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Implementing a Multilevel Intervention to Accelerate Colorectal Cancer Screening and Follow-up in Federally Qualified Health Centers Using a Stepped Wedge Design: A Study Protocol (Implementation Science)

Publication Topics

California Health Interview Survey; 2001 CA Health Interview Survey (CHIS 2001); Access to Health Care; Cancer; Racial and Ethnic Groups; Low-Income; Barriers to/Disparities in Health Care

Publication Type

CHIS Journal Article

Publication Date


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<a onclick="OpenPopUpPage('http:\u002f\\u002f_layouts\u002flistform.aspx?PageType=4\u0026ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}\u0026ID=1810\u0026RootFolder=*', RefreshPage); return false;" href=";ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&amp;ID=1810&amp;RootFolder=*">Karen Kim</a>

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Summary: Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. 

The purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation.

Findings: There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study.

This study cites data from the 2001 California Health Interview Survey.


Article 1

Journal Article: Implementing a Multilevel Intervention to Accelerate Colorectal Cancer Screening and Follow-up in Federally Qualified Health Centers Using a Stepped Wedge Design: A Study Protocol

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Press Release

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California Health Interview Survey (CHIS)

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Version: 2.0
Created at 11/17/2020 3:38 AM by i:0#.f|uclachissqlmembershipprovider|celeste
Last modified at 11/17/2020 3:53 AM by i:0#.f|uclachissqlmembershipprovider|celeste