Abstract
Background: Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering evidence-based programs to enhance population-level chronic disease outcomes. Yet, there is little guidance on how to end ineffective programs that continue in communities. The purpose of this analysis is to identify what strategies public health practitioners perceive to be effective in de-implementing, or reducing the use of, ineffective programs.Methods: From March to July 2019, eight states were selected to participate in qualitative interviews from our previous national survey of US state health department (SHD) chronic disease practitioners on program decision making. This analysis examined responses to a question about “…advice for others who want to end an ineffective program.” Forty-five SHD employees were interviewed via phone. Interviews were audio-recorded, and the conversations were transcribed verbatim. All transcripts were consensus coded, and themes were identified and summarized.Results: Participants were program managers or section directors who had on average worked 11 years at their agency and 15 years in public health. SHD employees provided several strategies they perceived as effective for de-implementation. The major themes were: (1) collect and rely on evaluation data; (2) consider if any of the programs can be saved; (3) transparently communicate and discuss program adjustments; (4) be tactful and respectful of partner relationships; (5) communicate in a way that is meaningful to your audience.Conclusions: This analysis provides insight into how experienced SHD practitioners recommend ending ineffective programs which may be useful for others working at public health agencies. As de-implementation research is limited in public health settings, this work provides a guiding point for future researchers to systematically assess these strategies and their effects on public health programming.
Highlights
Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering effective evidence-based programs to enhance population-level chronic disease outcomes [1,2,3]
In Spring 2019, we selected eight states to participate in key informant interviews who previously participated in our national survey of state health department (SHD) chronic disease practitioners on program decision making
After chronic disease directors were informed of the study, we reviewed position responses from the initial national survey to invite SHD chronic disease employees with position types likely to be involved in and have broad knowledge of how decisions were made about continuing and ending programs
Summary
Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering effective evidence-based programs to enhance population-level chronic disease outcomes [1,2,3]. Despite the focus on use of effective interventions, ineffective programs too often continue at public health agencies. De-implementation of interventions that are ineffective and replacing them with effective interventions is one way that public health agencies can meet their obligation of efficiency. Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering evidence-based programs to enhance population-level chronic disease outcomes. There is little guidance on how to end ineffective programs that continue in communities The purpose of this analysis is to identify what strategies public health practitioners perceive to be effective in de-implementing, or reducing the use of, ineffective programs
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