African Americans suffer a disproportionate burden of incidence and mortality from breast, prostate, and colorectal cancer. Though the causes of these cancer disparities are likely multi-factorial in nature, there are no doubt disparities in early detection that contribute to the mortality disparities. Community-based approaches have been increasing in the effort to raise awareness and early detection for these cancers. However, more often than not, such interventions are tested in randomized controlled trials, become evidence- based, and then fail to reach further implementation in the community.
The aim of the proposed project is to identify an optimal implementation strategy using a set of evidence-based interventions that aim to increase early detection of breast, prostate, and colorectal cancer among African Americans as a model. These three interventions will be packaged and interwoven into a single """"""""Cancer Early Detection Ministry"""""""" (CEDM), which will be delivered through trained Community Health Advisors in church settings. The implementation and sustainability will be evaluated using the RE-AIM Framework. Fourteen local African American churches will be randomized to a high or a low community autonomy implementation strategy, in which the level of technical assistance is varied (monitoring and evaluation only vs. monitoring/evaluation plus technical assistance and training, respectively). By varying the level of technical assistance, we will be able to determine what level of technical assistance leads to successful implementation and sustainability. We will also identify church organizational capacity characteristics that lead to successful implementation and sustainability.
The specific aims of this research are to: (1) Package the three interventions into a single Cancer Early Detection Ministry (CEDM), develop a local cancer screening resource guide, and pilot test the materials and training. (2) Implement the CEDM in 14 churches in Prince George's County, Maryland. We will evaluate the implementation outcomes involving treatment fidelity and identify church organizational capacity characteristics that led to successful implementation. We will compare the two implementation strategies (high vs. low community autonomy) to determine the optimal level of technical assistance necessary for successful implementation. (3) Evaluate the sustainability of the CEDM over a two-year period of time. We will identify church organizational capacity characteristics that led to sustainability, and compare the two implementation strategies (high vs. low community autonomy) to determine the optimal level of technical assistance for successful sustainability.
The proposed project would begin to provide some answers to inform the emerging but critical field of dissemination/implementation research. If more can be learned about ways to effectively disseminate/implement and sustain cancer community-based communication interventions, cancer control research can have significantly greater impact on cancer disparities. In this time of uncertain resources, an effective implementation strategy will be a significant step toward the elimination of disparities in cancer early detection, which would have a significant impact on mortality in African American communities.
