MPH 507 Week 8 Program Evaluation Proposal Example

Program and Evaluation Proposal: Screen at Home, HPV Self-Collection Offered in Person to Overdue Women in Tolliver County, 2026 to 2028

Student Name

Chamberlain University

MPH 507: Public Health Program Planning and Evaluation

Instructor Name

Month Day, Year

Program and Evaluation Proposal: Screen at Home, HPV Self-Collection Offered in Person to Overdue Women in Tolliver County, 2026 to 2028

Summary

Laurel Valley Community Health Center proposes Screen at Home, a two-year program in which community health workers bring overdue women in their thirties to mid-sixties a swab they use themselves, which the regional laboratory tests for high-risk HPV, handed over at home in Tolliver County, a composite rural county, with a patient navigator to see women with positive results through follow-up. The program aims to bring at least 45% of the 1,180 overdue women in the health center's panel up to date by June 2028, to raise the panel's up-to-date rate from 70% to 80%, and to raise completion of follow-up after a positive result from 64% to 85%. A stepped-wedge evaluation, with districts starting in an order set by lot, will test whether the program caused any change.

The Need

Three in ten of the center's women in the eligible age band were overdue when charts were pulled in March 2026. In interviews, overdue women most often named the speculum exam, weekday appointments, the absence of a female clinician, travel and the cost of follow-up, not a lack of interest. About a third of women referred for colposcopy in 2025 did not attend. The county has trusted community health workers, a laboratory contract for PCR-based HPV testing and a monthly colposcopy clinic at the regional hospital.

The Program and Why It Should Work

The intervention removes the barriers women named. With a PCR assay, a woman's own swab finds precancer nearly as reliably as a clinician's, and putting devices directly to women in underscreened communities reaches far more of them than asking women to request a kit (Arbyn et al., 2018). In a U.S. health system, mailing kits raised screening among overdue women from 17% to 26% within six months (Winer et al., 2019); the proposal expects in-person delivery by known health workers to do better in a rural county where mail and trust are both less reliable. Community health workers and navigators have improved screening and follow-up in federally qualified health centers (Roland et al., 2017).

Each month, community health workers phone and then visit the women on that month's list, walk through how the kit works and how often screening is needed, and either wait while the woman collects a sample or leave a kit with a return envelope, with reminders at one and three weeks. Kits are also offered at monthly church food distributions. Anyone whose kit shows high-risk HPV hears from the navigator by phone, gets a follow-up booked to the risk-based guidance (Perkins et al., 2020) and has a ride arranged.

How the Parts Agree

The proposal's components were checked against each other, and the check found and corrected two mismatches from earlier drafts.

Table 1

How the Proposal's Components Agree

Note. Note. Each row was checked against the next during assembly.

Changes Since the Earlier Drafts

Two changes are flagged so reviewers can follow the revisions. First, the logic model's short-term outcome originally read "women aware of self-collection," which no objective measured and which the evaluation could not have tested. It was replaced with knowledge of the screening interval, which the objectives and data plan both include. Second, the evaluation design originally compared the county with a neighboring county, but the data plan showed that no comparable records exist there, so the design was changed to a stepped wedge within the county.

Staffing, Cost and Timeline

Staffing: three existing community health workers at 20 hours a week each, a half-time navigator, a data coordinator at 8 hours a month and an external evaluator. Main costs, to be confirmed in the budget, are staff time, 1,200 kits and laboratory testing under the existing contract, mileage, transport for follow-up and the evaluator. Districts join at four-month intervals from July 2026, in a drawn order, and all three are running by spring 2027; the grant period ends in June 2028. Quarterly process reports go to the health center's quality committee, and a final evaluation report is due in September 2028.

Limitations Specific to This Proposal

The evaluation cannot measure cancer outcomes within two years because cases in the county are few. Because kit and courier arrive together, the two effects cannot be pulled apart. With only three districts, chance differences between them may affect the stepped-wedge comparison, which the analysis will adjust for but cannot remove. Women in later districts may hear about kits early, which would understate the program's effect. Follow-up outcomes will be compared only with the 2025 log, so that comparison is descriptive.

What Will Be Learned

By September 2028, the health center will know how many overdue women a community health worker program can bring up to date in a rural county, which women it misses, whether women with positive results complete follow-up when navigated, what the program costs per woman screened and whether the program, rather than other changes, explains the result. If the program works, it can be sustained within the health center's existing staff and laboratory contract, and the evaluation will show what it would take to extend it to women who are not yet health center patients.

Sustainability

The program is built on staff and contracts the health center already has, so continuing it after the grant would require funding about 30 hours a week of community health worker and navigator time and the cost of kits and tests. Laboratory testing of self-collected samples can be billed for insured women in the same way as clinician-collected tests, which would cover part of the cost. The health center's board has agreed to review the program's results in September 2028 with a decision on funding from its operating budget.

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

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