CPCRN: Your Partner
in Cancer Control
Kurt M. Ribisl, PhD
University of North Carolina at Chapel Hill
CPCRN Coordinating Center
CDC, Atlanta, GA
May 24, 2010
1
CPCRN Mission
To accelerate the adoption of evidence-
based cancer prevention and control in
communities.
2
Organization
• One of five Thematic Research Networks in the
Prevention Research Centers (PRCs)
– Only Thematic Network focused on dissemination and
translation
• Collaboration with two Federal Agencies
– CDC – Division of Cancer Prevention and Control
– NCI – Division of Cancer Control and Population
Sciences
• Ten Network Centers at major research institutions
3
PI’s
Michelle Kegler, DrPH
Jennifer Allen, ScD, MPH, RN
Marcia Ory, PhD, MPH
Betsy Risendahl, PhD
Roshan Bastani, PhD
James Hebert, ScD, MSPH
Cathy Melvin, PhD
Kurt Ribisl, PhD (Coord Ctr)
Maria Fernandez, PhD
Vicky Taylor, MD, MPH
Matthew Kreuter, PhD, MPH
4
Network Center Map
5
Selected Projects
1.
2.
3.
4.
5.
6.
7.
2-1-1 to Reduce Disparities
HPV Vaccination
Use of Evidence-Based Practice
Cancer Registry Data
BCCEDP
CRC Control Programs
FQHC Research
6
• 240 active systems
• 46 states, DC, Puerto Rico
• 80% of U.S. population
• 14.3 million calls in 2008
7
Survey administered in four 2-1-1 systems
Goal (~300 surveys/Center)
8
Assessing six cancer control actions
Mammography
Pap testing
Colonoscopy
HPV vaccination
Smoking
Smoke-free home policies
9
2-1-1 callers vs.
U.S. population
- 2-1-1 callers (n = 1,413)
- 2008 BRFSS (n = 415,194)
10
Unmet Needs
Cancer needs of 2-1-1 callers (n=1,413)
- Need at least one action
72%
- Need two or more
42%
- Need three or more
17%
11
Risk Factors 2-1-1
Callers vs. BRFSS
Risk factor/ preventive
measure
211 Respondents (n)
2-1-1*, %
BRFSS U.S, %
p
No health insurance
All (n=1408)
37.2
15.2
<.0001
Current cigarette smoker
All (n=1408)
39.6
18.4
<.0001
Has smoke-free policy
All (n=1408)
69.4
76.4
<.0001
Ever had a colonoscopy
50.2
61.4
<.0001
19.4
18.4
<.0001
Received HPV vaccination
(daughter)
Men and women,
50+ (n=337)
Women, 18-26
(n=229)
Have daughters 9-17,
(n=271)
35.9
na
Up-to-date on mammography
Women, 40+ (n=529)
56.5
76.3
<.0001
Up-to-date on Pap smear, last
yr
Women, 18+
(n=1128)
53.5
57.8
<.0001
Received HPV vaccination (self)
* Adjusted for gender and age
12
Information and Referral…
Mammograms
Pap smears
Colonoscopies
HPV vaccination
girls 9-17
Merck Patient Assistance
Program
Smoking cessation
Smoke-free home policy
13
HPV Projects
• HPV Policy Analysis
– Started in 2008
– Participants from UCLA, UNC, UT, UW, & CDC
– Produced a detailed database of state legislative
bills nationwide re: vax from 1/06-6/08
– Will help guide development of future policies
– Manuscript in preparation
14
HPV Projects
• HPV Measures Review
– Started in 2007, let by Jennifer Allen (Harvard)
– Participants from Harvard, Emory, Morehouse,
UCLA, UNC, UT, UW, & CDC
– Conducted a lit review of surveys re: knowledge,
attitudes, behaviors related to HPV vaccination
– Provided important info re: quality of existing
measures
– Manuscript in press at Vaccine
15
HPV Projects
• HPV Cognitive Testing
– Participants from UNC, Harvard, UCLA, UT, UW,
WU, NCI, & CDC
– 57 cognitive interviews conducted to cog test 20
survey items for parents/caregivers of vax-eligible
girls
– 13 items revised based on findings
– Produced a set of validated survey items for use
in CPCRN HPV survey and others
– Led by Alice Richman/Noel Brewer (UNC-CH)
16
HPV Projects
• HPV Latino Survey
– Participants from UCLA, Harvard, UT, UW,
WU, & CDC
– Bilingual survey with 24 core items targeted
@ parents/ caregivers of vax-eligible girls (917)
– Administered in multiple settings
– Builds on lessons learned from Measures and
Cog Testing projects
17
Promoting EvidenceBased Practice
• National and Statewide Trainings
• Research and Partnerships with
Cancer Control Planners
18
Designing Prevention
Programs that Work
Training Topics
Important Concepts
What do we mean by
evidence-based?
• Define evidence-based (EB)
• Continuum of evidence
• Benefits of using EB strategies/programs
Needs assessment &
program planning
• Community and target audience analysis
• Determinants of behavior
Finding an evidence-based
strategy or program
• Sources of EB strategies & programs
• Selecting a strategy or program (“fit”)
Adapting the evidenced-based
program to meet your needs
• Define: adaptation, core elements, fidelity
• Discuss what can & cannot be changed
Evaluating your program
• Process evaluation (e.g., implementation,
fidelity, program adaptations)
• Outcome evaluation
19
History of Trainings
(Coming June 2010 to This Center)
Audience
Reach
Health educators – Georgia Federation of
Professional Health Educators – A SOPHE Chapter
102
SW GA Mini Grant applicants:
Community-based organizations
35
National Breast and Cervical Cancer Early Detection
Program (NBCCEDP)/CDC (2 parts)
Recruitment & professional development coordinators
116
Comprehensive Cancer Control Program Directors
120
National Association of Chronic Disease Directors
28
REACH US Grant Applicants
62
20
CPCRN Partners’ Awareness & Use of EBPs and EBP
Resources: EBP Resource Inventory Partner Survey
Peggy Hannon et al. (U Washington)
21
Purpose
• Funders increasingly seek evidence-based
approaches and programs (EBPs)
• Many program planners have limited training
for finding and using EBPs
• CPCRN seeks to create a training framework
and interactive tool to facilitate cancer control
planners’ use of EBPs
22
Key Questions
• Do community-based cancer control planners
use EBPs?
– Do planners want to use EBPs?
– What resources are available to support EBP use?
– Are planners aware of and using these resources?
• What training and support is needed to enhance
use of EBPs?
23
EBP Resources
Inventory
• Web-based resources
– Cancer Control P.L.A.N.E.T
– Guide to Community Preventive Services
– Research-Tested Intervention Programs
• In-person training program
– Using What Works
24
Pilot Survey: CDC Cancer
Conference, 2007
• 63 participated in interactive survey w/
hand-held devices
• Use of resources varies
– 35% (R-TIPs) – 72% (P.L.A.N.E.T.)
• Most find using EBPs challenging
– 32% agree EBPs easy to find & obtain
– 24% agree EBPs easy to adapt
25
Partner Survey
• Each CPCRN Center surveyed > 30
partners
• Key survey domains
–
–
–
–
Source of their programs
Perceptions of EBPs
Use of EBP resources
Perceived EBP training needs
• 240 respondents included in analyses
26
Partners’ Program
Sources
Developed Own
Program
69
Used Existing
Program
68
Adapted Existing
Program
69
0
20
40
60
80
100
% Doing Activity in Past Year
27
Awareness & Use of
EBP Resources
43
Guide
28
49
P.L.A.N.E.T.
36
Ever heard of
Ever used
22
R-TIPs
13
Any of the
above
65
48
0
20
40
60
80
Percent
Note. 80-85% of those who had ever used these resources rated them
as somewhat or very useful
28
EBP Resource Use
& EBP Beliefs
Never Used Resources
Used Resources
Our funding agency
encourages us to use
EBPs*
I know where to find
EBPs*
EBPs are easy to
implement
EBPs are easy for us
to adapt
1
Note. * indicates p < .01
1.5
2
2.5
3
3.5
4
Agreement w/ Statement (5= Strongly Agree)
4.5
5
29
Partners’ Training
Needs
Find resources
76
Adapt for cultural appropriateness
64
Develop imp. Plan
63
Assess resources
62
Obtain program materials
60
ID core elements
59
Implement and evaluate
55
Pilot test program
51
Involve partners
50
Recruit participants
46
0
20
40
60
80
100
30
Conclusion
• Cancer control planners know and like
“evidence based”
• Majority are not using EBP resources
• Majority report significant training
needs to support EBP use
Hannon PA, Fernandez ME, Williams R et al. Cancer control planners’ perceptions
and use of evidence-based programs. J Public Health Manag Pract, in press.
31
Novel use of Registry
Data in SC
Hebert JR, Daguise VG, Hurley DM, Wilkerson RC, Mosley C, Adams SA, Puett R, Burch JB,
Steck SE, Bolick-Aldrich Sl. Mapping cancer mortality-to-incidence ratios to illustrate racial and
gender disparities in a high-risk population. Cancer 2009;115:2539-52.
32
PrCA Incidence in Relation to Soil Metal
Concentration:
Unique Use of Combining SCCCR & Environmental Data
Selenium
Zinc
Legend
PrCA and Soil Overlay Categories
Low SIR and High Concentration
Middle Levels
High SIR and Low Concention
No data
Wagner SE, Burch JB, Hussey J, Temples T, Bolick-Aldrich S, Mosley C, Liu Y,
Hebert JR. Soil zinc content, groundwater usage, and prostate cancer incidence in
South Carolina. Cancer Causes Control 2009;20:345-53.
• Texas Cancer Information
– Texas Cancer Information
can connect patients,
caregivers, the general
public, health care policy
planners, physicians and
other health professionals
with reliable online cancer
information.
– Dr. Fernandez is on the
advisory committee.
– Dr. Fernandez is working
with Lewis Foxhall on
developing a logic model for
the TCI.
34
Promoting
Screening
• All Centers have projects
– Promoting cancer screening
– Have linkages with the Comprehensive Cancer
Program
• Promotion of screening through kiosks
– Washington University (Matt Kreuter et al.)
• Survey of BCCEDP
– Emory University (Escoffery and CPCRN)
35
36
Reach and specificity
Criteria for prioritizing among settings
Highest
reach
Laundromats •
Health centers •
Lowest
specificity
Public libraries •
Social services •
• Churches
• Beauty salons
Lowest
reach
Source: Kreuter et al.
Highest
specificity
Using technology to connect rarely and
never screened women to mammography
• kiosks equipped with telephones and wireless
technology
•placed in Laundromats and public libraries to reach
high volumes of rarely or never screened women
•kiosk-administered survey identifies women
needing mammograms
•instant connection to nearby, free mammography
programs directly from the kiosk
38
Inventory and Assessment of
National Breast and Cervical
Cancer Early Detection Program
• PI: Cam Escoffery, PhD (Emory)
• CPCRN Participating Centers-Advisory
Committee:
– Emory (Glanz, Kegler)
– Harvard (Sorenson)
– Morehouse (Blumenthal)
– SLU/Washington University (Kreuter)
– UCLA (Bastani)
– UNC (Porterfield)
– UT (Fernandez, Mullen)
– UW (Harris, Taylor)
• Funder: CDC
39
Purpose of Study
• Inventory NBCCEDP interventions used to recruit
women for screening and interventions used for
the professional development of program staff
and healthcare providers
• Assess the recruitment and professional
development interventions used based on their
application of evidence-based cancer prevention
practices
• Disseminate the findings to encourage effective,
evidence-based interventions for recruiting
women and the professional development of
healthcare providers
40
Research Questions
• What is the use of evidence-based resources for increasing
cancer screening by NBCCEDP grantees (i.e., Community
Guide, RTIPS)?
• To what extent do the recruitment and professional development
activities match evidence-based interventions to increase breast
and cervical cancer screening?
• To what extent do NBCCEDP grantees implement process
steps or core elements from evidence-based interventions for
their recruitment and professional development activities?
(intervention fidelity)
• What are interventions perceived to be effective by the
NBCCEDP? (practice-based evidence)
41
Promoting CRC
Screening
42
Goal
Help community organizations create effective
information resources for populations they serve
Approach
Make it easy to design and customize high
quality, audience tested information resources
43
`
44
44
45
45
St. Louis
Kansas City
El Paso
Lower Rio Grande Valley
Red-Controls
46
Calls to 1-800-4-CANCER
(group*time interaction, F=8.6, p=.004)
- St. Louis
- LRGV
Calls to
CIS
- Kansas City
- El Paso
Pre-MIYO
MIYO
47
47
About CRCCP
• 80% screening by 2014
• Using EBIs from the Guide
• client reminders
• small media
• reducing structural barriers
• provider assessment/feedback
• provider reminders
• 26 states & tribal orgs
48
49
49
Survey of NCCCP grantees
1. Do you have CRC resources targeted to…
- patients?
- spouses/partners?
- children of eligible adults?
- health care providers?
- community health centers?
- community organizations?
2. How satisfied are you with…
- the number of resources you have?
- the quality of resources you have?
50
Survey of NCCCP grantees
3. Are any resources further targeted by…
- rural-urban?
- SES?
- race or ethnicity?
- sex?
4. What is your highest priority population?
5. What EBIs and resources interest you
most?
51
Responses to date
- Web-based survey
- Program leaders and community partners
- 18 of 26 programs responded to date (69%)
- 77 of 180 invitees responded to date (43%)
52
New Cross-Center
Project
CPCRN Survey of Colorectal Cancer
Control Programs (CRCCP)
Proposal
• Survey CRCCPs to assess Dissemination
and Implementation (D&I) activity
• Identify precursors of D & I success
• Identify challenges to D & I
• Monitor progress over time
53
A unique opportunity for CPCRN
• Natural laboratory for dissemination
• Defined set of cancer control EBIs
• Large-scale practice settings
• Perfect timing
54
Survey of Federally
Qualified Health Centers
• Sample: FQHC in Network states belonging to their state
primary health care association.
• Focus on organizational factors that influence
implementation of evidence-based breast, cervical, and
colorectal cancer screening interventions in primary care
practice.
• The project would provide information about translation
processes in health center settings.
• We would be able to include multiple geographic areas and
health centers serving diverse patient populations.
55
FQHC Centers
•
•
•
•
•
•
•
•
•
California
Colorado
Georgia
Massachusetts
Missouri
North Carolina
South Carolina
Texas
110
14
28
24
21
27
22
58
Washington
25
Network members in states with smaller numbers of health centers
could survey all of the health centers in their state, and Network
members in states with larger numbers of health centers could
randomly select a sample of health centers.
56
FQHC Survey
Research Topics
Predictors of Adoption of
Cancer Control interventions
Organizational characteristics
Innovation-specific
infrastructure
General infrastructure
Organizational readiness to
adopt
Leadership and decision
making characteristics
Leadership stability (over time)
Centralized vs. decentralized
decision making process
Network characteristics
Professional network
How connected to others?
To whom are they
connected?
Formal affiliations
Sources of information for
program/strategy planning or
selection
EBI characteristics
57
CPCRN Strengths
• Advancing science for implementation and
translation research
• Strong community partnerships
• Focus on underserved populations
• Broad geographic outreach
• Research focus that complements CDC priorities
• Infrastructure funding provides impetus to focus
beyond discovery and be opportunistic
58
Contact Us
• CDC Contacts
– Kathi Wilson
– Vicki Benard
• UNC Coordinating Center
– Kurt M. Ribisl
– (919) 843-8042; kurt_ribisl@unc.udu
• Contact Centers Directly on Specific
Projects – please cc: Kurt/Kathi/Vicki
59