Grant Number:	5R01CA272757-03 Interpret this number
Primary Investigator:	Morales-Campos, Daisy
Organization:	University Of Texas Hlth Sci Ctr Houston
Project Title:	Investigating Facilitator-Driven, Multi-Level Implementation Strategies in Federally Qualified Health Centers to Improve Uptake of a Cancer Control Evidence-Based Intervention
Fiscal Year:	2025

Approximately 46,143 new cases of human papillomavirus-associated cancers occur annually in the U.S., and there are health differences based on racial, ethnic, socioeconomic, geographic, and gender in the incidence and mortality of HPV-related cancers. Despite the availability of a highly effective cancer control evidence-based intervention (EBI) that can reduce human papillomavirus-associated cancer mortality, it is underused in Texas. Federally Qualified Health Centers (FQHCs) often need support implementing and improving access to evidence-based preventive services. However, the current literature around implementation comes from large integrated healthcare systems, and there is limited research around what works in FQHC settings. Implementation studies in these resource-limited settings, like FQHCs, are essential to make progress towards state and national targets to improve uptake of the cancer control EBI. Preliminary data from our previous work suggest practice facilitation is a feasible approach for building the capacity in FQHCs to select and implement provider- and practice-level strategies to improve uptake of the cancer control EBI. Using a stepped-wedge cluster randomized trial, we will randomize three FQHCs (n=9 practices, 3 per FQHC) to receive facilitator-driven provider- (i.e., education, clinical practice plan) and practice-level (i.e., technical assistance plus assessment and feedback, training, and education of immunization navigators) implementation strategies. Informed by our conceptual framework and i-PARIHS, we will measure effectiveness (i.e., parents choosing the cancer control EBI for their 11-12 and 13-17 year olds) and implementation outcomes (i.e., increase the number of providers and their confidence in communicating with parents about the cancer control EBI; increase parental confidence and reduce perceived barriers to accessing the cancer control EBI for their children). We will conduct a baseline assessment at each clinical practice, which will provide comprehensive data to assist the practice facilitator in engaging with the providers and leadership using a participatory approach to develop an implementation plan with strategies for each practice. Along with quantitative evaluations, we will employ theory-guided, qualitative methods to assess the complexity associated with context and the recipients involved in the implementation of strategies in practices, along with sustainability. The study will advance our understanding of what it means to conduct implementation research in resource-limited practices that work with populations experiencing substantial disparities. Findings from the current study will inform national implementation efforts and contribute towards future research targeting dissemination and scale-up.




Trusted health system implementation strategies to increase vaccination (TRUE SYNERGI): a stepped-wedge cluster randomized trial to reduce HPV-related cancers.
Authors: Morales-Campos D.Y. , Adsul P. , Liang Y. , Donovan E. , Moczygemba L.R. , Kahn J.A. .
Source: Bmc Public Health, 2025-04-09 00:00:00.0; 25(1), p. 1331.
EPub date: 2025-04-09 00:00:00.0.
PMID: 40205591
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