在健康中心实施多层次、多组分干预措施以促进结直肠癌筛查的障碍和促进因素：关键知情人观点的定性研究。
Barriers and facilitators to implementing a multilevel, multicomponent intervention promoting colorectal cancer screening in health centers: a qualitative study of key informant perspectives.
机构信息
Joint Doctoral Program in Public Health at San Diego State University, University of California, San Diego, USA.
Department of Anthropology, University of California, Riverside, Riverside, USA.
出版信息
BMC Health Serv Res. 2024 Mar 29;24(1):404. doi: 10.1186/s12913-024-10749-y.
BACKGROUND
Colorectal cancer (CRC) continues to be a major cause of death in the U.S. despite the availability of effective screening tools. U.S. Latinos have lower rates of CRC screening and higher rates of death due to colorectal disease compared to non-Hispanic whites. Federally Qualified Health Centers (FQHCs) serve medically underserved populations, including many Latino patients. Given the low CRC screening rates, identifying culturally sensitive and cost-effective methods of promoting screening is a priority for many FQHCs.
METHODS
We interviewed FQHC leaders and providers using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation of a multilevel, multicomponent (ML-MC) CRC screening intervention (i.e., promotor navigation and group-based education) in FQHCs. A rapid qualitative analysis approach was used to identify themes organized according to the following CFIR constructs: intervention characteristics, outer and inner settings, and characteristics of the individual.
RESULTS
We completed interviews with 13 healthcare professionals in leadership positions at six FQHCs. The participating FQHCs perceived the ML-MC screening CRC program as feasible and expressed interest in implementing the program at their sites. Facilitators included financial incentives for increasing screening rates, the need for patient education programming, and involving promotores to support the work of clinical teams. Barriers included concerns about available resources to implement new programs, lack of federal reimbursement for health education, competing priorities of other health concerns, and the need for more resources for confirmatory screening and treatment following a positive screen.
CONCLUSIONS
FQHCs provide essential primary care to millions of underserved patients in the U.S. and have the ability and motivation to provide screenings for colorectal cancer. Partnering with an academic institution to deliver a group-based, promotor-led CRC screening intervention for patients not up to date with screening could help increase screening rates. By identifying the specific barriers and facilitators to implementing CRC intervention, findings suggest that group-based, promotor-led interventions are a promising approach.
背景
尽管有有效的筛查工具，结直肠癌（CRC）在美国仍然是主要的死亡原因。与非西班牙裔白人相比，美国拉丁裔的 CRC 筛查率较低，死于结直肠疾病的比例较高。合格的联邦医疗中心（FQHC）为医疗服务不足的人群提供服务，包括许多拉丁裔患者。鉴于 CRC 筛查率较低，确定促进筛查的文化敏感和具有成本效益的方法是许多 FQHC 的当务之急。
方法
我们使用实施研究综合框架（CFIR）对 FQHC 领导者和提供者进行了访谈，以确定在 FQHC 中实施多层次、多组件（ML-MC）CRC 筛查干预措施（即促进者导航和基于小组的教育）的障碍和促进因素。使用快速定性分析方法根据以下 CFIR 结构确定主题：干预措施的特征、外部和内部环境以及个体的特征。
结果
我们在六个 FQHC 完成了对 13 名处于领导地位的医疗保健专业人员的访谈。参与的 FQHC 认为 ML-MC 筛查 CRC 计划是可行的，并表示有兴趣在其站点实施该计划。促进因素包括提高筛查率的经济激励、患者教育计划的需求以及聘请 promotores 来支持临床团队的工作。障碍包括对实施新计划的可用资源的担忧、缺乏联邦医疗保险对健康教育的报销、其他健康问题的优先事项竞争以及对更多资源的需求以用于阳性筛查后的确认性筛查和治疗。
结论
FQHC 为美国数以百万计的服务不足的患者提供了基本的初级保健服务，并且有能力和动力为结直肠癌提供筛查。与学术机构合作，为不符合筛查条件的患者提供以小组为基础、以 promotor 为主导的 CRC 筛查干预措施，可能有助于提高筛查率。通过确定实施 CRC 干预措施的具体障碍和促进因素，研究结果表明，基于小组的、以 promotor 为主导的干预措施是一种很有前途的方法。
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