Rationale and Protocol Design for the Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal.

Abstract

This article presents the rationale and design for the adaptation and implementation of a patient navigation program for cervical cancer screening across contexts in Senegal. A model, based on the NIH NCI Patient Navigator Research Program (PNRP) model, informs the proposed program for adaptation which aims to reduce intrapersonal- (knowledge, communication), interpersonal- (stigma, misinformation), and community-level (women's lack of autonomy in healthcare decision-making) barriers. The specific aims of the study are to: 1) Evaluate the adaptation process of the evidence-based Patient Navigation Model utilizing the Dynamic Adaptation Process (DAP) across rural and urban contexts in Kedougou and Dakar, Senegal; 2) Conduct an effectiveness-implementation hybrid type 1 stepped-wedge randomized pragmatic trial of the adapted patient navigation program across Kedougou and Dakar, Senegal, and 3) Evaluate the implementation outcomes (feasibility, acceptability, fidelity, penetrance, sustainability, and cost) of The Adapted Patient Navigation Program across multiple contexts in the Kedougou and Dakar regions, using mixed methods and guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. The Adapted Program is integrated into the existing community health system and is being administered by the Heads of Reproductive Health at the Regional-Level and District Levels who act as Patient Navigator Leaders with oversight by the Regional and District Directors of Health. These individuals coordinate the patient navigation field activities that occur at the health post level. The Community Health Workers (Patient Navigators) are essential to engaging individual clients through education, empowerment, and by accompanying them to the clinical setting for screening and follow-up. The study is a mixed-methods study that collects data from three participant samples: (1) system and organizational stakeholders, (2) patient navigator team members, and (3) clients. The study informs the adaptation and implementation of patient navigation programs for cervical cancer screening in Senegal and other low- and middle-income countries.