Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool

Abstract

Background: Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model.

Methods: Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews.

Results: Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes.

Conclusions: Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women.

Keywords: Access to care; Breast cancer screening; Evaluation design and research; Service capacity.

Figure 1

BSPAN Program Service Area

Figure 2

BSPAN Program Logic Model

Figure 3

Breast Cancer Screening Process Model

Figure 4

County Capacity Assessment Process