Brotherton Julia M L, McDermott Tracey, Smith Megan A, Machalek Dorothy A, Shilling Hannah, Prang Khic-Houy, Jennett Chloe, Nightingale Claire, Zammit Claire, Pagotto Amy, Rankin Nicole M, Kelaher Margaret
Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia.
Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
Prev Med Rep. 2023 Apr 20;33:102213. doi: 10.1016/j.pmedr.2023.102213. eCollection 2023 Jun.
In this study, we aimed to document stakeholders' experiences of implementing Australia's renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20-69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25-74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al's (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.
在本研究中，我们旨在记录利益相关者实施澳大利亚更新后的国家宫颈癌筛查计划的经历。2017年12月，该计划从对20至69岁女性每两年进行一次细胞学检查，改为对25至74岁女性每五年进行一次人乳头瘤病毒（HPV）筛查。2018年11月至2019年8月期间，我们对包括政府、项目管理人员、登记工作人员、临床医生和医护人员、非政府组织、专业团体以及澳大利亚各地的病理实验室在内的关键利益相关者进行了半结构化访谈。通过电子邮件发出邀请的回复率为49/85（58%）。我们使用了普罗克特等人（2011年）的实施成果框架来指导我们的提问和主题分析。我们发现，利益相关者对实施是否成功的看法存在分歧。对变革有强烈的支持，但对实施的某些方面存在担忧。有人对启动延迟、沟通和教育的及时性、变革管理的不足、在规划和实施中未将原住民和托雷斯海峡岛民纳入、未能广泛提供自我采样以及国家癌症筛查登记的延迟感到沮丧。障碍主要围绕着未能认识到变革和登记建立的巨大规模，以及随之而来的资源不足、项目管理不善和沟通无效。促进因素包括利益相关者的善意和奉献精神、变革的有力证据基础以及在延迟期间各司法管辖区的支持。我们记录了大量的实施挑战，为其他向HPV筛查过渡的国家提供了经验教训。充分的规划、与利益相关者进行充分且透明的参与和沟通以及变革管理至关重要。
