Abstract
BackgroundPublic 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.MethodsThe 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).ResultsThirty 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%).ConclusionsOrganizational 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.
Highlights
Public health resources are limited and best used for effective programs
Participants Of the 579 eligible Local health department (LHD) chronic disease leads with valid email addresses, 376 (64.9%) completed the online survey
While improvements have occurred since early pilot data were collected in 2013 [2], the results of this study show that both inappropriate termination and continuation of programs continue, mainly due to funding-related issues
Summary
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. McKay and colleagues (2018) recently outlined several public health and social service initiatives that have been discontinued or warrant de-implementation because they are harmful (prone infant sleeping position), ineffective (D.A.R.E. school-based drug prevention program), low value (routine HIV counseling with HIV testing), or the issue dissipated (Ebola) [15]. Evidence suggests these phenomena could have negative impacts on our public health systems [15]
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