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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Colorectal cancer (CRC) screening effectively reduces CRC mortality and morbidity, yet screening rates remain below US national targets in rural and low-resourcedd settings. An effective intervention to improve screening is mailed fecal immunochemical tests (FIT) combined with patient navigation. However, these multicomponent interventions have been unevenly adopted across health systems and organizations, and studies of how to spread effective system-level approaches are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a mixed-methods evaluation of a multi-component scale-up approach designed to increase CRC screening rates in rural, low-resourced primary care clinics, based on findings from the SMARTER CRC pragmatic trial. The approach included five scale-up activities: (1) an Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program; (2) patient navigation training; (3) webinars on process design and communication strategies; (4) technical assistance; and (5) dissemination of the\n                      <jats:italic>Colorectal Cancer Screening Outreach for Rural Populations Facilitation Guide<\/jats:italic>\n                      . We measured engagement in scale-up activities, adoption of mailed FIT and patient navigation outreach, and modifications to organizations\u2019 CRC screening programs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 47 participants from 25 organizations participated in scale-up activities. Participants were most commonly from clinical practices (28%), hospital-based systems (24%), and community organizations (20%). All organizations participated in the ECHO series (100%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), and some also engaged in additional scale-up activities. Most organizations (84%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921) reported having a CRC screening program at baseline. Engagement in ECHO and other scale-up activities influenced adoption and modification of CRC screening patient outreach strategies for most organizations (69%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917). Participation led to modifications in existing programs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Participation in multifaceted scale-up activities increased organizational knowledge and engagement in CRC screening patient outreach within rural, low-resourced clinic settings. These activities also supported the refinement of existing CRC screening programs through the adoption and modification of outreach strategies. These findings can inform future efforts to optimize scale-up approaches for CRC screening and other complex interventions in rural, low-resourced healthcare settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Registered at clinicaltrial.gov (NCT04890054) and at the NCI\u2019s Clinical Trials Reporting Program (CTRP # NCI202101032) on May 11, 2021.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03428-w","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:36:51Z","timestamp":1784029011000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Scale-up evaluation results of a multi-level approach using mailed immunochemical test (FIT) and patient navigation to increase colorectal cancer screening rates in rural clinic settings"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2683-7912","authenticated-orcid":false,"given":"Jessica J.","family":"Currier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Coury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Myers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin S.","family":"Kenzie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda F.","family":"Petrik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Badicke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret McLain","family":"McDonnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryan Carbuccia","family":"Abbott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria D.","family":"Coronado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda M.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"3428_CR1","volume-title":"Colorectal Cancer Facts & Figs. 2023\u20132025","author":"American Cancer Society","year":"2023","unstructured":"American Cancer Society. 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