Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

Electra D. Paskett, Aaron J. Kruse-Diehr, Jill M. Oliveri, Robin C. Vanderpool, Darrell M. Gray, Michael L. Pennell, Bin Huang, Gregory S. Young, Darla Fickle, Mark Cromo, Mira L. Katz, Paul L. Reiter, Melinda Rogers, David A. Gross, Vickie Fairchild, Wendy Xu, Angela Carman, Jean M. Walunis, Ann Scheck McAlearney, Timothy R. HuertaSaurabh Rahurkar, Erika Biederman, Mark Dignan

Research output: Contribution to journalArticlepeer-review


Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.

Original languageEnglish
Pages (from-to)748-756
Number of pages9
JournalTranslational Behavioral Medicine
Issue number10
StatePublished - Sep 28 2023

Bibliographical note

Publisher Copyright:
© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: [email protected].


  • Appalachia
  • Colorectal cancer
  • Group randomized trial
  • Implementation strategy
  • Multilevel interventions

ASJC Scopus subject areas

  • Applied Psychology
  • Behavioral Neuroscience


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