MPH 507 Week 5 Intervention Plan Example

Intervention Plan: How Screen at Home Will Offer HPV Self-Collection in Person, Who Will Do It, How Often and Why It Should Work in Tolliver County

Student Name

Chamberlain University

MPH 507: Public Health Program Planning and Evaluation

Instructor Name

Month Day, Year

Intervention Plan: How Screen at Home Will Offer HPV Self-Collection in Person, Who Will Do It, How Often and Why It Should Work in Tolliver County

The Objective It Serves

Screen at Home exists to meet two of the objectives set in week 4: that close to half of the women on the March 2026 overdue list, 45% by the end of June 2028, have a valid result, and that at least 85% of those with a positive result complete recommended follow-up within 90 days. Every element of the plan below is there because it serves one of those two objectives.

Evidence, With Its Settings

Three bodies of evidence support the plan, and each comes from a setting that differs from Tolliver County in ways that matter.

Accuracy and reach of self-collection. Pooling dozens of accuracy studies and trials, Arbyn et al. (2018) showed that a PCR assay loses essentially nothing in sensitivity when the woman takes the sample herself, and that handing out devices in person in poorly screened communities brought in more than three quarters of women, whereas schemes requiring women to order a kit performed about like a letter. Most trials were in Europe and in low- and middle-income countries with national screening programs.

Mailed kits in a U.S. health system. In a trial among nearly 20,000 overdue women in an integrated health system in Washington State, mailing kits raised screening within six months to 26%, compared with 17% with usual reminders (Winer et al., 2019). That system had complete records and good insurance coverage; Tolliver County has neither to the same degree, but its women are reachable in person by health workers they already know.

Community health workers in health centers. A systematic review of programs in federally qualified health centers found that community health workers and patient navigators generally improved cancer screening and follow-up among the patients these centers serve (Roland et al., 2017).

The Mechanism, Stated Plainly

Why should any of this raise screening? The answer is simple enough to state in a paragraph. Overdue women in the county are not mainly unwilling to be screened; they named concrete barriers in the needs assessment: the speculum exam, weekday appointments, travel, the lack of a female clinician and the cost of follow-up. Self-collection removes the exam and the appointment. In-person delivery by a known health worker removes the need to request a kit, which the evidence shows is the step where opt-in programs lose most women, and adds a trusted person who can answer questions on the spot. Navigation after a positive result addresses the second failure point, where fear, confusion and travel stop women from completing follow-up. If those barriers explain most of the overdue status, removing them should raise screening and follow-up substantially.

Activities, Described Operationally

Who. Three community health workers already employed by the health center, each assigned 20 hours a week to the program and to one of the county's three districts, and one patient navigator at 20 hours a week.

What and how often. Each month, the data coordinator generates a list of overdue women in each district. Community health workers phone each woman up to twice, then visit those not reached. At the visit, they explain screening intervals and the kit in five minutes, using a one-page picture guide, and offer two choices: collect the sample now in private and hand it back, or keep the kit with a prepaid envelope. Women who keep a kit receive a reminder call at one week and a second visit at three weeks if it has not come back. Kits are also offered at the monthly church food distributions in each district.

Results. Negative results are sent by letter and text within two weeks of the laboratory result, with the date of the next screening. Positive results are called to the woman by the navigator, not mailed.

Follow-up. The navigator explains what the result means and what happens next, following the national risk-based guidance (Perkins et al., 2020), books the hospital's monthly colposcopy clinic or a repeat test as indicated, arranges transport through the county's medical transport service and calls the day before.

What Was Adapted and What Was Kept

Kept from the evidence: the self-collection device and PCR-based testing; direct offer rather than opt-in; a reminder for unreturned kits. Adapted for the county: in-person delivery instead of mail, because addresses in the hollows are unreliable and trust is personal; the option to collect during the visit, because women in the interviews worried about kits getting lost; offers at food distributions, which reach women who are not on the health center's list; and a dedicated navigator, because women in the Washington trial reported confusion after positive home results (Tiro et al., 2019) and the county's follow-up rate was already low.

Reach and Recruitment

The plan aims to reach all 1,180 women on the March 2026 list, plus women met at food distributions who are not health center patients and who will be offered both a kit and registration. Women without phones are reached by visit. Women who decline a kit are offered a clinician-collected test with a female clinician at a set monthly Saturday session, which the health center will add at its central site.

Safety and Quality

Community health workers will be trained for four hours on kit instructions, privacy, and what to say and not to say about results. Kits rejected by the laboratory as invalid will trigger a new kit within a week. The navigator will review every positive result with the health center's medical director before the call, so that the next step is clinically correct.

What Could Make the Plan Fail

The plan could fail if kits left at home are not returned, if the laboratory is slow, or if the hospital's colposcopy clinic cannot absorb the referrals. The first is watched through monthly return rates by district; the second through the ten-day turnaround objective; the third through a standing agreement with the hospital for six slots a month, reviewed each quarter.

Timeline of Delivery

Delivery is staged to match the evaluation. The first district begins in July 2026, after two weeks of training and a dry run with ten women. The second district begins in November 2026 and the third in March 2027, in an order drawn by lot. Each district receives the same activities from its start date.

References

Arbyn, M., Smith, S. B., Temin, S., Sultana, F., & Castle, P. (2018). Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: Updated meta-analyses. BMJ, 363, k4823. https://doi.org/10.1136/bmj.k4823

Perkins, R. B., Guido, R. S., Castle, P. E., Chelmow, D., Einstein, M. H., Garcia, F., Huh, W. K., Kim, J. J., Moscicki, A.-B., Nayar, R., Saraiya, M., Sawaya, G. F., Wentzensen, N., & Schiffman, M. (2020). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease, 24(2), 102-131. https://doi.org/10.1097/LGT.0000000000000525

Roland, K. B., Milliken, E. L., Rohan, E. A., DeGroff, A., White, S., Melillo, S., Rorie, W. E., Signes, C.-A. C., & Young, P. A. (2017). Use of community health workers and patient navigators to improve cancer outcomes among patients served by federally qualified health centers: A systematic literature review. Health Equity, 1(1), 61-76. https://doi.org/10.1089/heq.2017.0001

Tiro, J. A., Betts, A. C., Kimbel, K., Buist, D. S., Mao, C., Gao, H., Shulman, L., Malone, C., Beatty, T., Lin, J., Thayer, C., Miglioretti, D. L., & Winer, R. L. (2019). Understanding patients' perspectives and information needs following a positive home human papillomavirus self-sampling kit result. Journal of Women's Health, 28(3), 384-392. https://doi.org/10.1089/jwh.2018.7070

Winer, R. L., Lin, J., Tiro, J. A., Miglioretti, D. L., Beatty, T., Gao, H., Kimbel, K., Thayer, C., & Buist, D. S. M. (2019). Effect of mailed human papillomavirus test kits vs usual care reminders on cervical cancer screening uptake, precancer detection, and treatment: A randomized clinical trial. JAMA Network Open, 2(11), e1914729. https://doi.org/10.1001/jamanetworkopen.2019.14729