Implementation of health IT for cancer screening in US primary care: Scoping review

BACKGROUND: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. OBJECTIVE: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. METHODS: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record-based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer-relevant studies; 9/14, 64% of breast cancer-relevant studies; and 7/10, 70% of cervical cancer-relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. CONCLUSIONS: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations

Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences

BACKGROUND: While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. PURPOSE: To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. METHODS: A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. RESULTS: Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; CONCLUSION: These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population

Quantitative measures of health policy implementation determinants and outcomes: A systematic review

BACKGROUND: Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. METHODS: Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. RESULTS: Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. CONCLUSIONS: Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health. REGISTRATION: Not registered

Painted playgrounds for preschoolers’ physical activity and fundamental motor skill improvement: a randomized controlled pilot trial of effectiveness

Abstract Background Preschool children are not meeting recommended levels of physical activity (PA) nor are they proficient in fundamental motor skills (FMS), which are the foundation for PA. As such, interventions are needed to increase PA and FMS in young children. This trial examined the effects of an environmental (“painted playgrounds”) and capacity-building (written toolkit) intervention on child FMS, PA, and sedentary behavior at early childhood education (ECE) centers and examined feasibility. Methods In a randomized controlled trial, four ECE centers were randomly assigned to an intervention group or wait-list control. For intervention centers, stencils were spray painted adjacent to playgrounds and teachers were provided material for using stencils for FMS practice. Follow-up assessments were conducted six to eight weeks after baseline. Time spent in PA and sedentary behavior was assessed via accelerometry and FMS were evaluated using the Test of Gross Motor Development (TGMD-3) at baseline and follow-up. A repeated measures linear model was performed to test the effects of the painted playgrounds on the primary outcomes of interest. Feasibility was measured by stencil engagement via direct observation and satisfaction surveys. Results A total of 51 preschoolers completed baseline assessments (4.3±0.6 years; 43.1% male). There were no significant changes in PA or sedentary behavior (all confidence intervals contain 0) between control and intervention groups. Intervention children significantly improved ball skill, locomotor, and overall TGMD-3 percentile scores at follow-up (all (all confidence intervals contain 0), which was not observed in control group. However, there was no significant change in FMS between the control and intervention groups (confidence intervals contain 0). For stencil use, boys and girls interacted with different stencils during their free play. Directors and teachers reported children incorporated academic concepts and initiated games, and teachers prompted more PA opportunities on the playground. Conclusions This intervention did not show statistically significant changes in children’s PA, FMS, or sedentary behavior compared to a control group; however, small FMS improvements for the intervention group were found from baseline to follow-up. Further work should examine intervention fidelity as well as inexpensive supplies, teacher training, or other strategies to increase preschool children’s PA and improve FMS at ECE centers

Using mixed methods to understand women\u27s parenting practices related to their child\u27s outdoor play and physical activity among families living in diverse neighborhood environments

A convergent parallel mixed methods design was used to understand parenting practices for outdoor play, their influence on adolescent\u27s physical activity and outdoor play and the role of the neighborhood and child\u27s sex. Adolescents (n = 263) and their parents completed questionnaires and wore accelerometers. Parents (n = 30) participated in in-depth interviews. Parenting practices were examined by neighborhood disadvantage and child\u27s sex in quantitative (Chi-square and T-tests) and qualitative (comparative thematic analysis) samples. Multi-level linear mixed models examined the associations between parenting practices and two adolescent outcomes: physical activity and outdoor play. Parents in high disadvantage neighborhoods and of female adolescents imposed more restrictions on outdoor play. Restrictive parenting practices were negatively associated with outdoor play, but not physical activity. Policy and environment change that improves neighborhood conditions may be necessary to reduce parents\u27 fear and lessen restrictions on outdoor play

Neighborhood Influences on Women\u27s Parenting Practices for Adolescents\u27 Outdoor Play: A Qualitative Study

Understanding factors that influence parenting decisions for outdoor play is necessary to promote physical activity during critical years for adolescent adjustment. This study explored physical and social environmental influences on parenting decisions and rules for their child\u27s outdoor play using semistructured in-depth interviews with parents ( = 30, 29 of whom were mothers) of adolescents. Mothers from low- ( = 16) and high-disadvantage ( = 13) neighborhood environments were recruited to identify environmental factors that resulted in parenting decisions that either promoted or hindered outdoor play and identify differences across neighborhood types. Data were analyzed using a grounded theory approach. Mothers limit their child\u27s independent play, as well as the location and time of outdoor play, due to both social and physical aspects of their neighborhood. Seven themes (safety, social norms, sense of control, social cohesion and neighborhood composition, walkability, and access to safe places for activity) were identified as influencers of parenting practices. Mothers in high-disadvantage neighborhoods reported facing greater neighborhood barriers to letting their child play outside without supervision. Physical and social neighborhood factors interact and differ in low- and high-disadvantage neighborhoods to influence parenting practices for adolescent\u27s outdoor play. Community-level interventions should target both physical and social environmental factors and be tailored to the neighborhood and target population, in order to attenuate parental constraints on safe outdoor play and ultimately increase physical activity and facilitate adolescent adjustment among developing youth

Neighborhood Influences on Women’s Parenting Practices for Adolescents’ Outdoor Play: A Qualitative Study

Understanding factors that influence parenting decisions for outdoor play is necessary to promote physical activity during critical years for adolescent adjustment. This study explored physical and social environmental influences on parenting decisions and rules for their child’s outdoor play using semistructured in-depth interviews with parents (n = 30, 29 of whom were mothers) of adolescents. Mothers from low- (n = 16) and high-disadvantage (n = 13) neighborhood environments were recruited to identify environmental factors that resulted in parenting decisions that either promoted or hindered outdoor play and identify differences across neighborhood types. Data were analyzed using a grounded theory approach. Mothers limit their child’s independent play, as well as the location and time of outdoor play, due to both social and physical aspects of their neighborhood. Seven themes (safety, social norms, sense of control, social cohesion and neighborhood composition, walkability, and access to safe places for activity) were identified as influencers of parenting practices. Mothers in high-disadvantage neighborhoods reported facing greater neighborhood barriers to letting their child play outside without supervision. Physical and social neighborhood factors interact and differ in low- and high-disadvantage neighborhoods to influence parenting practices for adolescent’s outdoor play. Community-level interventions should target both physical and social environmental factors and be tailored to the neighborhood and target population, in order to attenuate parental constraints on safe outdoor play and ultimately increase physical activity and facilitate adolescent adjustment among developing youth

Satisfaction and effectiveness of a digital health tool to improve health behavior counseling among adolescent and young adult cancer survivors: a randomized controlled pilot trial

Abstract Background This pilot study examined the preliminary effectiveness of the PREVENT digital intervention that supports health care teams in delivering health behavior counseling on cancer survivors’ motivation to change behavior, their physical activity and food intake behaviors, and cardiovascular health (CVH). Methods Clinicians (physicians, nurse practitioners) at three urban cancer survivorship clinics were trained to use PREVENT. Patients were randomized to the PREVENT intervention or a wait-list routine care control group. Eligibility criteria for patients included: between ages 12–39, overweight or obese, were at least 6-months post-active cancer treatment, and had sufficient English proficiency. Results Fifty-five participants were enrolled; 27 were randomized to the PREVENT intervention and 28 to wait-list routine care control. The majority of the participants (82%) identified as non-Hispanic white, with an average age of 19.8 (SD ± 5.2) years. Patients that received the PREVENT intervention had greater increases in their self-efficacy, vigorous activity and number of food recommendations met than those who received routine clinical care. Changes in willingness, knowledge, and CVH outcomes were not significant. Conclusions The PREVENT digital intervention may provide improvements in preventive behaviors among AYA cancer survivors by supporting care teams with delivering evidence-based, tailored behavior change recommendations and resources to support patient health. Trial registration This trial ( NCT04623190 ) was registered on 11/02/2022