Pilot Project 1: Planning for Sustainability of Evidence-based Interventions

Partnership

Laura Linnan, ScD (UNC) serves as Co-PI for the “Planning for Sustainability of Evidence based Interventions” pilot project (and as Project Co-Lead, with Dr. Jonathon Livingston, NCCU, for the NCCU/UNC Outreach Core). Dr. Livingston has recently joined, replacing Dr. David Jolly, who retired following over 5 years as the original Co-PI from NCCU for this pilot project. Dr. Cherise Harrington will co-lead the pilot project with Dr. Linnan. Dr. Harrington will be assisted by Dr. Kristen Black (Cancer Health Disparities post-doctoral fellow – UNC) and Shauna Williams (NCCU – undergraduate Partnership training fellow).

Cancer Disparity

Cancer is the leading cause of death in NC. According to the NC Central Cancer Registry, State Center for Health Statistics, a total of 57,624 new cancer cases and 20,303 cancer-related deaths are projected to occur in NC in 2015 with 1,409 new cases and 479 deaths occurring in Durham County. Men (vs. women) have higher incidence and mortality from many cancers; and, African American men are at highest risk and suffer the greatest cancer disparities. For example, the age-adjusted cancer mortality rate for colorectal cancer is 49.8 for AA men vs. 39.6 for White men, 32.2 for AA women and 30.1 for White women. This same pattern exists for most types of cancer. However, evidence suggests that over 50% of cancer deaths can be prevented by eliminating tobacco use, increasing physical activity, and maintaining a healthy weight. The same pattern of high behavioral risk is evident among AA men in NC — 27.9% currently use tobacco (vs. 23.3% among White men), 55.3% do not meet physical activity guidelines (vs. 47.2% White men) and 26.2% maintain a healthy weight (vs. 27.5% White men).

Cancer rates are higher among Durham County residents than in the state as a whole; for example, in 2011, 26.4% of all deaths in Durham County were due to cancer compared with 22.8% in NC. From 2009 through 2013, overall age-adjusted cancer mortality rates in Durham County were higher than those for NC in colorectal cancer (14.8 vs. 14.3/100,000) and prostate cancer (24.8 vs. 22.1/100,000). Cancer disparities by race/ethnicity were observed in Durham County as well. From 2009 to 2013, overall cancer mortality was 28.4% for AA males (vs. 21.5% White males); and 26.6% for AA females (vs. 19.8% White females). Thus, innovative interventions to reach and engage African Americans, especially men in primary prevention efforts are needed to address persistently high behavioral risk profiles and cancer disparities.

Abstract

Developers of evidence-based interventions want to maintain the beneficial health outcomes of their efforts and “sustain” them over an extended period of time, even after external support from a donor agency or funder is terminated. Grounded in community-based participatory research, our interdisciplinary research team has produced a wide array of effective interventions focused on addressing cancer disparities and based on a strong, 15-year partnership with 300 beauty salons, 80 barbershops, and over than 3000 customers.

Unfortunately, and despite evidence of effectiveness, when the study was completed, these programs were typically not continued. The goal of the proposed pilot outreach project is to rigorously and systematically investigate factors that influence the sustainability of FITShop, a recent barbershop-based, evidence-based intervention designed to promote physical activity among African American men. This mixed-methods, two-phase proof-of-concept study will occur over 3 years and be guided by a planning–for-sustainability approach we will adapt from the work of Shediac-Rizkallah & Bone (1998) and Scheirer (2013).

In Phase 1, Aims 1-3, we will conduct approximately 30 interviews and community discussion groups to explore three hypothesized set of factors that influence sustainability: 1) Broad social, political and economic factors in the larger community; 2) Organizational influences (barbershop and hair care industry); and, 3) Program design and implementation factors that relate to the FITShop intervention.

Using these results, Phase 2 will implement a theory-guided approach to sustain the FITShop intervention in Durham, North Carolina – a community with disproportionately high cancer incidence and mortality rates (Aim 4). Consistent with the original FITShop study, we will measure six month physical activity outcomes (e.g. maintenance of health benefits) among 100 customers from 10 barbershops using both objective (Actigraph/FITBit) and self-report (CHART) measures.

This study will yield important new knowledge about how to 1) follow a theory-informed process to plan for sustainability of evidence-based interventions; 2) identify and work to advance theory and develop new measures of sustainability outcomes (e.g. maintenance of health benefits at the individual level, organizational/community capacity building, and institutionalization of programming); and, 3) assess the extent to which FITShop can be sustained in one community. Our results will have important implications for planning early in the initial funding period to sustain interventions, and will enhance the sustainability of the next generation of evidence-based interventions, to help eliminate persistent health and cancer disparities.

Co-Principal Investigators

Cherise Harrington, PhD NCCU	Laura Linnan, ScD UNC Lineberger