Collaborative Selection of Implementation Strategies for Improving Smoking Cessation Treatment and Lung Cancer Screening in Federally Qualified Health Centers: A Pilot Study

Abstract

Objective:

Federally qualified health centers (FQHCs) are key sites to address smoking and lung cancer screening (LCS) in the United States. We assessed the feasibility, acceptability, and appropriateness of a method for selecting implementation strategies to address smoking cessation treatment (SCT) and LCS delivery in FQHCs.

Methods:

Two Massachusetts FQHCs partnered with an external implementation team of clinical content experts and community health research staff to pilot test a roadmap method to improve SCT and LCS from December 2022 through May 2023. During a 3-month period, the internal and external team (1) identified, anticipated, and experienced barriers to implementation; (2) mapped workflows; (3) selected implementation strategies to address barriers, including data and population health infrastructure, health care provider knowledge, and patient travel; and (4) pilot tested selected strategies. Qualitative group interviews at the end of the 3-month pilot with internal teams of 9 FQHC staff identified key implementation determinants guided by the Consolidated Framework for Implementation Research. We surveyed FQHC staff on a 5-point Likert scale, with higher values reflecting favorable outcomes, about the feasibility, acceptability, and appropriateness of the strategy selection process; we calculated summary (median [IQR]) scores.

Results:

Teams selected 6 strategies to address key barriers; 5 strategies were implemented partially or fully during the pilot. Qualitative interviews highlighted implementation determinants in the inner setting and outer context domains. Internal implementation teams rated the roadmap as feasible (median [IQR] = 4.0 [3.3-5.0]), acceptable (median [IQR] = 4.0 [4.0-5.0]), and appropriate (median [IQR] = 4.0 [4.0-5.0]).

Conclusions:

The roadmaps process was feasible in FQHCs and produced implementable strategies aimed at barriers to LCS and SCT delivery in FQHCs. This process warrants further testing in a larger trial of LCS and SCT implementation strategies.