Evaluation of an implementation support program for rural communities using a two-tiered, embedded framework

Evaluate the impact of Implementation Studio (the "Studio") on community-based organizations' (CBOs) EBI implementation, including changes in breast and colorectal (CRC) cancer screening status among Hispanic/Latino/a EBI recipients.

A two-tiered, embedded framework consisted of 1) surveys (n = 38) comparing up-to-date breast and CRC screening status among EBI recipients pre/post-EBI delivery (Tier 1); and semi-structured interviews (n = 13 total; n = 7 leaders, n = 6 community health workers) with CBO staff assessing EBI implementation outcomes using rapid qualitative analysis methods (Tier 2) guided by Proctor's Implementation Research Outcomes Framework. Surveys and interviews were conducted in Spanish/English by phone/virtually September 2022-September 2023.

Up-to-date screening status increased by 16.6% for breast and 19.3% for CRC screening pre/post-EBI implementation, albeit not statistically significant overall (p = 0.168). CBOs reported that implementing EBIs cultivated their confidence and enhanced CBOs' workforce capacity (acceptability). CHWs (the primary EBI implementers) proficiently used the Studio tools to adapt the EBIs to improve fit and implement them in the rural Hispanic/Latino/a communities (appropriateness). Remote delivery increased the EBI accessibility for the community (feasibility). Key drivers of costs were CHWs' time to adapt and implement EBIs (costs). CBOs expressed the need to address clients' social needs to maintain EBI's impact (sustainability).

CBOs successfully implemented CHW-led EBIs, and their efforts increased up-to-date cancer screening among rural Hispanic/Latino/a community members. These findings demonstrate that Studio is a promising strategy for building CBOs' capacity to implement EBIs and increase cancer screening.