In an effort to address the growing cancer burden, the Government of India introduced a national program for screening and prevention of the most common cancers (oral, breast, and cervical) in 2016. To support the screening program, the National Institute for Cancer Prevention Research (NICPR) adopted the Project ECHO (Extension for Community Healthcare Outcomes) model for training health care providers in cancer screening. Very few studies examine the impact of the ECHO model on provider behavior or health outcomes related to cancer screening. We assess the change in knowledge and, skills among primary care physicians attending NICPR ECHO trainings and the impact of the training program on the implementation of cancer screening services.
Prior to the start of the online phase and upon completion of the 14 weeks, trainees answered a 23-item questionnaire (administered online via SurveyMonkey). We conducted a descriptive and bivariate analysis of the pre-post assessments conducted on trainees participating in the online phase and where available report on the weekly quizzes and the hands-on workshop assessments.
Six hundred forty-one medical officers have participated in the trainings, across nine cohorts of trainees and this study presents data from 116 primary care physicians that completed both the pre- and post-assessments, trained from May 2019 to February 2020. Almost two-thirds had completed medical training (MD equivalent) (69.7%) and 85% were working in government healthcare facilities. Trainees reported statistically significant improvements before and after the online phase, when queried specifically on knowledge and skills using visual vignettes about oral and cervical cancer screening. Trainees did not report significant changes in the provision of cancer-screening services after completing the program.
Study findings support the effectiveness of the training program in reaching primary care physicians across the country and improving their knowledge and skills related to screening for breast, oral, and cervical cancer. After the training, very few primary care physicians mentioned implementing cancer screening services highlighting barriers that require further study and development of complementary implementation strategies. Study findings could inform the development and refinement of training for cancer-screening programs in low- and middle-income countries.