Assessing multilevel barriers and facilitators to implementing strategies for cancer screening among Asian Americans in federally qualified health centers: a case study of a community-clinic partnership to improve care for safety-net patients.

Background: Cancer screening disparities among medically underserved Asian Americans are well documented. Assessing determinants of success in implementing multilevel cancer screening strategies in safety-net settings is critical to improve screening and cancer equity.

Methods: Academic, clinic, and community partners established the Advancing Care Together (ACCT) formal network to implement multilevel strategies that promote cancer screening among low-income Chinese, Korean, and Vietnamese adults in Orange County, California. ACCT focused on breast, cervical, and colorectal cancer. From August 2018 to January 2021, meetings, surveys, and interviews were conducted with community and clinic partners before implementing evidence-based strategies (EBS) such as educational workshops and community navigation, aligned with cultural and linguistic factors, to increase cancer screening. We evaluated formative data, collected during meetings and interviews and via patient navigator intake forms, to identify barriers and facilitators to implementing EBS in Asian-serving community clinics. We assembled a code book, aligned with the exploration, preparation, implementation, and sustainment framework to guide data analysis of implementation determinants of cancer screening.

Results: During the implementation of cancer screening EBS, ACCT staff and community navigators identified barriers in the inner context (lack of language-concordant providers, staff turnover) and outer context (referral wait times, transportation, and cultural stigma). Academic and community partnerships can support multilevel EBS to increase cancer screening (bridging factors). Additional support for clinic and quality improvement staff may be needed to evaluate cancer screening outcomes, and routine training on evaluating electronic medical records is needed (innovation factors).

Conclusion: Community-clinic-academic partnerships can increase cancer screening and awareness in Asian American communities, including addressing cultural screening barriers and identifying adaptation needs for educational materials. Additionally, longstanding clinic- and community-level barriers persist in federally qualified health centers serving underrepresented Asian American communities. These barriers in the cancer screening process include high turnover among clinic quality improvement teams and difficulty prioritizing cancer screening throughout the COVID-19 pandemic.