Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings

Abstract

Highlights Thinking through when to let go: theory for identifying interventions that may not add value.Examples of interventions ideal for discontinuation in public health and social service settings.De‐implementation of interventions in the context of dissemination and implementation science.

Iterative Decision‐making for Evaluation of Adaptations (IDEA): A decision tree for balancing adaptation, fidelity, and intervention impact

“…There are some instances, however, in which voltage drop is unacceptable to stakeholders, or, even if acceptable to stakeholders, the data may indicate more harm than benefit from the adapted EBP. In these cases, de‐implementation of the adapted EBP, and implementation of alternative strategies, may need to be considered (Helfrich, Hartmann, Parikh, & Au, ; McKay, Morshed, Brownson, Proctor, & Prusaczyk, ; Norton, Kennedy, & Chambers, ). Regardless of whether stakeholders further adapt the EBP, revert to the unadapted EBP, or adopt a new clinical intervention entirely, we recommend ongoing evaluation to identify opportunities for improvement.…”

No Easy Answers: Avoiding Potential Pitfalls of De‐implementation

“…Here, we see the appearance of a pharmaceutical intervention driving a policy of de‐implementation when none of the three categories developed by McKay et al. () would apply. In practice, behavioral interventions were largely discontinued while PrEP became a leading form of HIV prevention, but not because HIV behavioral interventions were (a) harmful or no longer effective, (b) the least effective or efficient to provide, or (c) no longer necessary.…”

“…In McKay et al. (), DEBI interventions are discussed as an example of the de‐implementation criterion for interventions that are not the most effective or efficient to provide or are no longer necessary (“low‐value” interventions). The DEBI program was built over the course of more than 20 years, during which the CDC funded the development, dissemination, and implementation (Dworkin, Pinto, Hunter, Rapkin, & Remien, ) of nearly 30 evidence‐based, behavioral HIV‐prevention interventions.…”

“…In “Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings,” the authors offer three criteria for identifying interventions appropriate for de‐implementation: they must be (a) harmful or not effective, (b) not the most effective or efficient to provide, or (c) no longer necessary (McKay, Morshed, Brownson, Proctor, & Prusaczyk, ). The authors also describe scenarios in which the de‐implementation process may take place, examining frameworks that may help us conceptualize that process.…”

“…De‐implementation is an implicit part of the implementation process and requires the increased attention McKay et al. () provide. However, we are concerned that the authors highlight examples of de‐implementation without delving more deeply into the more‐complex issues inherent in the process, including the importance of community input and the recognition that it is a dynamic, ecological process (Kelly, ; Trickett, ).…”