Design of an implementation blueprint to reduce breast cancer disparities using health equity informed implementation science frameworks

Over several decades, health services research has generated key insights about the multilevel drivers of cancer health disparities. The next phase of disparities research should leverage these insights to design, implement, and rigorously evaluate interventions to reduce cancer health disparities. Implementation science process, determinants, and evaluation frameworks offer novel methods to accelerate dissemination and implementation and advance health disparities research. In this paper, we describe the integration of implementation science determinants, and evaluation frameworks within a validated A3 quality improvement template to provide cancer centers with an actionable blueprint to increase mammography screening among underserved populations. In 2023, the American College of Radiology and the Radiology Health Equity Coalition (RHEC) sponsored participation in the National Academy of Medicine Scholars in Diagnostic Excellence program to develop strategies to reduce care gaps that limit access to timely, high-quality screening and diagnostic breast imaging. The RHEC, convened by the American College of Radiology, brings together patient-focused radiology societies together to collect, assess, and disseminate resources and best practices. To develop an actionable blueprint to increase breast cancer screening percentages among underserved patient populations, we leveraged a validated A3 quality improvement template that has demonstrated reliability, measurement, content and construct validity to guide practitioners through the development, implementation, and testing of interventions. We adapted this template to develop an implementation blueprint using published implementation science determinants, process, and evaluation models and frameworks, training courses, and resources from the National Cancer Institute’s health-equity focused implementation toolkit. The implementation blueprint includes 8 sections: Problem, Targets, Current Situation, Determinants, Evidence-Based Practice Intervention, Recommendations, Action Plan, and Sustain & Follow-Up. The breast cancer disparities focused implementation blueprint includes health equity focused problem statement, SMART goal with defined patient population experiencing increased deaths from breast cancer, fishbone diagram modified using the CFIR determinants framework and health equity questions to identify cancer screening barriers and facilitators. The key driver diagram maps to identified barriers and discrete implementation strategies using the CFIR–ERIC mapping tool. Action plans include tracking health equity focused implementation outcomes. Determinants of program sustainability were evaluated using the Program Sustainability Assessment Tool (PSAT). Our implementation blueprint derived from implementation science determinants, process, and evaluation frameworks provides an actionable template for cancer centers to reduce breast cancer disparities by increasing mammography screening.