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

• Published in: BMC health services research Vol. 20; no. 1; p. 258
• Main Authors: Allen, Peg, Jacob, Rebekah R, Parks, Renee G, Mazzucca, Stephanie, Hu, Hengrui, Robinson, Mackenzie, Dobbins, Maureen, Dekker, Debra, Padek, Margaret, Brownson, Ross C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.03.2020; BioMed Central; BMC
• Subjects: Access to information; Accreditation; Chronic Disease; Chronic diseases; Chronic illnesses; Clinical decision making; Cross-Sectional Studies; Data collection; De-implementation; Decision Making; Disease prevention; Employment terminations; Evidence-based decision making; Evidence-Based Practice; Evidence-based public health; Female; Funding; Health departments; Health services; Humans; Implementation science; Leadership; Local Government; Male; Mis-implementation; Odds Ratio; Pilot projects; Planning; Program Evaluation; Public health; Public Health Administration; Quality improvement; Resource Allocation; Surveys; Surveys and Questionnaires; United States; Workforce; United States; United States > US; Mis-implementation; Evidence-based decision making; De-implementation; Evidence-based public health; Health departments; Implementation science
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-020-05141-5

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. 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). 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%). 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.