A Delphi Study of Implementation Strategies for Cervical Cancer Control Policies in Africa

About This Grant

Project Summary/Abstract Cervical cancer burden falls heavily on women in low- and middle-income countries (LMICs). Cancer control policies have the potential to address this burden by enhancing the reach of evidence-based primary, secondary and tertiary clinical services, and the fidelity with which they are delivered—however, these policies must be implemented if they are to achieve population health improvements. However, we lack a robust, empirically- grounded, theoretically-driven understanding of the determinants of policy implementation success, nor of strategies that could improve policy implementation. This project engages a network of experts from African LMICs and global agencies through: (A) a three-round Delphi process to identify determinants of policy implementation success in LMICs, beginning with the CFIR (version 2 plus modifications for LMICs); (B) qualitative interviews, leveraging the CFIR and Bullock et al.’s policy implementation framework, to understand the process and mechanisms by which these determinants operate; and (C) another three-round Delphi process to identify strategies, from a subset of those in the ERIC compendium, that could be used to strengthen cervical cancer policy implementation in African LMICs. This study focuses on cervical cancer policy, but has relevance for other cancer policies and other public health policies more broadly. The findings of this research can equip researchers and policymakers with empirically- informed, expert-selected strategies that could be implemented and evaluated. To our knowledge, this is the first study to systematically engage global experts in a theory-based, rigorous process to identify both determinants of policy implementation success and strategies to address these determinants. The project will leverage expertise of the MPIs in global cancer control and policy-focused implementation science, a Scientific Advisory Board that includes implementation science experts and global cancer control experts, and an Expert Panel of ~60 policymakers and other experts from African LMICs. There has been much emphasis on crafting and introducing cancer control policies and plans in countries around the world. We need to improve our understanding of how these are being implemented, and how this implementation could be improved so that greater population health improvements can be achieved. This research will generate the necessary building blocks—grounded in D&I science and modified for the LMIC context through rigorous expert engagement processes—to strengthen policy implementation, and ultimately work toward cervical cancer elimination globally.