Background: For the past two decades there has been increased emphasis on implementing community coalition-driven, evidence-based interventions. However, little information is available to determine which elements of coalition infrastructure and partnerships are most supportive of successful intervention implementation. The Educational Program to Increase Colorectal Cancer Screening (EPICS) is a cluster randomized controlled trial (cRCT) currently underway in 20 communities located in 12 US states. The objective of this paper is to describe the role of three elements important in EPICS implementation by community coalitions: organizational infrastructure, facilitator selection and partnership formation. We hypothesized that more experienced community coalitions with larger, formal structures will train more facilitators and establish more partnerships when compared to smaller, less formal coalitions.
Methods: National Black Leadership Initiative on Cancer (NBLIC) community coalitions were charged with recruiting facilitators and community partners for EPICS delivery. The role of the facilitators was to deliver the educational intervention to small groups of participants. Facilitators selected were either community health educators (CHEs) – persons with a health professions degree - or community health workers (CHWs). Partnerships were formed with churches, clinics and other community sites to serve as settings and to assist in participant recruitment. Data were collected using a mixed method approach: two self-administered surveys (Organizational Assessment and Facilitator Baseline, Knowledge, Attitudes and Confidence Survey) and telephone key informant interviews. Descriptive analyses of the three groups of study participants (e.g., community coalitions, facilitators and partners) and correlational analysis was also performed within each community coalition to test for differences in facilitator and partnership type.
Results: A total of 20 community coalitions, 204 facilitators and 61 community institutions formed partnerships for EPICS implementation. Organizational Structure: All but one community coalition targets primarily African American populations (95.24%). Facilitator Selection: CHEs and CHWs were demographically similar (e.g., gender, race, age, language of preference, marital status, religious preference, and insurance coverage). While the association between community coalition size and the number of CHEs was not significant, there was a significant difference between community coalition size and the number of CHWs. Smaller and medium-sized coalitions engaged more CHWs as facilitators (p=0.0071). Partnership Formation: Community coalition size did not correlate with partnership type or number. Community coalitions indicating partnerships with clinics were more likely to select CHEs than CHWs (p=0.0338).
Conclusions: We examined multiple organizational characteristics to determine their relationship to facilitators and partners implementing EPICS. Although demographically similar, CHWs were selected more often by smaller and medium-sized community coalitions to train as EPICS facilitators. This finding suggests that smaller community coalitions, with a less formal structure were more likely to engage individuals with limited health backgrounds to facilitate the intervention. As a community-driven intervention, EPICS facilitation does not require a health professional for delivery. Interestingly, for community coalitions planning to implement EPICS in clinical settings, CHEs were selected over CHWs as facilitators.
Citation Format: Selina A. Smith, Sandra J. Hamilton, Rene D. Jackson, Mechelle D. Claridy, Ernest Alemah-Mensah, Joyce Q. Sheats, Joyce Q. Sheats. Factors impacting implementation of a community coalition-driven evidence-based intervention: Results from a cluster randomized controlled trial. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C11.