Exploring leadership as a factor influencing implementation of evidence-based cancer prevention and screening services in community health centers

Jennifer H Tektiridis, The University of Texas School of Public Health


A gap exists between scientific discovery and population health benefit. This gap is larger for medically underserved populations, many of whom receive care in community health centers. The field of implementation research seeks to close this gap. Leadership is one of the many factors influencing implementation of evidence-based health services and programs. What it is that defines effective leadership practice is not fully discernible from implementation science models. Further, little is known about what practices define leadership for delivery of essential health services, such as delivery of cancer prevention and screening interventions, in a specific context - community health centers. This exploratory qualitative study aims to contribute to this understanding to advance the field of implementation science and, in the long-term, to close the gap between research discovery and program delivery to improve population health. In this theory-driven applied thematic analysis, attributes of leadership identified by community health center leaders as important for implementation of evidence-based cancer prevention and screening clinical services, were identified. These were assessed for fit with leadership attributes of the Full Range Leadership Theory (FRLT) Transformational, Transactional and Passive-Avoidant typologies to determine if there was a dominant typology or dominant factors within a typology. The FRLT was selected because of its well-validated leadership measurement instrument, the MLQ (Form 5X) and its use in other studies of leadership in health settings. Forty eight leaders from community health center leaders in fourteen states participated in focus group and in-depth personal interviews from April 2011 to August 2012. Using a modified appreciative inquiry approach, interviewers asked open-ended questions about practice change initiatives followed by questions broadly informed by the Consolidated Framework for Implementation Research and its Inner Setting domain constructs, including Readiness for Change, for which leadership is a sub-construct. Community health center leaders described leadership traits that fit best with the Full Range Leadership Theory Transformational typology and with its Inspirational Motivation and Intellectual Stimulation factors. A majority of the expressions of leadership fit best with attributes of communicating a compelling and achievable vision, maintaining enthusiasm for the mission, challenging followers to think creatively and finding solutions to difficult problems. There were fewer descriptions of leadership that fit with the Transactional typology and almost none that fit with the Passive-Avoidant typology. Three themes emerged as context for community health center leadership - plans, seeks buy-in and develops resources. Understanding the perspectives of community health center leaders regarding leadership for practice change and linking these to a well-validated leadership theory provides insight into leadership in this context. Community Health Center leaders may be able to improve the effectiveness of their practice change initiatives if they combine leadership attributes of the Transformational typology factors of Inspirational Motivation and Intellectual Stimulation. Obtaining buy-in from internal and external stakeholders is an important contextual factor that may be facilitated through articulating a compelling vision of the future while at the same time appealing to followers' analytical reasoning, attributes of Inspirational Motivation and Intellectual Stimulation factors.

Subject Area

Public health|Health care management

Recommended Citation

Tektiridis, Jennifer H, "Exploring leadership as a factor influencing implementation of evidence-based cancer prevention and screening services in community health centers" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3639457.