JMIR Publications

ABSTRACT

Background:

Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care practices, our team developed a tablet-based digital health program (mPATH®) designed to identify patients needing CRC screening, provide education, and empower patients to request a screening test via the program. Based on recommendations from clinical staff and providers in previous formative research to determine the best strategy to implement the program in primary care, we divided mPATH into two separate tablet programs: mPATH-CheckIn and mPATH-CRC.

Objective:

Our objectives were to qualitatively assess facilitators and barriers to implementing and maintaining mPATH in primary care clinics.

Methods:

After the practices implemented mPATH, we conducted telephone interviews with providers, clinic managers, front desk and nursing staff recruited from a subset of eight of the participating primary care clinics with varying size and degrees of adoption of mPATH. The interview was designed to collect perceived facilitators and barriers to using mPATH. All interviews were administered by a single project staff member with no prior contact with participants. Interviews were audio recorded and reviewed and respondents were offered a $50 gift card. Two study team members independently coded each interview transcript and developed a codebook to identify meaningful categories in the database. The coders met periodically to resolve discrepancies. Data within each category were abstracted and synthesized into themes. Themes were determined inductively by prevalence and salience in the data per the principles of thematic analysis.

Results:

A total of 33 interviews were completed between September 2021 and April 2023 with providers (n=8), clinic managers (n=9), nursing staff (n=8), and front desk staff (n=8). Interviews averaged 25 minutes. Barriers and facilitators identified varied among clinic sites, and by clinic role. Overall, the primary factors driving continued use of mPATH beyond 12 months were staff buy-in, potential time savings and workflow improvement. The primary barriers identified in discontinuing use were perceived lack of need for the program and technical issues. There was no significant indication that clinic size or randomization to low or high intensity bundling of intervention strategies played a role in the decision.

Conclusions:

Implementation of a tablet-based CRC screening tool in primary care practices is feasible with staff buy-in and validation of potential time savings and workflow improvements but may be limited by perceived lack of need and technical issues. Clinical Trial: NCT03843957