PROJECT SUMMARY Candidate: Dr. Melinda Davis has a PhD in social developmental psychology and is a Research Assistant Professor in the Oregon Health & Science University (OHSU) School of Medicine (Department of Family Medicine) and Assistant Professor in the OHSU-PSU School of Public Health (Health Behavior). She is the Director of Community Engaged Research for the Oregon Rural Practice-based Research Network (ORPRN) at OHSU. This K07 builds upon her applied experience as a practice facilitator and participatory researcher, addresses critical gaps in scientific training, and provides pilot data for an R01 submission in year 3 in response to PAR-16-238. Guided by a multidisciplinary team of mentors, Dr. Davis will, through this K07, consolidate her skills in implementation science, mixed-methods, and cancer prevention and control. She will also secure her transition to research independence. Research Focus: Bridging the gap between knowledge of evidence based interventions (EBIs) and application in “real world” settings is a critical issue in cancer prevention and control research. Screening for colorectal cancer (CRC) saves lives, yet disparities exist for rural and low-income populations. Although direct mail (DM) programs can increase CRC screening rates by nearly 40%, this EBI is not yet routine practice. Moreover, implementation and intervention outcomes vary widely across settings. Research is needed to inform how best to scale DM programs and to support follow-up colonoscopy on positive fecal tests. Guided by the social ecological model and consolidated framework for implementation research we propose three aims: Aim 1: Identify factors associated with higher levels of primary care practice readiness to implement direct mail programs to increase colorectal cancer (CRC) screening. H1: Leadership culture and higher levels of adaptive reserve will be associated with readiness. Aim 2: Pilot test tailored implementation support for a direct mail program in four rural primary care practices clustered in one Medicaid Accountable Care Organization (ACO). Aim 3: Elucidate barriers, facilitators, and adaptations to direct mail program components and the associated impact on implementation and intervention outcomes. Training Goals: The training proposed fills critical gaps to enable Dr. Davis to conduct trials to improve the identification, adaptation, and implementation of EBIs to improve cancer prevention in rural primary care. The mentoring, training, and research aims ensure scientific growth in three areas: (1) Knowledge of advanced implementation science research methods; (2) Mixed methods research design and analysis; and (3) Leading multidisciplinary teams in cancer prevention and control. Environment: The OHSU Department of Family Medicine provides institutional support for this K07. Research and training activities also utilize the robust infrastructure of the Oregon Rural Practice-based Research Network (ORPRN), Oregon Clinical and ...