Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review

Abstract Background Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. Methods We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. Results Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. Conclusions Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs

Children with Chronic Hepatitis B in the United States and Canada

ObjectivesTo test the hypothesis that children with chronic hepatitis B living in the US and Canada would have international origins and characteristic hepatitis B virus (HBV) genotypes and laboratory profiles.Study designClinical characteristics of children enrolled in the Hepatitis B Research Network were collected from 7 US and Canadian centers.ResultsChildren (n = 343) with an age range of 1.0-17.8 years were enrolled; 78% of the children were Asian, 55% were adopted, and 97% had international origins with either the child or a parent born in 1 of 31 countries. The majority had HBV genotype B (43%) or C (32%), and the remainder had genotype A (5%), D (16%), E (4%), or multiple (<1%). Children with genotype B or C were more likely to be Asian (98% and 96%), more consistently hepatitis B envelope antigen positive (95% and 82%), had higher median HBV DNA levels (8.2 and 8.3 log10 IU/mL), and less frequently had elevated alanine aminotransferase values (43% and 57%) compared with children with other genotypes. The percentage of hepatitis B envelope antigen positivity and of those with HBV DNA ≥6 log₁₀ IU/mL declined with age.ConclusionsThe majority of children in the Hepatitis B Research Network have HBV genotypes that reflect their international origins. Clinical and laboratory data differ substantially by patient age and HBV genotype. Use of these data can help drive the development of optimal strategies to manage and treat children with chronic hepatitis B