1. Objective 1: Know about RTIPS and remember this resource next time you need to find an evidence-based program. Objective 2: Be able to use RTIPS to identify an evidence-based program that fits your needs. Source: The Guide to Community Preventive ServicesThe Guide to Community Preventive Services 1

2. Many Community Guide recommendations are linked to programs in RTIPs Provides access to data and resources that can help planners, program staff, and researchers to design, implement and evaluate evidence- based cancer control programs. Source: The Guide to Community Preventive ServicesThe Guide to Community Preventive Services 2

3. Part 1: Learn about RTIPS: RTIPs only include programs that meet the following criteria Intervention research outcomes have been published in a peer-reviewed journal. The study must have produced one or more positive behavioral or psychosocial outcomes (p≤.05) among individuals, communities, or populations. The evidence of outcomes must be demonstrated in at least one study, using an experimental or quasi-experimental design. Studies that are based on single group, pre/posttest designs do not meet this requirement. Programs’ messages, materials and other intervention components include English and can be disseminated in a U.S. community or clinical setting. Programs that are research-tested are not necessarily evidence-based. There is a difference. Research-tested: tested in at least 1 study with strong study design. Evidence-based: based on a body of literature, typically multiple studies in different settings and with different populations

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5. A database of actual programs and products that you can adapt for your own use It provides: – program summaries: includes a list of journal articles about the program – actual program materials (e.g., brochures, implementation manual, fliers, handouts) or ways to access them Research-Tested Intervention Programs (RTIPs) Source: The Guide to Community Preventive ServicesThe Guide to Community Preventive Services 5

6. RTIPs contains Programs on these topics: – Breast Cancer Screening (N=22) – Cervical Cancer Screening (N=8) – Colorectal Cancer Screening (N=11) – Diet/Nutrition, Obesity, Physical Activity (N=55) – Informed Decision Making (N=6) – Sun Safety (N=17) – Survivorship (N=12) – Tobacco Control (N=28) Research-Tested Intervention Programs/RTIPs Source: The Guide to Community Preventive ServicesThe Guide to Community Preventive Services 6

7. RTIPs contains: – Description of the program – Program materials that you can use or adapt – Program scores (1.0=lowest, 5.0=highest): Dissemination capability Cultural appropriateness Age appropriateness Gender appropriateness Research integrity Intervention impact (Utility) – List to research articles published about the program Research-Tested Intervention Programs/RTIPs Source: The Guide to Community Preventive ServicesThe Guide to Community Preventive Services 7

8. RTIPs has recently updated the way it scores programs with RE-AIM. The five RE-AIM steps to translate research into action are: – Reach the target population – Effectiveness or efficacy – Adoption by target settings or institutions – Implementation (consistency of delivery of intervention) – Maintenance of intervention effects in individuals and settings over time (not scored in RTIPs b/c most studies don’t have data on this) 8 Updated RTIPs Score: RE-AIM

9. Research-tested Intervention Programs (RTIPs) http://rtips.cancer.gov/rtips/index.do 9

10. PubMed Search: breast cancer screening and Latino and church Results: 9 A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas. Allen JD, Pérez JE, Tom L, Leyva B, Diaz D, Idalí Torres M. J Cancer Educ. 2014 Mar;29(1):136-43. doi: 10.1007/s13187-013-0560-3. Effects of a culturally sensitive education program on the breast cancer knowledge and beliefs of Hispanic women. Hall CP, Hall JD, Pfriemer JT, Wimberley PD, Jones CH. Oncol Nurs Forum. 2007 Nov;34(6):1195-202. Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans. Sauaia A, Min SJ, Lack D, Apodaca C, Osuna D, Stowe A, MGinnis GF, Latts LM, Byers T. Prev Chronic Dis. 2007 Oct;4(4):A99. Epub 2007 Sep 15. Participation and program outcomes in a church-based cancer prevention program for Hispanic women. Lopez VA, Castro FG. J Community Health. 2006 Aug;31(4):343-62.

11. RTIPs Not ALL RTIPs programs are created equally. Be sure to read the program scores or the more recent RE-AIM scores to compare programs. Note that not all RTIPs programs are “evidence-based”. 11

12. Program 3 ________ Program 2 ________ Part 2: Finding a Program that Fits your Needs Community Assessment Findings  Health goals  Behavioral/ environmental objectives  Priority population  Organization/coalition (capacity and resources) Compare Program 1 ________

13. Assessing Detailed Fit To assess detailed fit, get EBA materials Educational materials (e.g., handouts, booklets, etc.) Protocols and implementation guides Information from EBA website and EBA developers Journal articles or other literature about the EBA

14. Detailed Comparison of EBAs & Community Assessment Findings 1.Health goals, behavioral and environmental objectives 2.Determinants - objectives 3.Delivery possibilities and preferences 4.Characteristics of priority population 5.Organization/ coalition/ community context/resources

15. 1.Health Problem, Behavior Compare the community assessment findings to the EBA: Community assessment – Prevalence & seriousness of health problem, behaviors – Objectives related and specific behaviors, e.g., Evidence-based approach (EBA) – Which behavioral outcomes were effectively changed? 1. Decide to get colorectal cancer screening 2. Choose type of screening test 3. Make appointment for screening 4. Keep appointment

16. 1.Health Problem, Environment Community assessment, e.g., – Lack of available and accessible screening facilities – Objective: Increase availability and accessibility of screening facilities EBA – Are these issues addressed by the EBA?

17. 2. Determinants Mild fear arousal Belief selection Persuasive communication Methods Modeling FOBT Determinants Attitudes Self-Efficacy Beliefs Awareness, Risk perception Reduce CRC morbidity & mortality Access to Free/low cost tests Behaviors & Environment Health ObjectivesGoal

18. 3.Delivery Community assessment – Capacity and resources: setting, channels, personnel, e.g., via general-audience oriented or ethnic-audience oriented channels; via community health workers Population: which used, preferences/ attitudes? Capacities and resources: which channels available EBA – Delivery setting, format, program deliverers, channels used

19. 4.Priority Population Community assessment – Priority population’s characteristics Evidence-based approach – Statistics* – Pictures* – Language* *Kreuter, Lukwago, Bucholtz, Clark, Sanders-Thompson. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav,, 2003, 30, pp. 133-146.

20. 5.Capacity and Resources Community assessment ̶Existing programs/ facilities ̶Facilitators and barriers for implementation ̶Infrastructure, leadership, other roles ̶Capabilities, willingness, and resource EBA ̶What is needed for implementation? ̶Which contextual factors influenced effectiveness?

21. Working in groups of 2-3 people, use RTIPs to find potential programs to match the given scenario. Bonus: Try to find programs using both The Community Guide and RTIPs as starting points. RTIPs Activity 21 Activity #2: Finding EB Programs

22. Refer back to your community assessment and think about: – Was the program conducted with people who had similar: Socioeconomic status Resources Ethnicity Traditions Priorities Community structure and values. – Is the program appropriate for the age of your audience? 22 Criteria for Selecting a Program

23. Choose a program that is well-matched with: – Your health topic (e.g., breast or cervical cancer, nutrition, physical activity) – What your community is already doing about the health issue. – Capacity of your organization and partner organizations. 23 Criteria for Selecting a Program

24. Pay attention to the strategies the programs used to achieve their objectives. – These strategies can include: Providing information Enhancing skills Improving the services and/or support systems that exist Changing incentives or barriers that maintain the problem Promoting access Making suggestions for policy changes 24 Criteria for Selecting a Program

25. Remember to avoid a program that takes more resources than you have. Consider these resources in selecting an evidence-based program – Personnel – Technical (expertise needed) – Fiscal – Community linkages or partners Different evidence-based programs will take different amounts of money, labor, and/or time. 25 Your Resources

26. Scenario: You want to develop a community program in East Los Angeles. This a community with a large Mexican American population. Based on your needs assessment, you have chosen cervical cancer as your health topic with the following goals and objectives: Goal: Reduce cervical cancer mortality among Mexican American women, ages 18 to 65, in East LA. Objective 1: Increase the number of women who receive Pap test screening by 20 percent during the life of the program. Objective 2: Obtain information about the cervical cancer screening behaviors of Mexican American women, ages 18-65, in East LA. Objective 3: Increase the number of Mexican American women who will be able to associate HPV with cervical cancer by 20 percent. Scenario 1 26

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28. Selecting an Evidence-Based Approach EBA Selection Tool – Handout #3

29. Take-home Points Refer to your community assessment when considering fit Select evidence-based programs, strategies and policies that fit your o Goals and objectives, including for determinant change o Delivery possibilities and preferences o Characteristics of the priority population o Organization/coalition/community context Select EBAs with a stronger evidence base

30. Questions ?

31. Program A: African American women Ages 40+ Live in low-income housing Distrust physicians Have limited access to medical care Conducted in churches, community centers, homes, and clinics Included a church program and educational brochures and training health care providers who work with the target audience. Program B: Cambodian women, refugees Ages 18+ Live in a farming community Limited English skills Unfamiliar with Western medicine Conducted in home and community settings Included an outreach worker manual and letters to the target audience, a clinical resource manual, and a Khmer- language video. 31 Activity: Which Would You Pick? You want to find an evidence-based program to increase cervical cancer screenings among Mexican American women in East Los Angeles. You have narrowed your search to two evidence-based programs, Program A and Program B.

32. ProgramFoCaSCambodian Women’s Health Target audience Ages 40+ African American Low-income housing communities Ages 18+ Cambodian women Cancer type Breast and cervicalCervical Setting Community centers Individual homes Community churches Clinic waiting and exam rooms Home-based Community-based “The need” (reasons why underscreened) Limited access and referral to preventive and treatment services Fear and fatalistic views of breast cancer Distrust of medical community Doctors may be less likely to recommend screening to older or minority women Refugees, relocated to mainly farming communities, not familiar with Western medicine, services, and prevention Low levels of being absorbed into the culture; limited English-language skills Limited access to preventive care Program scores Dissemination capability: 3.0 Cultural appropriateness: 5.0 Age appropriateness: 5.0 Gender appropriateness: 5.0 Integrity: 3.3 Utility: 3.3 Dissemination capability: 4.0 Cultural appropriateness: 5.0 Age appropriateness: 4.5 Gender appropriateness: 5.0 Integrity: 2.8 Utility: 2.5 32

33. Selected the Cambodian Women’s Health Project because: – Target age: 18+ – Cancer type: Cervical – “Need”: Immigrants, limited sense of belonging to majority community, limited English, farming community. 33 Let’s Review: Program Selection