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Abstract：
BACKGROUND: Despite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico\'s AI communities.
METHODS: Guided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.
RESULTS: The Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers\' perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.
CONCLUSIONS: Findings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.
METHODS: Guided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.
RESULTS: The Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers\' perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.
CONCLUSIONS: Findings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.
摘要：
背景：尽管结直肠癌（CRC）筛查有效，美洲印第安人（AI）在美国的筛查率很低。许多AI在印度卫生服务机构接受护理，部落,和城市印度(I/T/U)医疗保健设施，缺乏关于实施CRC筛查干预措施的已发表证据。为了解决这个差距，新墨西哥大学综合癌症中心和阿尔伯克基地区西南部落流行病学中心与新墨西哥州两家部落运营的医疗机构合作,旨在提高新墨西哥州AI社区的CRC筛查率.
方法：以社区参与研究的原则为指导，我们通过焦点小组（两个焦点小组与提供者（n=15）和四个焦点小组与社区成员（n=65））与来自两个部落医疗机构和部落社区成员的提供者接触，引出关于实施《社区预防服务指南》（TheCommunityGuide）的可行性和适当性的观点，建议基于证据的干预措施（EBIs）和增加CRC筛查的策略。在每个部落医疗机构中，我们聘请了一个多部门行动小组（MAT）参与了一项实施调查，以记录其医疗保健设施实施EBIs和战略的程度，以及一项组织准备情况调查，询问他们的医疗机构是否可以实施其他策略来提高CRC筛查的使用率。
结果：社区指南推荐了获得社区成员最可行和适当支持的EBI和策略，包括：提供者的一对一教育，提醒,小媒体,以及减少结构性障碍的干预措施。从提供者的角度来看，可行和可接受的策略包括一对一教育，患者和提供者提醒，以及提供者的评估和反馈。普遍而言,提供者提到需要患者导航员，他们可以提供有关CRC的文化上适当的教育并协助运输，并改善了对筛查后协调临床随访的支持。准备情况调查强调了部落设施的总体准备情况，而实施情况调查强调，正在实施的战略很少。
结论：这项研究的结果有助于有关部落医疗机构实施研究的有限文献，并为选择特定的实施策略以促进AI社区中CRC筛查的采用提供了信息。
方法：以社区参与研究的原则为指导，我们通过焦点小组（两个焦点小组与提供者（n=15）和四个焦点小组与社区成员（n=65））与来自两个部落医疗机构和部落社区成员的提供者接触，引出关于实施《社区预防服务指南》（TheCommunityGuide）的可行性和适当性的观点，建议基于证据的干预措施（EBIs）和增加CRC筛查的策略。在每个部落医疗机构中，我们聘请了一个多部门行动小组（MAT）参与了一项实施调查，以记录其医疗保健设施实施EBIs和战略的程度，以及一项组织准备情况调查，询问他们的医疗机构是否可以实施其他策略来提高CRC筛查的使用率。
结果：社区指南推荐了获得社区成员最可行和适当支持的EBI和策略，包括：提供者的一对一教育，提醒,小媒体,以及减少结构性障碍的干预措施。从提供者的角度来看，可行和可接受的策略包括一对一教育，患者和提供者提醒，以及提供者的评估和反馈。普遍而言,提供者提到需要患者导航员，他们可以提供有关CRC的文化上适当的教育并协助运输，并改善了对筛查后协调临床随访的支持。准备情况调查强调了部落设施的总体准备情况，而实施情况调查强调，正在实施的战略很少。
结论：这项研究的结果有助于有关部落医疗机构实施研究的有限文献，并为选择特定的实施策略以促进AI社区中CRC筛查的采用提供了信息。
