Center for Global Health, National Cancer Institute, Bethesda, MD.
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
JCO Glob Oncol. 2022 Aug;8:e2200054. doi: 10.1200/GO.22.00054.
Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting?
We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening.
These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors.
Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge.
尽管癌症的全球负担越来越多地落在中低收入国家（LMICs）身上，但癌症预防和控制的大部分证据来自高收入国家，可能无法直接适用于 LMIC 环境。在本文中，我们关注以下问题：当支持循证干预或实施策略的大多数证据来自高收入国家时，在将干预措施或策略转移和适用于特定 LMIC 环境时，需要哪些当地的、背景相关的证据？
我们借鉴了一个现有的框架（人群、干预、环境、转移-过渡过程模型），用于评估干预措施在不同环境之间的可转移性，并将该模型应用于两个案例研究，作为涉及实施烟草使用治疗指南和人乳头瘤病毒 DNA 自我采样进行宫颈癌筛查的学习案例。
这两个案例研究说明了研究人员、政策制定者、实践者和消费者如何从不同的角度并根据不同的优先事项来处理对本地证据的需求。由于不同群体对本地证据的使用和期望可能不同，因此通过多利益相关者参与来协调这些优先事项至关重要，利益相关者共同参与定义问题并共同创造解决方案，同时促进对背景因素的标准化报告。
本地、背景相关的证据对研究人员和实践者都很重要，其缺失可能会阻碍不同环境下的研究和实施工作的转化。然而，研究人员、实践者和其他利益相关者必须能够清楚地阐明所需数据的类型以及为什么它很重要。特别是在资源有限的情况下，应优先考虑证据的生成，以解决知识方面的实际需求和差距。
