Connecting Implementation Science, Community-Engaged Research, and Health Promotion to Address Cancer Inequities in Massachusetts: The UMB/DF-HCC U54 Outreach Core

Abstract

The Outreach Core of the U54 Partnership between the Dana-Farber/Harvard Cancer Center and the University of Massachusetts Boston created a new model for addressing cancer inequities that integrates implementation science, community-engaged research, and health promotion. Key elements of the approach include engaging a Community Advisory Board, supporting students from underrepresented minority backgrounds to conduct health promotion and community-engaged research, increasing the delivery of evidence-based cancer prevention programs to underserved communities (directly and by training local organizations), supporting research-practice partnerships, and disseminating findings. Our model highlights the need for long-term investments to connect underserved communities with evidence-based cancer prevention.

Background

About half of the cancers occurring in the US could be prevented using existing evidence-based interventions (EBIs)—including programs, practices, and policies.¹ However, inadequate and uneven delivery of EBIs to underserved communities drives ongoing cancer inequities.² Innovative approaches are needed, and we offer the model of the Outreach Core from the U54 Partnership between the Dana-Farber/Harvard Cancer Center and the University of Massachusetts Boston. We connected implementation science, community-engaged research, and health promotion to improve cancer prevention and control among underserved communities in Massachusetts.

Program Context

This program was funded by the National Cancer Institute (NCI) Comprehensive Partnerships to Advance Cancer Health Equity program, which supports collaboration between institutions serving underserved populations and underrepresented students (here, the University of Massachusetts Boston) and NCI-designated cancer centers (here, the Dana-Farber/Harvard Cancer Center). The funding mechanism focused on increasing the University of Massachusetts Boston’s capacity for cancer research and education and the ability of both partners to support under represented minority (URM) students and investigators in cancer research, expand cancer equity research, and offer cancer prevention outreach to underserved communities.³ The partnership has been active in various forms since 2005. This iteration (2016–2021) included an Outreach Core led by co-directors (SR, TD, and CS) and one principal investigator (KV), a group with extensive expertise in cancer equity and community-engaged research.

The research team worked with partners representing the Black community of Greater Boston, the Latino community of Greater Lawrence, and the Brazilian community of Greater Boston; detailed descriptions of the communities appear elsewhere.⁴ The three communities represent tremendous diversity and include substantial representation of immigrants, racial and ethnic minorities, and/or low-income populations. Notably, these communities have rich, multi-sector action focused on health equity and social justice. The Community Advisory Board, researchers, and study staff co-wrote this piece to offer our collective appraisal.

The Outreach Core Approach

As seen in Figure 1, we utilized six strategies to connect implementation science, health promotion, and community-engaged research to build infrastructure for addressing cancer equity.

Figure 1.

Integrating implementation science, community-engaged research, and evidence-based health promotion to address cancer equity, with exemplar instructions between strategies in italics.

Strategy 1: Investing in a Community-Engaged Partnership to Address Cancer Equity

We used a participatory implementation science approach, emphasizing ongoing engagement between stakeholders and researchers to improve research-practice linkages, promote systems change, and address health inequities.^5,6

Activities:

Our engagement style emphasized multi-directional learning and joint determination of program priorities based on local needs and opportunities to create change.⁷ This approach supported flexibility as community priorities shifted. For example, with the onset of the COVID-19 pandemic, the group came together to coordinate services and advocacy related to food insecurity and under-employment. As the pandemic progressed, the group coordinated action to address issues of vaccine access and hesitancy among local communities of color. The advisory board included five members with rich expertise in social justice and community health, representing the Brazilian Worker Center, the City of Lawrence Mayor’s Health Task Force, Greater Love Tabernacle, and Health Resources in Action. Some partnerships have been active since 2005 and others since 2016.

Strategy 2: Increasing the Diversity of the Cancer Research Workforce

The US is moving toward becoming a majority-minority nation. Still, racial and ethnic minorities are dramatically underrepresented in the biomedical and health research workforce, missing critical opportunities to leverage the talents and expertise of communities most impacted by structural inequities.⁸

Activities:

From 2017 to 2021, we supported 33 URM students through paid summer internships focused on health promotion and/or community-engaged research. A group of 14 students continued for year-long internships. In addition to projects, interns participated in journal clubs, professional development, seminars, poster presentations, and offerings from the U54 Research Education Core and other URM training programs. Students also had access to a mentoring network that included supervisors, graduate students, a Community Health Educator, and Core faculty. Among the 13 interns who graduated between 2018 and 2020 and responded to follow-up surveys, 6 work in cancer equity or other research positions. For faculty, successes include the appointment of 2 Core members (one URM and one non-URM racial minority) to tenure-track, Assistant Professor positions, and the promotion of one URM Core member to Full Professor. The junior appointments can be indirectly attributed to the grant, which provided access to research opportunities, professional networks, and leadership roles.

Strategy 3: Building Capacity in Local Organizations for Evidence-Based Cancer Prevention

An ongoing challenge for cancer equity is the limited uptake and implementation of EBIs in public health settings, with wider service delivery gaps for those from lower socioeconomic position and racial and ethnic minorities.⁹ We focused on EBIs delivered through community-based organizations (CBOs), such as the YMCA and faith-based organizations (FBOs), given their reach and trust among marginalized and excluded communities and interest in increasing EBI-related capacity.^10–12

Activities:

We used an established curriculum¹³ to increase practitioner capacity for EBI use (40 CBO and FBO staff members) and program evaluation (11 FBO staff). We also offered training, a mini-grant, and technical support for CBOs and FBOs to adapt and implement programs on biobanking (14 organizations) and human papillomavirus vaccination (12 organizations). These programs reached 265 and 161 community members, respectively. For both programs, Community Advisory Board guidance was critical for increasing the relevance and equity focus of the content, for example, starting the biobanking training with a discussion of medical mistrust and discrimination in communities of color. Finally, we updated a previously developed searchable portal, using iterative design processes responding to end-user feedback (Figure 2). The portal was updated regularly and contained over 230 resources, including local health data, health promotion programs, and tools. It had 4421 unique visitors during the grant cycle (September 1, 2016 - August 31, 2021).

Figure 2.

Web portal supporting EBI use in CBOs and FBOs, with local data and searchable resources (www.planetmassconect.org).

Strategy 4: Delivering Health Promotion Programming

The core structure included a community health educator who participated in the NCI National Outreach Network. The program seeks to improve linkages with diverse communities, incorporate health promotion activities into research programs, and develop and disseminate cancer prevention EBIs among underserved communities.¹⁴

Activities:

We conducted evidence-based educational outreach for the prevention of colorectal, breast, and skin cancer. Additional events responded to requests from community partners, for example, a mental health event for young people in the context of the COVID-19 pandemic.

Strategy 5: Disseminating Cancer Equity Research

Given that so much research evidence is under-utilized in practice and policy settings, we took a proactive, practice- and community-focused approach to dissemination to increase the utility and uptake of findings.¹⁵

Activities:

Our dissemination efforts had two primary audiences. First, to meet the needs of staff and leaders from CBOs and FBOs, we used the web portal to disseminate research evidence and local data. As an example of our responsive approach, we also used the portal, newsletters, and meetings to share COVID-19 health communication resources, infographics, and messaging toolkits in English, Spanish, and Portuguese. The team also participated in three events to prepare local organizations to address vaccine hesitancy. Second, we engaged community members in dissemination activities through six events called Science Cafés. These events brought researchers, trainees, and community members together for conversations about research, cancer equity, and social justice; 144 community members participated.

Strategy 6: Supporting U54 Research-Practice Partnerships

Our final focus was to broaden the scope of community-engaged research and implementation science across the U54 Partnership.

Activities:

We supported five cross-institutional teams in the areas of community-based and community-engaged research and delivered training in these areas to student interns. The Core supported researchers with community engagement plans, access to populations, and participant recruitment. The Core also provided a base for three pilot grants that emphasized community engagement and/or implementation science.

Conclusions

Connecting implementation science, community-engaged research, and health promotion yielded several significant benefits. First, the community-engaged approach (including joint project leadership by CAB members leading health promotion in underserved communities) was critical to center impact and equity in decision-making. Second, the rare opportunity for URM students to access paid internships focused on community engagement and health promotion exposed students to population science research careers and allowed them to make significant contributions to their communities. Third, responsive dissemination activities offered insight into new ways to engage community audiences, for example, linking dissemination with opportunities for youth development and engagement in science. Fourth, agility in response to changing community needs and priorities was critical to retaining a balance between knowledge and action. In the short-term, our approach supported health promotion and dissemination goals. For longer term infrastructure development, we supported goals of diversifying the workforce, positioning local organizations to more effectively leverage EBIs to address cancer equity, increasing the quantity and quality of cancer equity research within the partnership, and equipping researchers to better leverage community- and practice-based expertise. A partnership-wide evaluation is underway at this time to understand the overall impact on goals of advancing cancer equity.

While there were many successes, we also experienced a series of challenges. As an example, cancer prevention and control are important to our community partners. Still, urgent and immediate housing demands, mental health concerns, the COVID-19 pandemic, and social needs rightly took precedence at times. Second, the differing agendas, resources, and orientations between researchers and partners can be challenging to balance. Finally, we recognize the need to better address cancer health equity from a systems perspective and work not simply to make the most of faulty systems but to address structural inequities as a routine part of practice. Our position is that connecting implementation science, community-engaged research, and health promotion offers a unique opportunity to build the necessary infrastructure to achieve cancer equity.