Increasing Reach and Implementation of Evidence Based Programs for Cancer Control

描述(申请人提供)：癌症的可预防负担将持续存在，直到我们弥合已知的预防和早期发现与我们在社区所做的事情之间的差距。癌症控制P.L.A.N.E.T.、研究测试干预计划、社区指南和加拿大最佳实践门户网站等资源提供了大量基于证据的方法和计划(EBA)。然而，尽管知道什么是有效的，以及eBA的可用性，但它们往往不在社区中使用。许多以社区为基础的癌症控制规划者(“规划者”)不知道在哪里找到eBA，也不知道如何将eBA与他们社区的需求相匹配；他们需要更具体的指导来使eba适应当地的环境和人口，并且他们需要在规划实施方面得到帮助。现有资源和模型的一个核心问题是它们不是工具。他们没有响应用户的需求，他们让规划者做的工作超过了他们合理的能力，他们没有提供及时的、相关的、基于科学的帮助。这项研究将交付并评估一种能够满足这些需求的工具。长期目标是通过在社区中扩大覆盖范围、实施和维持有效的计划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者发现、适应和实施EBAS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、交互的、决策支持和计划规划工具(为适应癌症控制的测试干预措施的社区量身定制的援助-TACTICC)。这项研究将以一个新的概念模型为指导，该模型集成了四个框架：a)RE-AIM，以确定本研究的较长期结果；b)互动系统框架，以指导重点加强EBA使用的实施能力；c)干预图谱，以提供项目适应的系统过程；以及d)社会认知理论，以提供信息，以识别决定因素和中间过程，例如，自我效能感，以采用和实施行为。具体目标2是评估TACTICC在增加EBA采用、适应和实施方面的有效性，方法是将代表430个组织单位的社区规划者随机分配到TACTICC或通常的传播实践中，并测量基线、6个月和12个月的行为指标。这项拟议的研究具有重要意义，因为它1)通过在规划者之间建立能力以在社区中采用、调整和实施eBA，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，该框架扩展了现有的模型，并明确定义了程序采用、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.