Factors Influencing Implementation of a Colorectal Cancer Screening Improvement Program in Community Health Centers:...

Area of Science:

• Implementation science
• Public health interventions
• Cancer screening

Background:

• Evidence-based health programs, like mailed fecal immunochemical test (FIT) outreach, require successful implementation to impact health outcomes.
• Organizational factors often limit the successful implementation of such public health initiatives.

Purpose of the Study:

• To evaluate how organizational factors influenced the implementation of a mailed FIT outreach program within the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) trial.
• To identify key factors distinguishing high, medium, and low implementation levels in health centers.

Main Methods:

• Eight health centers participated in the STOP CRC pragmatic trial.
• Implementation levels were categorized by the proportion of eligible patients mailed a FIT kit.
• Configurational comparative methods, guided by the Consolidated Framework for Implementation Research, identified influential organizational and program factors.

Main Results:

• Implementation success varied, with FIT kits mailed to 21.0-81.7% of eligible patients across centers.
• A two-factor solution consistently distinguished implementation levels: a centralized implementation team and advance mailing of an introduction letter.
• High implementation was associated with both factors; medium with one; and low with neither.

Conclusions:

• Full implementation of the STOP CRC intervention necessitates a dedicated, centralized implementation team with allocated staffing.
• The advance mailing of an introduction letter prior to the FIT kit is crucial for successful program delivery.
• These organizational and intervention characteristics are critical for maximizing the reach of mailed FIT outreach programs.