Department of Family Medicine, University of Colorado School of Medicine, 1844 Kona St. Eugene, Aurora, CO, OR 97403-2142, USA.
Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
J Behav Med. 2023 Oct;46(5):821-836. doi: 10.1007/s10865-023-00400-2. Epub 2023 Apr 8.
Key clinical and community members need to be involved in the identification of feasible and impactful implementation strategies for translation of evidence-based interventions into practice. While a wide range of implementation strategies has been developed, there is little research on their applicability for cancer prevention and control (CPC) efforts in primary care. We conducted a survey of primary care physicians to identify implementation strategies they perceive as most feasible and impactful. The survey included both primary prevention behavior change counseling and cancer screening issues. Analyses contrasted ratings of feasibility and impact of nine implementation strategies, and among clinicians in different settings with a focus on comparisons between clinicians in rural vs. non-rural settings. We recruited a convenience sample of 326 respondents from a wide range of practice types from four practice-based research networks in 49 states and including 177 clinicians in rural settings. Ratings of impact were somewhat higher than those for feasibility. Few of the nine implementation strategies were high on both impact and feasibility. Only 'adapting to my practice' was rated higher than a 4 ("moderate") on both impact and feasibility. There were relatively few differences between rural and non-rural clinicians or associated with other clinician or setting characteristics. There is considerable variability in perceived impact and feasibility of implementation strategies for CPC activities among family medicine clinicians. It is important to assess both feasibility and impact of implementation strategies as well as their generalizability across settings. Our results suggest that optimal strategies to implement evidence-based CPC activities will likely need to be adapted for primary care settings. Future research is needed to replicate these findings and identify practical, implementation partner informed implementation strategies.
关键的临床和社区成员需要参与确定可行且有影响力的实施策略，以将循证干预措施转化为实践。虽然已经开发了广泛的实施策略，但针对这些策略在初级保健中用于癌症预防和控制（CPC）的适用性的研究很少。我们对初级保健医生进行了一项调查，以确定他们认为最可行和最有影响力的实施策略。该调查包括初级预防行为改变咨询和癌症筛查问题。分析对比了 9 种实施策略的可行性和影响力评分，并比较了不同环境中的临床医生，重点是比较农村和非农村环境中的临床医生。我们从四个实践基础研究网络中的广泛实践类型中招募了 326 名方便样本，来自 49 个州，其中包括 177 名农村环境中的临床医生。影响评分略高于可行性评分。这 9 种实施策略中很少有既能提高影响又能提高可行性的策略。只有“适应我的实践”在影响和可行性上的评分都高于 4（“中等”）。农村和非农村临床医生之间以及与其他临床医生或环境特征相关的差异相对较少。家庭医学临床医生对 CPC 活动实施策略的感知影响和可行性存在很大差异。评估实施策略的可行性和影响力以及它们在不同环境中的通用性非常重要。我们的研究结果表明，实施循证 CPC 活动的最佳策略可能需要针对初级保健环境进行调整。需要进一步研究来复制这些发现并确定实用的、实施伙伴知情的实施策略。
