Generating the evidence base for implementation strategies targeting colorectal cancer screening in the accelerating colorectal cancer screening through implementation science (ACCSIS) research projects

Implementing evidence-based interventions for population-level benefit can be challenging in resource-limited primary care settings. Research is needed to identify, specify, and systematically study implementation strategies that address the multilevel, contextual influences on implementation in these settings. This study reviewed and compared the implementation strategies proposed by Research Projects (RPs) funded through the Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) initiative. ACCSIS research projects implemented multilevel interventions to increase colorectal cancer screening and follow-up among their local populations. Participating AC`CSIS RPs provided structured information about activities proposed to facilitate the implementation of evidence-based interventions to increase colorectal cancer screening, follow-up, and referral across project phases (i.e., exploration, preparation, implementation, sustainment). Three implementation science experts reviewed and matched program data to implementation strategies and domains using the Expert Recommendations for Implementing Change (ERIC) classification. ACCSIS RP teams then reviewed and validated matched strategies. Analyses examined similarities and differences among implementation strategies used by each RP and tracked across the screening continuum. Seven ACCSIS RPs participated in this analysis. Collectively, they reported 89 unique activities that matched 68 ERIC implementation strategies (range: 3 to 17 per site). Several similarities were noted across RPs, such as: four RPs developed and distributed educational materials and three used external facilitation as an implementation strategy. Of the nine domains under which the ERIC strategies are classified, most strategies used by the ACCSIS RPs fell under the domain of using evaluative and iterative strategies (e.g., conducting a local need assessment), followed by training and education (e.g., provider education). All RPs used strategies focused on screening and six used strategies to ensure screening follow-up; only one RP used strategies to improve access to treatment. Most strategies were reported in the preparation and implementation phases. Systematically documenting and collating implementation strategies across ACCSIS RPs contributes to the evidence base of how multilevel interventions can be implemented to reduce the burden of colorectal cancer through screening and follow-up. Study findings can be used to guide real-world implementation efforts, including future scale-up and sustainment.