuquerque, NM
| | | | | | - Miria Kano
- 1University of New Mexico, Albuquerque, NM
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Adsul P, de Cortina SH, Pramathesh R, Jayakrishna P, Srinivas V, Nethan ST, Dhanasekaran K, Hariprasad R, Madhivanan P. Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore. PLOS Glob Public Health 2022; 2:e0000570. [PMID: 36962451 PMCID: PMC10021426 DOI: 10.1371/journal.pgph.0000570] [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] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Cervical cancer is the second most common cancer among Indian women. Screening is an effective prevention strategy, but achieving high screening rates depend upon identifying barriers at multiple levels of healthcare delivery. There is limited research on understanding the perspectives of providers who deliver cancer prevention services. The objective of this study was to explore physician perspectives on cervical cancer prevention, barriers to effective implementation, and strategies to overcome these barriers in India. Guided by the "Multilevel influences on the Cancer Care Continuum" theoretical framework, we conducted semi-structured interviews with physicians in Mysore, India. From November 2015- January 2016, we interviewed 15 (50.0%) primary care physicians, seven (23.3%) obstetrician/gynecologists, six (20.0%) oncologists, and two (6.7%) pathologists. We analyzed interview transcripts in Dedoose using a grounded theory approach. Approximately two-thirds (n = 19, 63.3%) of the participants worked in the public sector. Only seven (23.3%) physicians provided cervical cancer screening, none of them primary care physicians. Physicians discussed the need for community-level, culturally-tailored education to improve health literacy and reduce stigma surrounding cancer and gynecologic health. They described limited organizational capacity in the public sector to provide cancer prevention services, and emphasized the need for further training before they could perform cervical cancer screening. Physicians recommend an integrated strategy for cervical cancer prevention at multiple levels of uptake and delivery with specific efforts focused on culturally-tailored stigma-reducing education, community-level approaches utilizing India's community health workers, and providing physician training and continuing education in cancer prevention.
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Affiliation(s)
- Prajakta Adsul
- Public Health Research Institute of India, Mysore, India
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Sasha Herbst de Cortina
- Public Health Research Institute of India, Mysore, India
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
- School of Medicine, University of California Irvine, Irvine, California, United States of America
| | | | | | | | - Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India
- Health Promotion Sciences Department, Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. Implementation Research and Practice 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington, USA
- Georgetown University, Center for Men’s Health Equity, Washington, USA
- Department of Health Systems Administration at the School of Nursing & Health Studies, Georgetown University, Washington, USA
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Abdi HI, Hoover E, Fagan SE, Adsul P. Cervical Cancer Screening Among Immigrant and Refugee Women: Scoping-Review and Directions for Future Research. J Immigr Minor Health 2021; 22:1304-1319. [PMID: 32350683 DOI: 10.1007/s10903-020-01014-5] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to explore existing research on determinants of cervical cancer screening among immigrants and refugees in the U.S. A scoping review was conducted on 77 studies targeting immigrant and/or refugee women in the U.S., investigating factors related to cervical cancer screening. Sixty-three percent of studies were conducted in the past ten years, and included 122,345 women. Studies predominately explored knowledge, beliefs and barriers related to cervical cancer and screening. Common beliefs included fear of cancer, treatment and death. Participants perceived pap smears to be associated with embarrassment, pain and fear. Barriers to screening were reported in three categories: psychosocial (shame and embarrassment), communication (inability to speak in English), and barriers related to access (lack of insurance or primary care provider). Study findings indicate research focused at the individual-level and future research should focus on exploring multilevel influences on cancer screening uptake.
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Affiliation(s)
- Hamdi I Abdi
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN, 55455, USA
| | | | | | - Prajakta Adsul
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, 1 University of New Mexico, 2325 Camino de Salud, Albuquerque, NM, 87131, USA.
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Blair CK, Adsul P, Guest DD, Sussman AL, Cook LS, Harding EM, Rodman J, Duff D, Burgess E, Quezada K, Brown-Glaberman U, King TV, Baca E, Dayao Z, Pankratz VS, Davis S, Demark-Wahnefried W. Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors. Nutrients 2021; 13:2319. [PMID: 34371829 PMCID: PMC8308636 DOI: 10.3390/nu13072319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 06/06/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/22/2023] Open
Abstract
Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with Master Gardeners from the Cooperative Extension System. Initially developed and tested in Alabama, the program was adapted for the different climate, growing conditions, and population in New Mexico. This paper chronicles the feasibility, acceptability, and preliminary efficacy of "Southwest Harvest for Health". During the nine-month single-arm trial, 30 cancer survivor-Master Gardener dyads worked together to establish and maintain three seasonal gardens. Primary outcomes were accrual, retention, and satisfaction. Secondary outcomes were vegetable and fruit (V and F) intake, physical activity, and quality of life. Recruitment was diverse and robust, with 30 survivors of various cancers, aged 50-83, roughly one-third minority, and two-thirds females enrolled in just 60 days. Despite challenges due to the COVID-19 pandemic, retention to the nine-month study was 100%, 93% reported "good-to-excellent" satisfaction, and 87% "would do it again." A median increase of 1.2 servings of V and F/day was documented. The adapted home-based vegetable gardening program was feasible, well-received, and resulted in increased V and F consumption among adult cancer survivors. Future studies are needed to evaluate the effectiveness of this program and to inform strategies to increase the successful implementation and further dissemination of this intervention.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Dolores D. Guest
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Elizabeth M. Harding
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA;
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Dorothy Duff
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM 87107, USA;
| | - Ellen Burgess
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Karen Quezada
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Ursa Brown-Glaberman
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Towela V. King
- School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (T.V.K.); (E.B.)
| | - Erika Baca
- School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (T.V.K.); (E.B.)
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Vernon Shane Pankratz
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA;
- University of New Mexico Prevention Research Center, Albuquerque, NM 87131, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Abstract
Implementation science (IS) has emerged in response to a striking research-to-practice gap, with the goal of accelerating and addressing the development, translation, and widespread uptake of evidence-based interventions (EBIs). Despite the promise of IS, critical gaps and opportunities remain within the field to explicitly facilitate health equity, particularly as they relate to the role of social determinants of health and structural racism. In this commentary, we propose recommendations for the field of IS to include structural racism as a more explicit focus of our work. First, we make the case for including structural racism as a construct and promote its measurement as a determinant within existing IS frameworks/models, laying the foundation for an empirical evidence base on mechanisms through which such factors influence inequitable adoption, implementation, and sustainability of EBIs. Second, we suggest considerations for both EBIs and implementation strategies that directly or indirectly address structural racism and impact health equity. Finally, we call for use of methods and approaches within IS that may be more appropriate for addressing structural racism at multiple ecological levels and clinical and community settings in which we conduct IS, including community-based participatory research and stakeholder engagement. We see these as opportunities to advance the focus on health equity within IS and conclude with a charge to the field to consider making structural racism and the dismantling of racism an explicit part of the IS research agenda.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Prajakta Adsul
- Department of Medicine, University of New Mexico, Albuquerque, NM
| | - April Oh
- National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, MD
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Percy-Laurry A, Adsul P, Uy A, Vinson C. Improving Evidence-Based Program Repositories: Introducing the Evidence-Based Cancer Control Programs (EBCCP) Web Repository. Am J Health Promot 2021; 35:897-899. [PMID: 33827272 DOI: 10.1177/08901171211006589] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To reduce the research to practice gap, promoting the utility of evidence-based repositories is essential among both practitioners and researchers. Organizing these repositories to address the needs of these audiences requires a user-centered design approach as proposed recently in an article by Harden et al, 2020. This commentary builds on the proposed solutions to introduce a recently redesigned Evidence-Based Cancer Control Programs (EBCCP) web repository (formerly Research-Tested Intervention Programs (RTIPs)) from the National Cancer Institute. Specifically, we describe the user-centered redesign process, strategies for broader dissemination of the repository using digital tools and provide future directions for the evidence-based program repository.
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Affiliation(s)
- Antoinette Percy-Laurry
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Prajakta Adsul
- Department of Internal Medicine, 2511School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Annabelle Uy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Cynthia Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Blair CK, Harding EM, Adsul P, Moran S, Guest D, Clough K, Sussman AL, Duff D, Cook LS, Rodman J, Dayao Z, Brown-Glaberman U, King TV, Pankratz VS, Servin E, Davis S, Demark-Wahnefried W. Southwest Harvest for Health: Adapting a mentored vegetable gardening intervention for cancer survivors in the southwest. Contemp Clin Trials Commun 2021; 21:100741. [PMID: 33659763 PMCID: PMC7896154 DOI: 10.1016/j.conctc.2021.100741] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/26/2020] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Few diet and physical activity evidence-based interventions have been routinely used in community settings to achieve population health outcomes. Adapting interventions to fit the implementation context is important to achieve the desired results. Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with certified Master Gardeners from the Cooperative Extension Service with the ultimate goal of increasing vegetable consumption and physical activity, and improving physical functioning and health-related quality-of-life. Harvest for Health has potential for widespread dissemination since Master Gardener Programs exist throughout the United States. However, state- and population-specific adaptations may be needed to improve intervention adoption by other Master Gardener Programs. Our primary objective was to adapt this evidence-informed intervention that was initially incepted in Alabama, for the drastically different climate and growing conditions of New Mexico using a recommended adaptation framework. Our secondary objective was to develop a study protocol to support a pilot test of the adapted intervention, Southwest Harvest for Health. The adaptation phase is a critical first step towards widespread dissemination, implementation, and scale-out of an evidence-based intervention. This paper describes the adaptation process and outcomes, and the resulting protocol for the ongoing pilot study that is currently following 30 cancer survivors and their paired Extension Master Gardener mentors.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Sara Moran
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Dolores Guest
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Kathy Clough
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dorothy Duff
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ursa Brown-Glaberman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Towela V. King
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - V. Shane Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Eduardo Servin
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Prevention Research Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Arana-Chicas E, Gómez-Trillos S, Cartujano-Barrera F, Xinico-Aju SA, Alvarez CS, Adsul P, Rosenthal MS, Braithwaite D, Hurtado-de-Mendoza A, Cupertino AP. Cancer Prevention in Indigenous Communities from Guatemala: A Needs Assessment Study. J Health Care Poor Underserved 2021; 31:1595-1611. [PMID: 33416741 DOI: 10.1353/hpu.2020.0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Guatemala lacks cancer prevention strategies and has low screening rates. OBJECTIVE To assess the history of chronic conditions, risk factors, and cancer screening uptake among three Indigenous populations of Southwestern Guatemala. METHODS We conducted a health needs assessment. RESULTS The assessment was completed by 247 adults. Median age was 40 years old (IR: 28-59). Most participants were female (94.3%), of Mayan descent (95.8%), and did not have a primary health care provider (84.2%). Most have never been screened for colorectal (men=100.0%; women=98.8%), prostate (75.0%), breast (90.9%), or cervical (76.9%) cancer, and all have severe tooth decay. However, most participants reported healthy behaviors including being physically active (women=59.7%; men=92.9%), being nonsmokers (women=99.6%; men=78.6%), and not consuming alcohol (women=82.3%; men=46.7%). CONCLUSIONS Although most participants reported healthy behaviors, there is a remarkable lack of access to cancer screening. An increase in cancer incidence is expected unless cancer prevention efforts are undertaken.
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Krupp K, Adsul P, Wilcox ML, Srinivas V, Frank E, Srinivas A, Madhivanan P. Prevalence and correlates of metabolic syndrome among rural women in Mysore, India. Indian Heart J 2020; 72:582-588. [PMID: 33357649 PMCID: PMC7772584 DOI: 10.1016/j.ihj.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/24/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
Aims Metabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India. Methods Data were gathered in a community-based study of 500 rural and tribal women residing in the Mysore district, between the age of 30–59 years. The study used the WHO STEPS approach, in which information on demographics and behavioral risk factors were collected. Along with anthropometric measurements, blood pressure, blood glucose, lipids were measured. A harmonized definition of MetS recommended by International Diabetes Federation Task Force on Epidemiology and Prevention was used in this study. Results Three out of five study participants were found to have MetS (47.1%, n = 223). Of those, 56.5% met 3 of the 5 criteria, 32.2% met 4 criteria, and 11.2% met all 5 criteria. Among the entire sample, low HDL was the most prevalent criterion (88.4%), followed by elevated glucose (57.9%), elevated triglycerides (49.3%), elevated BP (41.5%), and increased waist circumference (15.3%). In this sample, women with METS were generally older (p < 0.001), housewives (p = 0.001), that consumed salty highly processed foods (p = 0.020) and had low physical activity (p = 0.015). Conclusions This study showed a high prevalence of MetS in rural women. There is a compelling need for interventions aimed at reducing CHD risk factors in this population.
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Affiliation(s)
- Karl Krupp
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; Public Health Research Institute of India, Mysore, India.
| | - Prajakta Adsul
- National Cancer Institute, National Institutes for Health, USA
| | - Meredith L Wilcox
- Midwest Biomedical Research/Center for Metabolic and Cardiovascular Health, Addison, IL, USA; MB Clinical Research, Boca Raton, FL, USA
| | | | | | - Arun Srinivas
- Department of Cardiology, Apollo Hospital, Mysore, India
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; Public Health Research Institute of India, Mysore, India; Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, USA; Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, USA
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Gravitt PE, Rositch AF, Jurczuk M, Meza G, Carillo L, Jeronimo J, Adsul P, Nervi L, Kosek M, Tracy JK, Paz-Soldan VA. Integrative Systems Praxis for Implementation Research (INSPIRE): An Implementation Methodology to Facilitate the Global Elimination of Cervical Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:1710-1719. [PMID: 32561563 DOI: 10.1158/1055-9965.epi-20-0501] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has called for a systems thinking approach to health systems strengthening to increase adoption of evidence-based interventions (EBI). The Integrative Systems Praxis for Implementation Research (INSPIRE) methodology operationalizes the WHO systems thinking framework to meet cervical cancer elimination-early detection and treatment (CC-EDT) goals. METHODS Using a systems thinking approach and grounded in the consolidated framework for implementation research, INSPIRE integrates multiple research methodologies and evaluation frameworks into a multilevel implementation strategy. RESULTS In phase I (creating a shared understanding), soft systems methodology and pathway analysis are used to create a shared visual understanding of the CC-EDT system, incorporating diverse stakeholder perspectives of the "what, how, and why" of system behavior. Phase II (finding leverage) facilitates active stakeholder engagement in knowledge transfer and decision-making using deliberative dialogues and multiple scenario analyses. Phase III (acting strategically) represents stakeholder-engaged implementation planning, using well-defined implementation strategies of education, training, and infrastructure development. In phase IV (learning and adapting), evaluation of key performance indicators via a reach, effectiveness, adoption, implementation, and maintenance framework is reviewed by stakeholder teams, who continuously adapt implementation plans to improve system effectiveness. CONCLUSIONS The INSPIRE methodology is a generalizable approach to context-adapted implementation of EBIs. IMPACT Replacing static dissemination of implementation "roadmaps" with learning health systems through the integration of systems thinking and participatory action research, INSPIRE facilitates the development of scalable and sustainable implementation strategies adapted to local contexts.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Magdalena Jurczuk
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Graciela Meza
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | | | - Jose Jeronimo
- Global Coalition Against Cervical Cancer, Arlington, Virginia
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Laura Nervi
- College of Population Health, University of New Mexico, Albuquerque, New Mexico
| | - Margaret Kosek
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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Adsul P, Nayaka S, Pramathesh R, Gowda S, Jaykrishna P, Srinivas V, Madhivanan P. Using photovoice to understand the context of cervical cancer screening for underserved communities in rural India. Glob Health Promot 2020; 27:50-58. [PMID: 32400290 DOI: 10.1177/1757975920915677] [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
Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30-51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women's health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, USA.,Public Health Research Institute of India, Mysore, India
| | | | | | - Savitha Gowda
- Public Health Research Institute of India, Mysore, India
| | | | | | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India.,Mel & Enid Zuckerman College of Public Health, University of Arizona, USA
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Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri J. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health 2020; 20:654. [PMID: 32393218 PMCID: PMC7216595 DOI: 10.1186/s12889-020-08777-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 01/15/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. METHODS A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM. RESULTS Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. CONCLUSIONS Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.
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Affiliation(s)
- Breanne E Lott
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mario J Trejo
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Christina Baum
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - D Jean McClelland
- Health Sciences Library, University of Arizona, 1501 N Campbell Ave Ward 6, Tucson, AZ, 85724, USA
| | - Prajakta Adsul
- School of Medicine and Cancer Center, University of New Mexico, MSC08 4720, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.,College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.,Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore, 560021, India
| | - Scott Carvajal
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Kacey Ernst
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - John Ehiri
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
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Yousefi Nooraie R, Kwan BM, Cohn E, AuYoung M, Clarke Roberts M, Adsul P, Shelton RC. Advancing health equity through CTSA programs: Opportunities for interaction between health equity, dissemination and implementation, and translational science. J Clin Transl Sci 2020; 4:168-175. [PMID: 32695484 PMCID: PMC7348010 DOI: 10.1017/cts.2020.10] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 10/31/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Dissemination and implementation (D&I) science is dedicated to studying how to effectively translate and apply research in real-world contexts. There has been increasing interest in health equity within the D&I field to ensure the equitable implementation of evidence-based programs/practices across a range of diverse populations and settings. At the same time, health equity researchers recognize the potential of D&I science to promote the more widespread dissemination, implementation, and sustainment of evidence-based interventions to address health inequities. The National Center for Accelerating Clinical and Translational Science Clinical and Translational Science Award (CTSA) Program has been a champion for community engagement and translational scholarship in its mission to improve individual and population health. The overall CTSA infrastructure and resources within and among CTSA hubs are well-equipped to facilitate a health equity focus to D&I across the phases of translational research. This paper proposes a framework that demonstrates the interaction and opportunities between health equity and D&I science and highlights how CTSAs can support and facilitate wider efforts in translational research with a focus on equitable D&I.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Bethany M. Kwan
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Colorado Clinical & Translational Sciences Institute, Aurora, CO, USA
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York, New York, NY, USA
| | - Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Megan Clarke Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Prajakta Adsul
- Implementation Science Team, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, MD, USA
- Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Wray R, Weaver N, Adsul P, Gautam K, Jupka K, Zellin S, Goggins K, Vijaykumar S, Hansen N, Rudd R. Enhancing organizational health literacy in a rural Missouri clinic: a qualitative case study. Int J Health Care Qual Assur 2019; 32:788-804. [PMID: 31195931 DOI: 10.1108/ijhcqa-05-2018-0131] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy. DESIGN/METHODOLOGY/APPROACH The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change. FINDINGS Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible. ORIGINALITY/VALUE The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.
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Affiliation(s)
- Ricardo Wray
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Nancy Weaver
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Prajakta Adsul
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA
| | - Kanak Gautam
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Keri Jupka
- Parents as Teachers, St Louis, Missouri, USA
| | - Stacie Zellin
- National Council on Alcoholism & Drug Abuse, St Louis, Missouri, USA
| | | | | | - Natasha Hansen
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Rima Rudd
- Harvard School of Public Health, Boston, Massachusetts, USA
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Adsul P, Srinivas V, Gowda S, Nayaka S, Pramathesh R, Chandrappa K, Khan A, Jayakrishna P, Madhivanan P. A community-based, cross-sectional study of hrHPV DNA self-sampling-based cervical cancer screening in rural Karnataka, India. Int J Gynaecol Obstet 2019; 146:170-176. [PMID: 31074835 DOI: 10.1002/ijgo.12859] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/19/2018] [Accepted: 05/08/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the feasibility of implementing a high-risk HPV (hrHPV) DNA-based screening program for cervical cancer and the prevalence of hrHPV DNA-positive women in a community setting in rural India. METHODS A cross-sectional study was conducted at the community level in the Hunsur taluk of the Mysore district from January to August 2016. Cervical cancer screening was conducted with self-collected vaginal samples that were analyzed using the Hybrid Capture 2 (HC2) assay (Qiagen, USA). RESULTS The majority of participants were aged 30-39 years, with no formal schooling, from a lower caste, and lived below an annual household income of US$1499. After group health education and one-on-one counseling, a total of 473 women underwent self-sampling. Of these, 36 (7.6%) were positive for hrHPV and only 24 (66.6%) underwent follow-up diagnostic triaging. Cancer was detected in two women, who were referred to appropriate healthcare facilities for further treatment. CONCLUSION Implementation of hrHPV DNA-based screening tests using self-sampling can be feasible in rural settings in India. However, substantial resources are required for providing health education and one-on-one counseling to inform asymptomatic women about the benefits of testing and, more importantly, to improve compliance with follow-up.
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Affiliation(s)
- Prajakta Adsul
- Implementation Science team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.,Public Health Research Institute of India, Mysore, Karnataka, India.,Department of Epidemiology, Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Savitha Gowda
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Shivamma Nayaka
- Public Health Research Institute of India, Mysore, Karnataka, India
| | | | | | - Anisa Khan
- Public Health Research Institute of India, Mysore, Karnataka, India
| | | | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India.,Department of Epidemiology, Stempel College of Public Health, Florida International University, Miami, FL, USA.,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Ngo-Metzger Q, Adsul P. Screening for Cervical Cancer. Am Fam Physician 2019; 99:253-254. [PMID: 30763054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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Cadet GDJ, Coudray MS, Stephens DP, Adsul P, Siddaiah A, Madhivanan P. Knowledge, gender, and guidance: Factors influencing Indian mothers responses to Attention Deficit Hyperactivity Disorder (ADHD). Indian J Health Wellbeing 2019; 10:195-200. [PMID: 35070918 PMCID: PMC8782239] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the current study, we examined the socio-demographic characteristics and attitudes of Indian mothers, their knowledge about behaviors related to Attention Deficit Hyperactivity Disorder (ADHD) and the relationship with ADHD diagnosis among their children. Previous research showed 11.3% of primary school children in India have been diagnosed with ADHD, yet little research has been conducted on how mothers perceive these behaviors. A survey was completed by 100 mothers with children aged between 4-12 years. The Centers for Disease Control (CDC) ADHD Checklist for Children was used to assess the presence of ADHD symptoms in Indian children. The surveys were analyzed to identify maternal ADHD knowledge, socio-demographic characteristics and attitudes associated with ADHD within the context of Indian culture using SPSS. It was determined that the gender of the child, the geographical location the mother was raised, willingness of mother to seek professional help, mother's knowledge on handling child's behavior and mother's knowledge on ADHD were significantly associated with ADHD. Further analyses revealed that a lack of knowledge of ADHD and handling child's behavior were most associated with anADHD diagnosis based on the CDCADHD checklist.
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Affiliation(s)
| | - Makella S Coudray
- Robert Stempel College of Public Health and Social Work Florida International University, US
| | | | - Prajakta Adsul
- Division of Cancer Control and Population Sciences National Cancer Institute, US
| | - Anand Siddaiah
- Public Health Research Institute of India Teresian College, PG Department of Psychology, Mysore, Karnataka, IN
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, US Public Health Research Institute of India, Mysore, Karnataka, IN
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Moreland-Russell S, Adsul P, Nasir S, Fernandez ME, Walker TJ, Brandt HM, Vanderpool RC, Pilar M, Cuccaro P, Norton WE, Vinson CA, Chambers DA, Brownson RC. Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control. Cancer Causes Control 2018; 29:1221-1230. [PMID: 30535940 PMCID: PMC6384813 DOI: 10.1007/s10552-018-1108-y] [Citation(s) in RCA: 3] [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] [Received: 10/14/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE In 2015-2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants' knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration. METHODS Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants. RESULTS Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates. CONCLUSIONS Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.
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Affiliation(s)
- Sarah Moreland-Russell
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA.
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA.
| | - Prajakta Adsul
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Seif Nasir
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Timothy J Walker
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Heather M Brandt
- Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Robin C Vanderpool
- Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Meagan Pilar
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Paula Cuccaro
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Cynthia A Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Raza SJ, Xu P, Barnes J, Fisher R, May A, Darwish O, Dang B, Adsul P, Freeman CA, Siddiqui SA. Outcomes of renal salvage for penetrating renal trauma: a single institution experience. Can J Urol 2018; 25:9323-9327. [PMID: 29900820] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable level of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center. MATERIALS AND METHODS An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed, for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of < 0.05 was considered as significant. RESULTS A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS). was 20. High grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy, on multi-variable analysis (OR 17.09 CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a sub group analysis of non-NG. CONCLUSIONS CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.
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Affiliation(s)
- S Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
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Adsul P, Wray R, Boyd D, Weaver N, Siddiqui S. Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients. J Cancer Educ 2017; 32:580-588. [PMID: 27029194 DOI: 10.1007/s13187-016-1025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists' perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30-60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members' involvement in discussions about treatment, especially patients' spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient's condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient's practical, emotional, and social experiences. Their styles to elicit the patient's preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists' routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.
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Affiliation(s)
- Prajakta Adsul
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA.
| | - Ricardo Wray
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
| | - Danielle Boyd
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Nancy Weaver
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Sameer Siddiqui
- Department of Surgery, School of Medicine, Saint Louis University, 3635 Vista Ave, St. Louis, MO, 63110, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
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