Key elements of comprehensive cancer control plans include the development of goals, objectives and strategies to address the cancer burden within the state, tribal organization or territory. Goals are typically broad statements that delineate the purposes of the cancer plan itself and are represented as high level primary outcomes. For example, a comprehensive cancer control program could have a goal of decreasing cancer mortality. In developing rural-relevant goals there are a few important considerations:
- Is a goal sufficiently high-level if it is focused on one population group?
- How are you defining rural?
- Is geographically targeting more appropriate?
- Do data support the need for a rural-specific objective?
- Would a rural-specific objective that corresponds to a broader goal be more appropriate?
Relatedly, objectives are specific, measurable statements of what needs to be done to achieve corresponding goals. The most recent Comprehensive Cancer Control Program notice of funding opportunity recommended the use of S.M.A.R.T.I.E objectives, an expansion of the typically used S.M.A.R.T. objectives:
- Specific- Concrete, detailed, well-defined within the coalition/program goals
- Measurable- Data are available to measure objective (e.g., prevention activities)
- Attainable- Doable with available resources
- Relevant- Aligned with goals of the plan/coalition
- Timebound- Measurable within the 5-year plan
- Inclusive- Bring in traditionally exclude people, particularly those most impacted
- Equitable-Seeks to address systemic injustice, inequity or oppression
When developing rural-relevant objectives, taking into account the S.M.A.R.T.I.E. objective guidance, there are a few important considerations:
- Are there data to provide a baseline measure and targets? (measurable)
- What is a reasonable target? (E.g., Healthy People 2030)
- What data sources are available? (Behavioral Risk Factor Surveillance System (BRFSS), State Cancer Profiles ,CDC PLACES data (potentially))
- Can these data sources provide a baseline estimate?
- Are these data updated frequently enough to measure progress
- See June 2022 webinar and GHEA website article for more information
- How might this be achieved with available and/or potentially accessible resources? (attainable)
- How are rural partners included in the process? (inclusive and equity)
- Are there important intersections to consider in potential objectives? (e.g., rurality and race/ethnicity)
Implementing evidence-based strategies at the community, clinic, provider and or patient-level are critical to helping meet these objectives and subsequently meeting proposed goals. There are two key resources available that comprehensive cancer control programs, coalitions and partners can use to identify proven strategies and interventions to address cancer across the continuum from prevention to survivorship, with a particular focus on prevention and screening:
- Are there important intersections to consider in potential objectives? (e.g., rurality and race/ethnicity)
- The Community Guide: This resource describes how the Community Preventive Services Task Force has assessed strategies to increase the use of preventive services and positive health behaviors, including cancer-relevant services and behaviors such as cancer screening, sunscreen use, HPV vaccination and tobacco cessation. Potential strategies are reviewed by the Task Force and determined to be either not recommended, insufficient evidence or recommended.
- The National Cancer Institute’s Evidence-Based Cancer Control Programs: This resource is a searchable database to provide public health practitioners with access to programs to address several areas of cancer control, ranging from HPV vaccination to tobacco control to cancer screening to survivorship care. The database also allows users to filter by community type (e.g., rural) and delivery location (e.g., clinic or community). For each program, program materials, implementation guides and other information are available. Additionally, each program has been assessed based on the research integrity, intervention impact and dissemination capabilities as well as in accordance with the RE-AIM framework which assesses reach, effectiveness, adoption and implementation.
For more information on developing and implementing rural-relevant goals, objectives and strategies, please review this previous GHEA webinar:
Author: Whitney Zahnd, Ph.D., Assistant Professor, University of Iowa