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Using Evidence-Based Interventions to Improve Cancer Screening in the National Breast and Cervical Cancer Early
Amy DeGroff1, Aundrea Carter, Kristy Kenney
1National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Program Services Branch, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs DeGroff, Rice, and Miller, Mss Carter, Melillo, Royalty, and Gressard, Kenney and Messrs Myles).
Context:
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening to low-income, un-, and underinsured women through more than 11 000 primary care clinics. The program is well-positioned to work with health systems to implement evidence-based interventions (EBIs) to increase screening among all women.
Objective:
To collect baseline data on EBI use, evaluation of EBIs, and related training needs among NBCCEDP grantees.
Design:
The Centers for Disease Control and Prevention conducted a Web-based survey in late 2013 among NBCCEDP grantees for the period July 2012 to June 2013. This was the first systematic assessment of EBIs among NBCCEDP grantees.
Setting:
The Centers for Disease Control and Prevention's NBCCEDP.
Participants:
Primarily program directors/coordinators for all 67 NBCCEDP grantees.
Main Outcome Measures:
Data captured were used to assess implementation of 5 EBIs, their evaluation, and related training needs. Frequencies and proportions were determined. Cluster analysis identified grantees with similar patterns of EBI use for NBCCEDP clients and providers.
Results:
On average, 4.1 of 5 EBIs were implemented per grantee for NBCCEDP clients and providers. Four clusters were identified including "high overall EBI users," "high provider EBI users," "high EBI users with no provider assessment and feedback," and "high client EBI users." Only 1.8 EBIs were implemented, on average, with non-NBCCEDP clients and providers. Fewer than half (n = 32, 47.8%) of grantees conducted process or outcome evaluation of 1 or more EBIs. Overall, 47.6% of grantees reported high or medium training needs for client-oriented EBIs and 54.3% for provider-oriented EBIs.
Conclusions:
The NBCCEDP grantees are implementing EBIs extensively with clients and providers. Increased EBI use among non-NBCCEDP clients/providers is needed to extend the NBCCEDP's reach and impact. Grantee training and technical assistance is necessary across EBIs. In addition, grantees' use of process and outcome evaluation of EBI implementation must be increased to inform effective program implementation.
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