Assessing the implementation of interventions addressing socioeconomic inequalities in cancer screening in high-income countries

Abstract

Background: The context of an intervention may influence its effectiveness and success in meeting the needs of the targeted population. Implementation science frameworks have been developed, but previous literature in this field has been mixed. This paper aimed to assess the implementation success of interventions, identified from a systematic review, that reduced inequalities in cancer screening between people in low and high socioeconomic groups.

Design and Methods: The implementation framework by Proctor et al. was utilised to assess the potential success of 6 studies reporting on 7 interventions in the “real-world” environment. A standardised rating system to identify the overall implementation success of each intervention was established.

Results: Four interventions (57%) demonstrated high potential to be implemented successfully. Interventions included enhanced reminder letters and GP-endorsed screening invitations, containing evidence on the acceptability, from participants and stakeholders, appropriateness and direct cost of the intervention.

Conclusion: While some interventions reduced socioeconomic inequalities in cancer screening participation, there have been missed opportunities to integrate the experiences of the targeted population into design and evaluation components. This has limited the potential for transferability of outcomes to other settings.

Significance for public health

Interventions may be effective within a research context and the sample population but may not equally benefit all when implemented. Implementation science frameworks are useful in understanding how and why an intervention may succeed or fail in the “real-world” environment. This project assessed the implementation success of interventions, identified from a systematic review that reduced inequalities in cancer screening between people in low and high socioeconomic groups. Over half of the interventions that produced a positive impact in the research context had high potential for implementation success. This assessment demonstrated that no one size fits and for the socioeconomically disadvantaged, input from these participants along the implementation spectrum is a crucial element for ensuring transferability to other settings. To make sure finite research funding is used effectively, engagement with disadvantaged populations is of public health importance because programs or services need to be tailored to their specific needs to reduce inequalities.