Table 3 Recommendations for implementing ML/MC CRC screening programs in FQHCs (organized by CFIR and non-CFIR domains)

Intervention characteristics

• Tailor education and outreach materials to fit the needs of the community

Characteristics of the individual

• Integrate promotores into the healthcare team as patient navigators and health educators to engage with Latino patients during the screening process.

Inner setting

 Available resources

• Utilize “inreach” and outreach teams to increase awareness and uptake of CRC screening

• Offer free/discounted FIT kits for patients for in-person pick-up or mailed to their home

• Utilize internal quality improvement teams to focus on specific patient care and metrics

• Community-academic collaborations that can facilitate access to funding support for CRC programming

 Organizational incentives and rewards

• Integrate friendly competition among care teams in the health center

• Incorporate patient incentives such as raffles or monetary incentives may be an effective strategy for FIT kit or attendance at group-based events

 Relative priority

• Prioritize screening and preventative care alongside treatment and other health education initiatives.

 Culture of the health center

• Instill a culture of prevention among healthcare providers and staff at all levels.

 Goals & Feedback

• Set internal goals within the health center and highlight the impact of efforts

• Include a discussion of and progress toward HEDIS and health center quality measures during meetings with providers

• Develop a multidisciplinary, internal task force to increase screening rates, develop incentive systems, and address workflow challenges

 Networks & Communication

• Establish/enhance system-wide EHR notifications to indicate to providers which patients would benefit from group-based education and screening navigation.

Outer Setting

 Cosmopolitanism

• Build external relationships with social service and community agencies to address social determinants of health and to engage hard-to-reach populations.

 Patient Needs & Resources

• Understand and mitigate patient barriers (i.e., transportation, time, health literacy) to screening.

 External Policy & Incentives

• Consider national screening goals (i.e., UDS, HEDIS) to receive financial incentives for the health system.

• Inform health centers about reimbursement models (i.e., federal block grants, insurance payment policies, and financial incentives), in which the organization benefits from implementing cost-effective CRC preventative services.

• Consider creative funding models to allow for reimbursement (e.g., group-based with rotating 1:1 provider visits)

Non-CFIR Domains

Existing infrastructure for CRC screening and health education

• Provide culturally responsive, bilingual CRC screening education materials