Background. Cancer and other chronic diseases (e.g., heart disease, stroke) account for the majority of premature death, reductions in quality of life, and economic costs. The burden due to these diseases is preventable through the application of the practice of evidence-based cancer prevention (EBCP). To achieve success on preventing cancer through EBCP, public health practitioners and policy-makers need evidence- based information. However, little is currently known about how contextual differences might affect the transfer and translation of evidence-based interventions within and across countries. Goal. Our primary goal is to understand contextual similarities and differences in EBCP in the United States, Australia, Brazil and China. Methods. To advance dissemination science, we will use mixed (triangulated) methods across four countries to set the stage for a larger, cross-national study. This project has two parts.
Aim 1 uses qualitative method to understand the contextual factors influencing EBCP (i.e., factors at the individual, agency, community, sociocultural, and political/economic levels). To achieve this objective we will develop semi-structured interviews with key informants from each country covering six major domains: 1) biographical information and experience;2) awareness of the existence of evidence-based interventions;3) administrative support for EBCP;4) political climate and support for EBCP;5) key networks and partnerships to support evidence-based decision making;and 6) dissemination strategies that would further EBCP. A goal of 12 to 24 interviews per country (total = 48-96) will be used to achieve content saturation. The contextual information gathered from Aim 1 will be used to develop an Aim 2 quantitative tool for assessing EBCP that is reliable and valid and can be used across multiple countries. To develop the content, we will search for existing instruments covering our domains and target audiences using major peer-reviewed data bases. In addition to formal literature searching, we will conduct snowball sampling with our core research team. Using the evidence obtained in the previous stage, we will develop a survey instrument, which will undergo (test-retest) reliability testing in a sample of 50 individuas from each country (total = 200) followed by factor analysis using structural equation models and testing of internal consistency (n = 100 per country;total = 400). Dissemination and innovations. Results of this project will be disseminated widely to researchers, practitioners, and policy makers. This research is innovative by working in real world settings, developing new dissemination measures, and conducting the first cross-country study of its kind. Findings from the proposed study will form the foundation of a larger, cross-country study. This future project would examine the impact of various dissemination strategies (e.g., workshops, technical assistance) that will be identified in the proposed study.
This project is relevant to public health because it addresses factors affecting the implementation of evidence- based practices that can result in population-level reductions in premature cancer morbidity and mortality. Sparse knowledge exists regarding effective approaches for cross-country dissemination of research-tested interventions among real world public health audiences. This work is expected to lead to a replicable dissemination model to impact cancer and other chronic diseases.