Abstract
Background: A growing number of studies have used implementation science (IS) frameworks, such as RE-AIM, to inform and evaluate the implementation of evidence-based cancer prevention services (e.g., cancer screening); however, the impact of such applications is not well understood, including whether the use of an IS framework can lead to reductions in health disparities. The purpose of this systematic review is to explore how IS frameworks can guide adaptations to cancer prevention services to specifically address health disparities. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. Searches were conducted in Ovid MEDLINE, PubMed, PsycINFO, CINAHL, and EMBASE. Search strategies used a combination of terms related to implementation science frameworks, cancer prevention, and/or intervention. All searches were conducted between January to May 2020. The QATSDD tool was used to assess the quality of studies included in the review. Results: A total of 1,025 titles and abstracts were screened, and 84 were deemed eligible for full-text screening. After full-text screening, n=27 articles were included for data abstraction and synthesis. Of the 27 studies that were included, an overwhelming majority (n=19, 70.3%) were based in the United States, utilized mixed-methods (n=12, 44.4%), focused only on a single cancer site (n=21, 81.5%), and took place in a health system (n=18, 66.7%). Approximately half of the studies (n=13, 48.2%) used an IS framework for post-implementation evaluation. Most notably, only one-third of studies (n=9, 33.3%) used an IS framework to address cancer-related health disparities. Of those nine studies, six (66.7%) of them used the Consolidated Framework for Implementation Research (CFIR). Other IS frameworks that were used to inform a health disparities adaptation were Diffusion of Innovations, Knowledge-To-Action, and RE-AIM. Most studies were at moderate risk of bias (n=19, 70.4%).Conclusion: Across the various cancer prevention studies that have been implemented, CFIR has been the dominant IS framework used to address health disparities. The application of such frameworks, however, has been used in pre-implementation and planning studies. It remains to be seen if IS frameworks used within a health disparities context in cancer prevention interventions can reduce cancer-related outcomes.Trial registration: PROSPERO CRD42020171970
51727 A Systematic Review of Implementation Science Frameworks Used in Cancer Prevention Interventions
