Adhiambo Harriet Fridah, Thomas Kathy, Coe Megan M, Oluoch Lynda, Ihaji Valary, Kerubo Mary Bernadette, Kinyua Alex, Njoroge Sarah, Ngure Kenneth, Shin Michelle, Odeny Thomas A, Weiner Bryan, Mugo Nelly, Gimbel Sarah
Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, United States of America.
International Clinical Research Center, University of Washington, Seattle, Washington, United States of America.
Res Sq. 2025 Jul 15:rs.3.rs-6933921. doi: 10.21203/rs.3.rs-6933921/v1.
Implementation strategies that are contextually refined are essential for optimizing the delivery of evidence-based interventions (EBI) to prevent cervical cancer in low-resource settings. This paper reports the application of the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture and disseminate strategy adaptations made to a single-visit, screen-and-treat approach with thermal ablation (SV-SAT+TA) strategy aimed at establishing sustainable cervical cancer prevention services in Kenya.
A FRAME-IS-based tracking spreadsheet was developed for data collection across 10 facilities during technical assistants' (TAs) site visits, phone calls, and monthly meetings with health providers between March 2023 and September 2024. Sources included tracking spreadsheets, TA narrative reports, and field notes from direct observations during the implementation phase. Descriptive statistics summarized site characteristics and adaptation trends. The exact Poisson test compared adaptation rates by facility level and period (early vs late).
A total of 28 adaptations were identified. Most adaptations (70%, n=20) occurred in the early phase. Over half were planned (57%, n=16). We made modifications to module two (What was modified). Educational adaptations were most common (57%, n=16), primarily targeting providers delivering screening and treatment services. Resources-related adaptations accounted for 21% (n=6). Additionally, 43% (n=12) of the adaptations aimed to increase adoption by expanding the number of clinicians offering the SV-SAT+TA. Nearly half (46%, n=13) targeted the organization level.Over six months, Level five facilities had 2.67 adaptations per facility, compared to 2.85 in Level four facilities (rate ratio = 0.93 (95% CI = 0.39-2.08, p = 0.89), indicating no statistically significant difference in adaptation rates by facility levels. However, adaptation rates significantly declined, from 2.0 per facility in the early phase to 0.80 in the late phase (rate ratio = 2.50, 95% CI: 1.12-6.02, p = 0.02), suggesting a reduction in adaptations over time.
Education and resource-related adaptations were critical to improving SV-SAT+TA implementation. Future research should focus on evaluating the impact of these adaptations on implementation and clinical outcomes, refining the FRAME-IS framework, and supporting the establishment of an adaptome to guide scalable strategies in similar settings.
NCT05472311.
针对低资源环境下预防宫颈癌的循证干预措施（EBI），因地制宜地优化实施策略至关重要。本文报告了循证实施策略的调整与修改报告框架（FRAME-IS）的应用情况，以记录和传播针对单次就诊、筛查与治疗结合热消融（SV-SAT+TA）策略所做的策略调整，该策略旨在肯尼亚建立可持续的宫颈癌预防服务。
在2023年3月至2024年9月期间，开发了一个基于FRAME-IS的跟踪电子表格，用于在技术助理（TA）进行现场访问、电话沟通以及与医疗服务提供者的月度会议期间，收集10个机构的数据。数据来源包括跟踪电子表格、TA的叙述性报告以及实施阶段直接观察的现场记录。描述性统计总结了机构特征和调整趋势。确切泊松检验比较了不同机构级别和时期（早期与晚期）的调整率。
共确定了28项调整。大多数调整（70%，n=20）发生在早期阶段。超过一半是计划内的（57%，n=16）。我们对模块二（修改内容）进行了修改。教育方面的调整最为常见（57%，n=16），主要针对提供筛查和治疗服务的人员。与资源相关的调整占21%（n=6）。此外，43%（n=12）的调整旨在通过增加提供SV-SAT+TA的临床医生数量来提高采用率。近一半（46%，n=13）针对组织层面。在六个月的时间里，五级机构每个机构有2.67项调整，而四级机构为2.85项（率比=0.93（95%CI=0.39-2.08，p=0.89），表明不同机构级别之间的调整率无统计学显著差异。然而，调整率显著下降，从早期阶段每个机构2.0项降至后期阶段的0.80项（率比=2.50，95%CI：1.12-6.02，p=0.02），表明随着时间推移调整有所减少。
教育和与资源相关的调整对于改进SV-SAT+TA的实施至关重要。未来的研究应侧重于评估这些调整对实施和临床结果的影响，完善FRAME-IS框架，并支持建立一个适应组，以指导类似环境下的可扩展策略。
NCT05472311。
