SEARCHING CONTEXT-TAILORED STRATEGIES TO ENHANCE ACCESSIBILITY TO COLORECTAL CANCER SCREENING THROUGH THE USE OF DIFFERENT TYPES OF EVIDENCE

BRUZZONE A; ESANDI ME; SCHENFELD Y; DOPAZO I; BELLANDO B; PICARDI G; SCHERNENCO J; ROBLES M; REIG ME

MAR DEL PLATA

Conferencia; Reunión anual de Sociedades de biociencias- SAIC; 2023

SOCIEDAD ARGENTINA DE INVESTIGACION CLINICA

Although colorectal cancer (CRC) ranks second in both incidence and mortality, screening coverage in Argentina is very low, particularly among individuals with low socioeconomic status and public health coverage. Screening programs are cost-effective and successful in reducing disease-specific mortality. However, their implementation by health systems is complex and sub-optimal, partly attributed to difficulties in strategies design. Using methods and tools from dissemination and implementation sciences would contribute to designing evidence-informed strategies tailored to the specific context of the program.Our work aimed to explore how different types of evidence, stakeholder involvement, and evidence-informed deliberation contribute to the design of implementation strategies that address accessibility barriers to CRC screening. The study objectives were: 1) to generate local evidence on accessibility barriers in a programmatic area of Bahía Blanca, 2) to produce empirical evidence on effective strategies for increasing users and health professional adoption and adherence to CRC screening, 3) to design implementation strategies through stakeholder involvement and deliberation, incorporating theoretical, empirical, and experiential evidence, 4) to analyze how these stakeholder-driven strategies address the local barriers to CRC.This research was part of a broader project conducted by an interdisciplinary team from UNS, with the aim of bridging the knowledge-action gap on priority health issues. It consisted in a 4-stage sequential study, using a mixed-method design. 1: Barriers’ assessment through key stakeholders’ interviews based on the consolidated meta-framework of Implementation Research and Michie´s theoretical framework. 2: Systematic review on the effectiveness of implementation strategies targeting to the uptake and adherence of CRC screening. 3: Evidence-informed deliberative dialogue involving key stakeholders aimed at designing contextualized implementation strategies. 4: Mapping exercise linking proposed strategies and barriers, considering Garbus´ accessibility dimensions (technical, economic, political or symbolic).Over 80% of the proposed strategies focused on the technical accessibility dimension (network organization), while the remaining strategies addressed symbolic barriers (knowledge gaps, fear, underappreciated health issue). However, no strategies targeted to barriers related to the political-economic dimensions were proposed, despite being perceived among the most critical ones (limited videocolonoscopy access, no screening policy, fragmented health system).In low-resource contexts, it is crucial to include political-economic dimensions in the design of strategies in order to advance effective and sustainable guidelines for CRC prevention. While a participatory approach helped lay the groundwork for new strategies, it cannot formalize a screening policy in AP2 alone, as some barriers and accessibility dimensions remain unaddressed.