Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

  • Swann Arp Adams
  • Catherine L. Rohweder
  • Jennifer Leeman
  • Daniela B. Friedman
  • Ziya Gizlice
  • Robin C. Vanderpool
  • Natoshia Askelson
  • Alicia Best
  • Susan A. Flocke
  • Karen Glanz
  • Linda K. Ko
  • Michelle Kegler
Original Paper


While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0–7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.


Community health center Colorectal cancer Screening Evidence-based interventions 



This research was conducted by the Cancer Prevention and Control Research Network, which is funded by the Centers for Disease Control and Prevention (CDC) Prevention Research Centers and the National Cancer Institute (NCI). This research was supported by the following cooperative agreements from the CDC Prevention Research Centers and the NCI: 3 U48 DP005030-01S5, 3 U48 DP005021-01S4, 3 U48 DP005014-01S2, 3 U48 DP005053-01S1, 3 U48 DP005013-01S1A3, 3 U48 DP005000-01S2, 3 U48 DP005017-01S8.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest to report.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Swann Arp Adams
    • 1
  • Catherine L. Rohweder
    • 2
  • Jennifer Leeman
    • 3
  • Daniela B. Friedman
    • 4
  • Ziya Gizlice
    • 5
  • Robin C. Vanderpool
    • 6
  • Natoshia Askelson
    • 7
  • Alicia Best
    • 8
  • Susan A. Flocke
    • 9
  • Karen Glanz
    • 10
  • Linda K. Ko
    • 11
  • Michelle Kegler
    • 12
  1. 1.Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health & College of NursingUniversity of South CarolinaColumbiaUSA
  2. 2.UNC Center for Health Promotion and Disease PreventionThe University of North Carolina at Chapel HillCarrboroUSA
  3. 3.School of NursingThe University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Health Promotion, Education, and Behavior & Cancer Prevention and Control Program, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  5. 5.UNC Center for Health Promotion and Disease PreventionThe University of North Carolina at Chapel HillChapel HillUSA
  6. 6.Department of Health, Behavior & SocietyUniversity of Kentucky College of Public HealthLexingtonUSA
  7. 7.Department of Community & Behavioral Health, College of Public HealthUniversity of IowaIowa CityUSA
  8. 8.Department of Community and Family Health, College of Public HealthUniversity of South FloridaTampaUSA
  9. 9.Family Medicine and Epidemiology & Biostatistics, The Prevention Research Center for Healthy NeighborhoodsCase Western Reserve UniversityClevelandUSA
  10. 10.Department of Biostatistics and Epidemiology, George A. Weiss University ProfessorUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  11. 11.Department of Health Services, Fred Hutchinson Cancer Research CenterUniversity of WashingtonSeattleUSA
  12. 12.Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory Prevention Research CenterEmory UniversityAtlantaUSA

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