Restricted Carryforward Scope: (ACCSIS) Accelerating Colorectal Cancer Screening through Implementation Science in Appalachia

This multi-site project aims to increase screening for colorectal cancer (CRC) in central Appalachia, a medically underserved region with pronounced cancer health disparities. The Appalachian Regional Commission classifies 32 eastern Ohio (OH) counties and the 54 counties in eastern Kentucky (KY) as Appalachian. CRC incidence and mortality rates in the study area are among the highest in the nation, and neither state meets the target proportion of eligible residents screened for CRC. The proposed work builds on our more than 12 year collaborative history, strong community relationships, ties with health care clinics, and our experience with community-based cancer prevention and control intervention research. Specifically, we will develop, implement and evaluate a multilevel intervention (MLI) with components targeting clinics (in-reach) and the community (outreach) to increase CRC screening, follow-up and referral-to-care among patients age 50-74 in Appalachian KY and OH. The overall goals of this project are to contribute to the evidence-base for MLI that increase rates of CRC screening, follow-up, and referral-to-care, particularly in rural, low-income, medically underserved populations, and help showcase best practices for how MLIs can be scaled-up to reduce the burden of CRC in the U.S. For the Planning-Exploratory Phase (UG3), our specific aims are to: „h Pilot test, measure, and refine a MLI to increase rates of CRC screening, follow-up and referral-to-care in Appalachian OH and Appalachian KY; and „h Provide evidence supporting transition to the Implementation Phase (UH3) [per National Cancer Institute (NCI) approval]. For the Implementation Phase (UH4), our specific aims are to: „h Test the revised MLI in a group randomized trial, delayed intervention to assess the impact of the MLI on increasing rates of CRC screening, follow-up, and referral-to-care among Appalachian KY and Appalachian OH populations; and „h Assess dissemination and sustainability of the intervention.