title: Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.
abstract: BACKGROUND
  Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies.
  
  
  METHODS
  Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation.
  
  
  RESULTS
  Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation.
  
  
  CONCLUSIONS
  Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover, our analytic approach is similar to previous case studies using CFIR and hence could facilitate comparisons across studies.
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Shuting
authors.initials: S
authors.lastname: Liang
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA. mkegler@emory.edu.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Kegler
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Cotter
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Phillips
authors.initials: P
authors.lastname: Emily
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Derrick
authors.initials: D
authors.lastname: Beasley
authors.affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: April
authors.initials: A
authors.lastname: Hermstad
authors.affiliation: Statistics and Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., 250 Williams St., Atlanta, GA, 30303, USA.
authors.forename: Rentonia
authors.initials: R
authors.lastname: Morton
authors.affiliation: Statistics and Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., 250 Williams St., Atlanta, GA, 30303, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Martinez
authors.affiliation: Statistics and Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., 250 Williams St., Atlanta, GA, 30303, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Riehman
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D055317:Evidence-Based Practice / Q000379:methods*; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D012107:Research Design; D014481:United States