Implementation strategies used in evidence-based interventions for cancer prevention and chronic disease control in federally qualified health centers: a systematic review

Background Federally qualified health centers (FQHCs) provide comprehensive health services to underserved areas or populations in the United States using evidence-based interventions (EBIs) to ensure equitable care delivery. To explore implementation generalization across FQHCs, we conducted a systematic review of EBI implementation strategies for the prevention and control of five common diseases (colorectal cancer, cervical cancer, diabetes, obesity, asthma). Methods We searched three databases using cognates for FQHC, implementation, and our diseases of interest. Eligible studies implemented an EBI in a FQHC and included a Uniform Data System measure. We coded for the presence of 73 implementation strategies based on the Expert Recommendations for Implementing Change (ERIC) compendium. We examined the frequency of implementation strategies and categories by disease group: cancer prevention (colorectal, cervical), chronic disease (diabetes, obesity, asthma), and multiple chronic conditions (e.g., team-based care, multiple outcomes). Results Ninety-six studies met eligibility criteria: colorectal cancer ( n = 41), cervical cancer ( n = 6), diabetes ( n = 24), obesity ( n = 9), asthma ( n = 4), and multiple chronic conditions ( n = 12). There was wide variability in the number of EBIs documented across disease targets. The total number of strategies and the specific strategies utilized differed for cancer prevention, chronic disease management and multiple chronic conditions. Conclusions The use of implementation strategies to improve care delivery in FQHCs varied across disease groups. These results can inform implementation science and practice regarding the selection of EBI implementation strategies that target individual or multiple chronic conditions in FQHCs. Registration PROSPERO 2023 CRD42023433237.