Developing partnerships to reduce disparities in cancer screening

Abstract

Background: Interventions in scientific settings to improve the well-being of women who are not regularly screened for cancer have failed. Consequently, community-based prevention and control efforts are needed.

Community context: From 2003 through 2007, three federal agencies and 1 nongovernmental agency collaborated with county-level public health counterparts from 6 states to address screening disparities in cervical and breast cancer in counties with the highest prevalence. This case study describes lessons learned from Team Up, a model pilot program.

Methods: We conducted a descriptive qualitative case study including 5 Southern states and 1 Midwestern state: Alabama, Georgia, Kentucky, Missouri, South Carolina, and Tennessee. The 6 states underwent a 5-step process to adopt, adapt, and implement 1 of 3 evidence-based interventions designed for cervical and breast cancer screening.

Outcome: The 6 participating states had various levels of success. Participating states formed and sustained viable interorganizational public health partnerships throughout the pilot program and beyond.

Interpretation: Although this innovative pilot faced many difficulties, participants overcame substantial obstacles and produced many key accomplishments. Team Up brought together 2 challenging public health strategies: the translation of evidence-based approaches to communities and populations, and partnerships among diverse people and organizations. Case study results suggest that using a mix of approaches can promote the transference of evidence from research into practice through local, regional, and national partnerships.

Figure 1

Team Up: Pilot program (2001-2007) and evaluation (2003-2008) phases.

Figure 2

Structural framework of Team Up partnership. Abbreviations: ACS, American Cancer Society; AL, Alabama; CDC, Centers for Disease Control and Prevention; GA, Georgia; KY, Kentucky; MO, Missouri; NCI, National Cancer Institute; SC, South Carolina; TN, Tennessee; USDA, United States Department of Agriculture.

Figure 3

Team Up evaluation organizational framework. Abbreviation: EBI, evidence-based intervention. 1. Partnership synergy is a collaborative process that enables a group of people and organizations to combine complementary knowledge, skills, and resources to accomplish more as a group than as individuals (Lasker and Weiss, 2003). The Lasker and Weiss Partnership Self-Assessment Tool identifies a partnership's strengths and weaknesses in areas known to be related to synergy: leadership, efficiency, administration and management, and sufficiency of resources. Response categories are based on 5-point Likert scales (extremely well [5] to not at all well [1]; excellent [5] to poor [1]; all of what it needs [5] to none of what it needs [1]). Overall synergy results are based on a compilation of definitive questions with the resulting categorical scores: Danger Zone (1.0-2.9) requires a lot of improvement; Work Zone (3.0-3.9) requires effort to maximize the partnership's collaborative potential; Headway Zone (4.0-4.5) encourages greater potential to progress further; and Target Zone (4.6-5.0) requires focus to maintain a synergistic partnership (http://partnershiptool.net/). 2. EBI: Evidence-based intervention. The term "evidence-based intervention" refers to an intervention that has been tested through randomly controlled experiments with efficacious results that have been published in peer-reviewed journals (http://www.aoa.gov/doingbus/fundopp/announcements/2008/ADDGS_Evidence_Based_FAQ.doc).