Increasing Reach and Implementation of Evidence Based Programs for Cancer Control

描述（由申请人提供）：可预防的癌症负担将持续下去，直到我们缩小预防和早期发现与我们在社区所做工作之间的差距。资源，如癌症控制P.L.A.N.E.T.，研究测试干预方案，社区指南和加拿大最佳实践门户网站提供了许多基于证据的方法和方案（EBA）。然而，尽管人们知道什么是有效的，也知道有没有基于电子商务的广告，但社区往往不使用这些广告。许多以社区为基础的癌症控制规划者（“规划者”）不知道在哪里可以找到EBA，也不知道如何将EBA与社区的需求相匹配;他们需要更具体的指导来调整EBA以适应当地环境和人群，他们需要在规划实施方面的帮助。现有资源和模型的一个核心问题是它们不是工具。它们对用户需求没有反应，它们使规划者做了比他们合理能做的更多的工作，它们没有提供及时的、相关的、基于科学的援助。这项研究将提供和评估一个工具，将满足这些需求。长期目标是通过扩大社区有效计划的覆盖范围、实施和维护来降低癌症发病率和死亡率。该项目的目标是提高癌症控制规划人员寻找、调整和实施循证医学的能力，这是朝着这一目标迈出的重要一步。具体目标1是开发和验证一个在线的、互动的、决策支持和方案规划工具（为社区调整经过测试的癌症控制干预措施提供量身定制的援助-TACTICC）。本研究将以一个新的概念模型为指导，该模型整合了四个框架：a）RE-AIM，以确定本研究的长期结果; B）交互系统框架，以指导加强EBA使用的实施能力的重点; c）干预映射，以提供计划适应的系统过程;以及d）社会认知理论，以告知确定决定因素和中间过程，例如，自我效能感，采用和实施行为。具体目标2是评估TACTICC在增加EBA采用，适应和实施的有效性，通过随机分配代表430个组织单位的社区规划人员到TACTICC或通常的传播实践，在基线，6个月和12个月的行为指标的措施。这项研究的意义在于：1）通过培养规划者在社区采用、调整和实施EBA的能力，填补了癌症控制实践中的一个关键空白;以及2）通过开发和应用一个概念框架来填补现有传播和实施框架中的概念空白，该概念框架扩展了现有模型，并明确定义了方案采用、调整和实施的具体任务和决定因素。

DESCRIPTION (provided by applicant): The preventable burden of cancer will persist until we close the gap between what is known about prevention and early detection and what we do in communities. Resources such as Cancer Control P.L.A.N.E.T., Research Tested Intervention Programs, The Community Guide, and the Canadian Best Practices Portal provide numerous evidence-based approaches and programs (EBAs). Despite knowledge about what works and availability of EBAs, however, they are often not used in communities. Many community-based cancer control planners ("planners") don't know where to find EBAs and don't know how to match EBAs to their community's needs; they need more specific guidance for adapting an EBA to fit their local settings and populations, and they need assistance in planning implementation. A central problem with existing resources and models is that they are not tools. They are not responsive to user needs, they make the planner do more work than they reasonably can do, and they do not offer timely, relevant, science-based assistance. This study will deliver and evaluate a tool that will fill these needs. The long term goal is to reduce cancer morbidity and mortality by expanding the reach, implementation, and maintenance of effective programs in communities. The project objective, to increase the capacity of cancer control planners to find, adapts and implements EBAs, is a major step toward this goal. Specific Aim 1 is to develop and validate an online, interactive, decision support and program planning tool (Tailored Aid for Communities adapting Tested Interventions for Cancer Control -TACTICC). This study will be guided by a new conceptual model that integrates four frameworks: a) RE-AIM to identify the longer range outcomes of this study, b) Interactive Systems Framework to guide the focus for enhancing implementation capacity for EBA use, c) Intervention Mapping to provide a systematic process for program adaptation, and d) Social Cognitive Theory to inform identification of determinants and intermediate processes, e.g., self-efficacy, for adoption and implementation behaviors. Specific Aim 2 is to evaluate the effectiveness of TACTICC in increasing EBA adoption, adaptation, and implementation, by randomizing community planners representing 430 organizational units to TACTICC or usual dissemination practice with measures of behavioral indicators at baseline, 6- and 12-months. The proposed study is significant in that it 1) fills a critical gap in cancer control practice by building capacity among planners to adopt, adapt and implement EBAs in communities; and 2) fills a conceptual gap in existing dissemination and implementation frameworks by developing and applying a conceptual framework that extends existing models and explicitly defines specific tasks and determinants of pro- gram adoption, adaptation and implementation.