Facilitators and Barriers of a Health Department-based Mailed Fecal Testing Program

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Mailed at-home stool testing is a viable strategy to increase colorectal cancer (CRC) screening rates.
• Barriers to CRC screening disproportionately affect vulnerable populations, including those with Medicaid insurance.
• Health departments can play a crucial role in facilitating CRC screening programs.

Purpose of the Study:

• To evaluate the facilitators and barriers of implementing a mailed fecal testing program for CRC screening.
• To identify key factors for successful program implementation within a health department setting.
• To provide insights for similar emerging CRC screening initiatives.

Main Methods:

• Qualitative study using interviews with key informants involved in program implementation.
• Utilized the Consolidated Framework for Implementation Research (CFIR) for interview guide design and analysis.
• Employed axial coding to identify and categorize facilitators and barriers.

Main Results:

• Successful implementation of a mailed fecal testing program is achievable in large county health departments.
• Strong partnerships, dedicated champions, and existing infrastructure are critical facilitators.
• Effective program design and addressing identified challenges are essential for success.

Conclusions:

• The study highlights the importance of strategic partnerships and strong leadership for CRC screening program success.
• Health departments can effectively implement mailed fecal testing programs for Medicaid beneficiaries.
• Lessons learned can inform the development and optimization of future CRC screening initiatives.