Rationale and Protocol Design for the Adaptation and Implementation of a Patient Navigation Program for Cervical...

Area of Science:

• Global Health
• Health Services Research
• Cancer Screening

Background:

• Cervical cancer screening faces barriers like limited knowledge, stigma, and low autonomy in healthcare decisions.
• Patient navigation programs, based on models like the NIH NCI PNRP, can address these multifaceted barriers.
• Adapting evidence-based programs is crucial for effective implementation in diverse, low-resource settings.

Purpose of the Study:

• To evaluate the adaptation process of a patient navigation model using the Dynamic Adaptation Process (DAP) in rural and urban Senegal.
• To conduct an effectiveness-implementation hybrid trial of the adapted patient navigation program.
• To assess implementation outcomes including feasibility, acceptability, fidelity, penetrance, sustainability, and cost.

Main Methods:

• A stepped-wedge randomized pragmatic trial and mixed-methods approach guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework.
• Data collection from system stakeholders, patient navigator teams, and clients.
• Integration of the adapted program into the existing community health system with designated Patient Navigator Leaders.

Main Results:

• The study is designed to evaluate the adaptation and implementation process, providing insights into effectiveness and barriers.
• Anticipated results will detail the feasibility, acceptability, and sustainability of the adapted patient navigation program.
• Mixed-methods data will illuminate the experiences of stakeholders, navigators, and clients.

Conclusions:

• The adapted patient navigation program shows promise for improving cervical cancer screening in Senegal.
• Successful implementation relies on integrating the program into existing health systems and empowering community health workers.
• Findings will inform the scale-up of similar programs in low- and middle-income countries.