Strategies for Reaching and Impacting Our Communities Sustainably (NWP-ROCS Program)

Widespread implementation, scale-up, and sustainability of evidence-based programs is critical to reducing the burden of cancer. Lay Health Advisor (LHA) programs are highly successful in improving cancer screening in communities and the early detection of cancer among patients. One of the most robust evidence-based and nationally disseminated LHA cancer prevention and screening programs is The National Witness Project (NWP). NWP is one of the few LHA programs (led by cancer survivors) with both longevity and evidence of impact in communities nationally. Despite its impact, NWP continues to face challenges to sustainability and the long-term delivery of the program and sites. Advancing the science of sustainability is urgent, as challenges to the sustainability of evidence-based programs are pervasive in all of public health and healthcare, for all settings and populations. Sustainability research is critically needed to make progress in improving cancer screening and outcomes. Our team is uniquely poised to lead and advance research in this area. Building off of our work on sustainability and a long-term partnership with NWP, we propose a national mixed-methods prospective study with the following aims. First, in aim 1 we will refine, with a sub-sample of NWP sites nationally (n=6), a package of sustainability strategies to support the ongoing delivery of NWP at scale in community-based settings. We will focus on strategies for building capacity and partnerships to enhance sustained impact and delivery of NWP and support retention of LHAs (e.g. novel curricula/training; tailored technical assistance; Community of Practice model to share lessons learned across sites), with the goal of enhancing capacity for: 1) building partnerships/identifying champions at academic/healthcare centers to leverage organizational resources; 2) building business case for program’s value; 3) addressing local community needs and context. In Aim 2, we propose to deliver and examine the impact of this refined package of sustainability strategies on multiple sustainability outcomes annually over four years across 16 NWP sites nationally using a pre-post cluster prospective design. Finally, in aim 3, we plan to apply a concurrent mixed-methods approach (n=200 surveys and 50-65 in-depth interviews) to examine the uptake, acceptability, appropriateness, feasibility and impact of sustainability strategies among up to 16 NWP sites to explore the processes through which strategies build capacity for and influence sustainability of programs in community settings over the 4 years. This research is timely, providing a key opportunity to advance scientific understanding of strategies to promote sustainability among a generalizable, nationally disseminated program. Findings lay the groundwork for enhancing sustainability of effective community-based programs and making progress in improving cancer screening among communities nationally.