Evidence-based interventions for cancer control could prevent more than half of cancers in the U.S. if scaled nationally, yet there remains a substantial gap in the adoption of these strategies across clinical and community settings, particularly in settings that serve socioeconomically vulnerable populations. We propose to develop an implementation laboratory (I-Lab) of community health centers (CHCs) across Massachusetts (MA) to increase implementation science in community health settings, enable a range of studies on the adoption and implementation of cancer prevention and control strategies, and allow for rapid-cycle testing of innovative approaches in settings that serve health disparities populations. We propose to partner with the Massachusetts League of Community Health Centers, a robust primary care association in MA, and 31 Mass League member CHCs that all use an interoperable, comprehensive data reporting platform, the Data Reporting and Visualization System (DRVS), to inform and evaluate implementation and quality improvement activities. We will develop a three-tiered Implementation Laboratory (I-Lab) that builds capacity and implementation readiness among MA CHCs and provides support for pilot implementation and evaluation of evidence-based interventions among a subset of CHCs that are ready to undertake implementation activities. The I-Lab will include 5 CHCs as active pilot sites, 10 CHCs in the learning community, and up to 16 in the early engagement tier across years 1-5. The I-Lab will offer a range of implementation supporting elements to its members, informed by the Interactive Systems Framework for Dissemination and Implementation (ISF), including a virtual and in-person learning community to enhance organizational capacity, an implementation support team to guide integration of evidence-informed strategies into clinical practice, an implementation practitioner to provide ongoing technical assistance to I-Lab pilot sites, and financial resources to support CHC participation in a variety of innovative and priority pilot implementation studies. The I-Lab, its members, and our ISCCCE investigators will be supported by a Data Management Unit to coordinate data collection, data sharing, and data-related communication across I-Lab members and ISCCCE investigators. We will also establish a Practice Surveillance Unit to monitor ongoing implementation activities, track outcomes of the rapid-cycle pilot studies, inform the development of future pilot studies, and assess for unintended negative impacts on other health disparities initiatives across the CHCs. To achieve the aims of the I-Lab, we have assembled a research, implementation, clinical, and community health team with extensive experience in cancer prevention interventions, cancer care equity, implementation science, community health improvement, research design and biostatistics. Our ultimate goals are to advance implementation science in cancer control and to create an implementation science ecosystem in CHCs across MA that engages health centers in deploying evidence-based strategies for cancer prevention and control and increases health equity.
