The preventable burden of cancer will persist until we close the gap between what is known about prevention and early detection and what we do in communities. Resources such as Cancer Control P.L.A.N.E.T., Research Tested Intervention Programs, The Community Guide, and the Canadian Best Practices Portal provide numerous evidence-based approaches and programs (EBAs). Despite knowledge about what works and availability of EBAs, however, they are often not used in communities. Many community-based cancer control planners ("planners") don't know where to find EBAs and don't know how to match EBAs to their community's needs;they need more specific guidance for adapting an EBA to fit their local settings and populations, and they need assistance in planning implementation. A central problem with existing resources and models is that they are not tools. They are not responsive to user needs, they make the planner do more work than they reasonably can do, and they do not offer timely, relevant, science-based assistance. This study will deliver and evaluate a tool that will fill these needs. The long term goal is to reduce cancer morbidity and mortality by expanding the reach, implementation, and maintenance of effective programs in communities. The project objective, to increase the capacity of cancer control planners to find, adapts and implements EBAs, is a major step toward this goal.
Specific Aim 1 is to develop and validate an online, interactive, decision support and program planning tool (Tailored Aid for Communities adapting Tested Interventions for Cancer Control -TACTICC). This study will be guided by a new conceptual model that integrates four frameworks: a) RE-AIM to identify the longer range outcomes of this study, b) Interactive Systems Framework to guide the focus for enhancing implementation capacity for EBA use, c) Intervention Mapping to provide a systematic process for program adaptation, and d) Social Cognitive Theory to inform identification of determinants and intermediate processes, e.g., self-efficacy, for adoption and implementation behaviors.
Specific Aim 2 is to evaluate the effectiveness of TACTICC in increasing EBA adoption, adaptation, and implementation, by randomizing community planners representing 430 organizational units to TACTICC or usual dissemination practice with measures of behavioral indicators at baseline, 6- and 12-months. The proposed study is significant in that it 1) fills a critical gap in cancer control practice by building capacity among planners to adopt, adapt and implement EBAs in communities;and 2) fills a conceptual gap in existing dissemination and implementation frameworks by developing and applying a conceptual framework that extends existing models and explicitly defines specific tasks and determinants of pro- gram adoption, adaptation and implementation.
Despite the growing number of evidence-based cancer prevention and control recommendations and programs to reduce the burden of cancer, most are not well diffused to provide public benefit, particularly among underserved communities. This project will take significant steps to meet this challenge by producing and testing a Web-based tool that will provide training and support to help close the gap between what is known and what is put into practice. Wider use of effective programs can effect significantly reduce cancer morbidity and mortality.
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