What makes for successful patient navigation implementation in cancer prevention and screening programs using an evaluation and sustainability framework.

BACKGROUND: Integrating patient navigation into cancer prevention and early detection efforts has been effective in increasing cancer screening rates for the medically underserved. Few publications have focused on how cancer screening interventions in the primary care setting using patient navigation as a primary strategy are implemented, adapted, and sustained. In 2006, the University of Colorado Cancer Center established a statewide colorectal cancer screening program to reduce disparities and improve colorectal cancer (CRC) screening for the medically underserved in partnership with the safety net system. The program, known as the Colorado Cancer Screening Program (CCSP), has provided navigation into preventive screening for more than 35,000 patients. METHODS: To evaluate sustainability and implementation, the Practical, Robust Implementation and Sustainability Model was used to examine the implementation and impact. To complement this model, the CCSP adapted the Program Sustainability Framework and Clinical Sustainability Framework and Assessment Tools to measure the capacity of participating clinics to sustain the program beyond grant funding. RESULTS: The domains most frequently targeted for improvement in the sustainability plans were Workflow Integration (8 clinics), Communication, Planning, and Implementation (8 clinics), and Funding Stability (5 clinics). Activities in the implementation plans included revising workflows for efficiencies, incorporating quality improvement strategies, and building a business case for patient navigation. CONCLUSIONS: Findings from this sustainability planning process provide insight about program outcomes, satisfaction, and illustrate that although funding remains one of the key sustainability questions, many clinic systems have prioritized other specific domains to continue sustainability beyond grant funding.

Kids, Cops, and Community: A Qualitative Assessment of Police, Youth, and Parent Perceptions of Each Other.

CONTEXT: Police and communities alike have experienced many traumatic incidents over the last 4 years, prompting police departments across the country to rethink their approach to community programs. PROGRAM: Aurora's Gang Reduction Impact Program (A-GRIP) launched "Kids, Cops, and Community" (KC&C) in Aurora, Colorado, as a community-based quality improvement project designed to improve community relations by better understanding Aurora police and community members' perceptions of each other and current A-GRIP and Aurora for Youth programs by assessing police, youth, and parents' perceptions of each other. IMPLEMENTATION: After a review of current scientific literature on police-community relations, a KC&C advisory group oversaw the creation of key informant interview and focus group guides. A-GRIP recruited participants for 37 interviews (20 police, 8 youth, and 9 parents) and 3 youth focus groups. The community advisory group assisted in the development of salient themes and practical recommendations. The final report outlined 5 major themes (pros/cons of types of police interactions, respectful communication, false uniqueness effect, parenting and police as parents, and youth-police programming awareness) and 2 specific recommendations (sustain/increase opportunities for police-youth interactions and increase community awareness of youth programming). EVALUATION: A-GRIP members had a rich discussion of the implications of these findings in which there was broad support for identifying a strategy to use these results to improve police-community relations. The coalition was challenged by identifying clear next steps because of turnover in administration and coalition leadership, but they have made progress in increasing information and resource sharing. DISCUSSION: This project provides the first model we are aware of that incorporates a systematic assessment of police, youth, and parent perspectives from the same community. Other communities may find value in adapting the KC&C process to identify promising approaches and refine programming elements of police-community engagement activities.

EndCancer: development and pilot testing of multimedia recruitment for a text message campaign to increase cancer screening.

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US but is preventable with timely colonoscopy screening. Although CRC incidence and mortality have been decreasing and screening rates increasing, southeastern Coloradans in particular remain in great need of CRC screening. Media outreach campaigns have previously proven successful in this region, and local clinical partners expressed interest in text messaging and social media community outreach. METHODS: The Colorado Cancer Screening Program partnered with the Colorado Cancer Coalition and two community health centers to develop theory-based text messages to encourage cancer screening behavior. Participants were recruited into this text message program through 4 weeks of radio advertisements, locally-posted flyers, and 12 weeks of social media messaging asking community members to text a key word or enter their phone number online to receive additional information about cancer screening. RESULTS: Facebook advertisement proved to be the most successful in engaging community members in the outreach campaign with over 22,600 exposed to ads. Radio and print advertisements were less successful than previous campaigns suggested. Theory-based text messages were effective in maintaining interest in the topic of cancer screening. Ninety-six percent of text message participants remained enrolled through receipt of all CRC messages. CONCLUSIONS: The EndCancer campaign provides evidence of strategies that can be used to reach hard-to-reach and hard-to-screen populations in need of CRC screening. Engagement was high with Facebook ads, and those who viewed ads clicked through to the sign-up page, an indication of intent to enroll. Given the promising results of engagement with Facebook ads among the target demographic, social media marketing may prove a successful avenue to enroll hard-to-reach populations into cancer screening educational initiatives.

Assessment of foraging devices as a model for decision-making in nonhuman primate environmental enrichment.

Continued progress to move evidence-based best practices into community and regulatory animal welfare standards depends in part on developing common metrics to assess cost, benefit, and relative value. Here we describe a model approach to evidence-based evaluation and an example of comprehensive cost-benefit assessment for a common element of environmental enrichment plans for laboratory-housed nonhuman primates. Foraging devices encourage a species-typical activity that dominates the time budget of primates outside captivity and provide inherent cognitive challenges, physical activity demands, and multi-sensory stimulation. However, their implementation is not standard, and is challenged by perception of high costs and labor; nutritional and health concerns; and identification of best practices in implementation (that is, device types, food type, frequency of delivery and rotation). To address these issues, we directly compared monkeys' engagement with different foraging devices and the comprehensive cost of implementing foraging opportunities. We recorded 14 adult male cynomolgus monkeys' interactions with 7 types of devices filled with a range of enrichment foods. All devices elicited foraging behavior, but there were significant differences among them both initially and over subsequent observations. Devices that afforded opportunity for extraction of small food items and that posed manipulative challenge elicited greater manipulation. The cost of providing a foraging opportunity to a single monkey is roughly US$1, with approximately 80% attributable to labor. This study is the first to perform a rigorous cost-benefit analysis and comparison of common foraging devices included in environmental enrichment. Its broader significance lies in its contribution to the development of methods to facilitate improvement in evidence-based practices and common standards to enhance laboratory animal welfare.