BMC Health Services Research (Mar 2020)

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

  • Peg Allen,
  • Rebekah R. Jacob,
  • Renee G. Parks,
  • Stephanie Mazzucca,
  • Hengrui Hu,
  • Mackenzie Robinson,
  • Maureen Dobbins,
  • Debra Dekker,
  • Margaret Padek,
  • Ross C. Brownson

DOI
https://doi.org/10.1186/s12913-020-05141-5
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 11

Abstract

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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.

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