Perspectives on program mis-implementation among U.S. local public health departments

Abstract

Background: Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments. Methods: The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert). Results: Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%). Conclusions: Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.

Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

“…These factors demonstrated an inverse relationship with mis-implementation outcomes (e.g., as agency capacity increased, the association with mis-implementation rates decreased). These ndings are consistent with our earlier study among US local health departments, which found organizational supports for EBDM were associated with lower perceived frequency of inappropriate continuation [21]. This suggests agency culture and capacity are signi cant protective factors against mis-implementation in multiple public health organizations rather than the skills of individual staff.…”

“…Compared with previous pilot work, perceived frequency of mis-implementation in SHD was higher in this study (36.5% vs 50.7% for inappropriate termination and 24.7% vs 48.5% for inappropriate continuation), although some of this difference may be attributable in part to updates to the mis-implementation survey item de nitions and changes in the approach to categorization of responses [9,10,21]. In earlier studies, the recoded dichotomized mis-implementation variables only included the often/always response.…”

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

“…Compared to previous pilot work, perceived frequency of mis-implementation in SHD was higher in this study (36.5% vs 50.7% for inappropriate termination and 24.7% vs 48.5% for inappropriate continuation), although some of this difference may be attributable in part to updates to the mis-implementation survey item de nitions and changes in the approach to categorization of responses (9,10,21). In earlier studies, the recoded dichotomized mis-implementation variables only included the often/always response.…”

“…These concepts support the factors that inform our original mis-implementation framework (8). In a cross-sectional U.S. study of local health departments, higher perceived organizational supports for EBDM were associated with lower perceived frequency of inappropriate continuation (21). In cross-country comparisons of mis-implementation involving Australia, Brazil, China, and the United States, leadership support and political contexts were common factors in whether chronic disease programs continued or ended inappropriately across four countries (22).…”

Leading the way: Qualities of leaders in preventing mis-implementation of public health programs

“…Preventing program mis-implementation is, therefore, necessary to sustain public health efforts and resources needed to improve health and well-being. In this context, mis-implementation refers to the inappropriate continuation of ineffective programs (17). Because executive management is responsible for making decisions such as approving or disapproving the continuance of a program, it is important to understand the attributes of public health leaders in preventing program mis-implementation.…”