Dr. Robin C. Vanderpool was the Assistant Professor in the Department of Health Behavior, University of Kentucky (UK) College of Public Health and member of the UK Markey Cancer Center, Cancer Prevention and Control Program. She was actively funded on several CDC grants focused on promotion of cancer prevention and screening in eastern Kentucky and also had several research projects focused on cancer treatment and survivorship in collaboration with other cancer center investigators.
Dr. Vanderpool taught graduate courses and advised students in the MPH program at UK. Prior to her academic faculty appointment, Dr. Vanderpool served as a health educator and senior research coordinator for the NCI’s Cancer Information Service, a NCI contract awarded locally to the UK Markey Cancer Control Program, for almost 10 years. She also spent time at NCI as a health communications intern (Health Promotions Branch) and fellow (Patient Education Branch) following completion of her MPH degree. Dr. Vanderpool holds a BS in psychobiology from Centre College, a MPH from Western Kentucky University, and a DrPH from the UK College of Public Health. She is also certified as a Health Education Specialist (CHES).
Questions & Answers
There will always be concerns about maintaining program effectiveness when adapting it for another audience (Cohen et al. 2015). We’ve had the opportunity to adapt the “1-2-3 Pap” intervention for audiences beyond young women in rural, Appalachian Kentucky. Specifically, this intervention has been adapted for statewide use in Kentucky, West Virginia, and North Carolina.
Based on lessons learned from these efforts – many of which are documented in Cohen et al. (2015) – several aspects of the program could be adapted depending on the target audience. The video can be modified to include human papillomavirus (HPV) and cervical cancer-related statistics for the target community/state; script changes to include locally-relevant messaging regarding HPV vaccination and cervical cancer; target audience members (e.g., varying ethnicities and races, inclusion of males), locally-known healthcare providers, influential community members, or widely-recognized figures among the target audience; and culturally-relevant graphics, visual images, or background shots.
Several of my colleagues explored implementation of the intervention at local health departments (LHDs) across Kentucky and North Carolina (Carmen et al.; publication forthcoming; McGladrey et al.; data not published). During these studies, the “1-2-3 Pap” video was distributed via multiple channels including internet venues (i.e., posted on a LHD website, YouTube, Facebook) and in LHD waiting rooms. In some instances, young women who had yet to initiate the HPV vaccine series were also targeted (the original study focused on adherence to doses 2 and 3 after receiving dose 1). However, these adaptations and new delivery methods were not tested in terms of program effectiveness, but provide additional evidence for future dissemination and implementation (D&I) research.
Our research team believes that “1-2-3 Pap" can be readily adapted for a wide variety of audiences. To best adapt the “1-2-3 Pap” intervention for other audiences, we recommend using the “Putting Public Health Evidence into Action” training materials developed by our colleagues at the Cancer Prevention and Control Research Network (CPCRN); please see section 6: “Adapting an Evidence-based Approach to Fit Your Community” (http://cpcrn.org/pub/evidence-in-action/).
Our research team found several facilitators while adapting the “1-2-3 Pap” intervention from a rural, Appalachian audience to statewide audiences of young women. Many LHD staff indicated in a recent study (Carmen et al.; publication forthcoming) that the intervention met their organizational priorities and goals; they also perceived the “1-2-3 Pap” intervention to be straightforward and easy to implement. The researchers also discovered that the most coordinated LHDs held staff meetings prior to implementation, which allowed for staff feedback and the opportunity to gain buy-in. Broad inclusion of staff members can help facilitate implementation; they can help determine the best channels and methods for distribution based on their experience with the target population. It is also imperative to identify local stakeholders, including “vaccination champions” and opinion leaders within potential partnering organizations, early in the program D&I process. Local stakeholders can help facilitate D&I by identifying appropriate messaging for the target audience, getting the word out to the community about the program, and providing additional program resources. For instance, a group of public health practitioners in North Carolina were instrumental in adapting the original “1-2-3 Pap” program for their state by developing culturally-relevant messages and delivery channels. The success of such programs can be substantially enhanced by partnering with stakeholders and involving them throughout the D&I process. Additionally, it would be helpful to pilot test the “1-2-3 Pap” intervention with your target audience prior to launch; this ensures that your audience understands the intervention materials. Practitioners may also face challenges when implementing the “1-2-3 Pap” intervention. Due to the current climate regarding vaccination, there may be community norms, specifically negative attitudes or beliefs regarding vaccination, which may need to be addressed. Challenges in developing effective partnerships with stakeholders may also occur due to differing attitudes about program effectiveness, limited workforce capacity, or funding. Similarly, successful program implementation within a given organization may be hindered by lack of resources (i.e., staff and funding), competing demands, and state/local mandates. Barriers can be minimized by doing background work; specifically, assessing program needs, such as staff time and training, and determining how your organization can meet these needs in the most relevant yet least burdensome manner (McGladrey; publication forthcoming). Program implementation may also be difficult if the vaccination infrastructure for a given area is inadequate. For example, some LHDs have expressed difficulty in keeping the HPV vaccine in-stock because of storage requirements (i.e., temperature). Issues surrounding insufficient vaccination data collection systems also surfaced during these studies. LHDs included in the previously mentioned study noted difficulties in obtaining baseline HPV vaccination rates as well as tracking 3- and 6-month follow-up vaccination rates. All programs experience challenges so we encourage practitioners to proactively work with the staff in their respective organization as well as their stakeholders to overcome them.
We highly recommend that practitioners use the “Putting Public Health Evidence into Action” training materials to help with program evaluation (http://cpcrn.org/pub/evidence-in-action/); section 3 (“Planning for Evaluation”) and section 7 (“Implementing and Evaluating Evidence-based Strategies”) will be most useful during the evaluation process. Prior to implementation of the “1-2-3 Pap” intervention, we recommend that practitioners investigate their respective HPV vaccination data collection systems to ensure access to baseline HPV vaccine series initiation and completion rates as well as accurate data collection for the duration of the project.
My professional interests include disparities across the cancer care continuum (prevention through survivorship) among Kentuckians, including our rural and Appalachian populations. I was the Primary Investigator of the Appalachian Center for Cancer Education, Screening, and Support (ACCESS), which is one of eight members of the Cancer Prevention and Control Research Network (CPCRN) funded by CDC and NCI. We had conducted a process and outcome evaluation of a Proactive Office Encounter (POE) model within an 8-site Federally Qualified Health Center (FQHC) in Appalachian Kentucky. The POE model involves a systematic approach to ensuring that patients’ comprehensive needs are met, including guideline-recommended breast, colorectal, cervical, and lung cancer screenings. At the national level, CPCRN is involved in multi-center projects aimed at furthering D&I science in topics such as HPV vaccination and colorectal cancer screenings in FQHCs. I was also actively involved with our CDC-funded Prevention Research Center, the Rural Cancer Prevention Center, which spearheaded the initial “1-2-3 Pap” research project in eastern Kentucky. Other notable projects include co-leadership of an HPV vaccination supplement award to our cancer center by NCI which involves an environmental scan of HPV vaccination activities in Kentucky. Additionally, I have led efforts to examine the potential linkage of state cancer registry data with survivorship care plans. I have several smaller projects focused on the concurrent management of a breast cancer diagnosis and employment as well as self-management of survivorship care among young adult cancer survivors.