Policy Adherence Research Articles

Understanding the impact of policy adherence and implementation on streams in the Umlazi River System

Although the national policy landscape is saturated with environmental and surface water management policies, there is limited evidence of successful policy implementation at a local level. This lack of policy adherence can have many economic, environmental, and public health effects in an area hence measure to improve adherence and implementation are essential. This study, therefore, looked at the lack of stream policy adherence and implementation by the government at Umlazi Township, which is the second biggest township in South Africa, with a population reported to be about half a million people. The study integrated three approaches: the Health Belief Model (HBM), Adaptive River Management, and Social-Ecological Model (SEM) to evaluate the scientific knowledge regarding river status, and uncertainty levels and finally evaluate the impact of policy implementation and evaluation on surface water quality management in the Umlazi area. Data was collected from local municipality workers and Sihlanzimvelo Initiative workers, as these two groups are primarily responsible for stream water management in the Umlazi Local. The data were thematically analyzed and revealed three main factors that contribute to the lack of policy adherence and implementation: citizens are not knowledgeable about on-stream management policy standards; policies on stream management are not implemented and enforced; and lastly, implementation and enforcement of these policies are perceived as difficult. Citizen environmental education and stream worker capacity building appear to be key in improving policy adherence and implementation in Umlazi streams.

Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities.

Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials’ use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.

"I think everybody will have to get together for it to work": NYCHA Tenant Perspectives on HUD's 2018 Smoke-Free Mandate Captured Prior to Policy Implementation.

In July 2018, a new federal mandate by the Department of Housing and Urban Development went into effect requiring all US public housing authorities to implement policies banning smoking in living units, indoor common areas, administrative buildings, and outdoor areas within 25 feet of these buildings. Although some housing authorities had smoke-free policies in place for decades, others had to implement them for the first time. Housing authorities continue to face challenges in ensuring compliance with these policies, and resident perspectives can greatly inform measures to promote adherence. We conducted in-person interviews with 20 New York City Housing Authority tenants in April 2018. Our thematic analysis examined resident opinions on the upcoming smoke-free housing policy. Although 65% of residents supported the policy, 50% anticipated poor adherence due to expected lack of enforcement, safety issues with smoking outdoors, and general discontent with the housing authority and living conditions. However, many participants felt adherence could be improved if the housing authority optimized resource-provision and communication with tenants. Our study adds to existing literature examining tenant views on the controversial topic of mandatory smoke-free housing policies, and our interviews were conducted at a unique time prior to policy implementation in the country's largest public housing authority. Based on our results, we provide recommendations for housing authorities including: (1) information and resource-provision, (2) safety enhancement, and (3) relationship building with tenants in order to maximize policy adherence. Our study is unique because we captured resident views prior to policy implementation in a housing authority without a preexisting smoke-free policy in place. In comparison, most recent research on this topic has focused on the postimplementation period or used survey research methods in the preimplementation phase. Our findings add to extant research about tenant perspectives on smoke-free housing policies and offer suggestions to address barriers to compliance.

Exploring the spatial disparity of home-dwelling time patterns in the USA during the COVID-19 pandemic via Bayesian inference.

In this study, we aim to reveal hidden patterns and confounders associated with policy implementation and adherence by investigating the home‐dwelling stages from a data‐driven perspective via Bayesian inference with weakly informative priors and by examining how home‐dwelling stages in the USA varied geographically, using fine‐grained, spatial‐explicit home‐dwelling time records from a multi‐scale perspective. At the U.S. national level, two changepoints are identified, with the former corresponding to March 22, 2020 (9 days after the White House declared the National Emergency on March 13) and the latter corresponding to May 17, 2020. Inspections at U.S. state and county level reveal notable spatial disparity in home‐dwelling stage‐related variables. A pilot study in the Atlanta Metropolitan area at the Census Tract level reveals that the self‐quarantine duration and increase in home‐dwelling time are strongly correlated with the median household income, echoing existing efforts that document the economic inequity exposed by the U.S. stay‐at‐home orders. To our best knowledge, our work marks a pioneering effort to explore multi‐scale home‐dwelling patterns in the USA from a purely data‐driven perspective and in a statistically robust manner.

Production efficiency and the role of collective actions among irrigated rice farms in Northern Thailand.

ABSTRACT The idea of shared irrigation management is expected to result in a better production outcome for farmers. However, there is little evidence of whether collective action participation leads to a higher level of production efficiency. Using cross-sectional survey data from irrigated rice farms in Northern Thailand, we found that a higher level of production efficiency is associated with higher participation in collective action. At the same time, engagement in collaborative works such as irrigation maintenance, group meetings, conflict resolution, and policy adherence has a marginal effect on farmers’ efficiency. Our findings suggest that complementing existing efforts in addressing irrigation issues with efforts to mobilize collective actions among farmers leads to an improved on-farm outcome.

Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis.

BackgroundInnovative surveillance methods are needed to assess adherence to COVID-19 recommendations, especially methods that can provide near real-time or highly geographically targeted data. Use of location-based social media image data (eg, Instagram images) is one possible approach that could be explored to address this problem.ObjectiveWe seek to evaluate whether publicly available near real-time social media images might be used to monitor COVID-19 health policy adherence.MethodsWe collected a sample of 43,487 Instagram images in New York from February 7 to April 11, 2020, from the following location hashtags: #Centralpark (n=20,937), #Brooklyn Bridge (n=14,875), and #Timesquare (n=7675). After manually reviewing images for accuracy, we counted and recorded the frequency of valid daily posts at each of these hashtag locations over time, as well as rated and counted whether the individuals in the pictures at these location hashtags were social distancing (ie, whether the individuals in the images appeared to be distanced from others vs next to or touching each other). We analyzed the number of images posted over time and the correlation between trends among hashtag locations.ResultsWe found a statistically significant decline in the number of posts over time across all regions, with an approximate decline of 17% across each site (P<.001). We found a positive correlation between hashtags (#Centralpark and #Brooklynbridge: r=0.40; #BrooklynBridge and #Timesquare: r=0.41; and #Timesquare and #Centralpark: r=0.33; P<.001 for all correlations). The logistic regression analysis showed a mild statistically significant increase in the proportion of posts over time with people appearing to be social distancing at Central Park (P=.004) and Brooklyn Bridge (P=.02) but not for Times Square (P=.16).ConclusionsResults suggest the potential of using location-based social media image data as a method for surveillance of COVID-19 health policy adherence. Future studies should further explore the implementation and ethical issues associated with this approach.

The Development of Cybersecurity Awareness Measurement Model in the Water Sector

:Cyber-attacks are one of the main threats to information systems, and humans have been identified as the weakest link with regards to information security. This study aims to develop a measurement instrument to evaluate the level of cyber security awareness (CSA) in the water sector in South Africa. There are lots of synergies with regards to cyber system usage across industries, and as a result this study will take a broad base approach in configuring an instrument that can be used to adequately assess the sample space in question. Having a reliable instrument to measure cyber security awareness helps mitigate the failed attempts at preparing employees for imminent cyber disruptions by pin-pointing areas where the training is needed before campaigns can be organised. This study will show that the psychology of employees with respect to cyber security awareness is compartmentalised into three traits: knowledge, attitude, and behaviour. These three traits were assessed under the following eight focus areas to check employee resilience to cyber security: IS policy adherence, Password management, Email use, Internet use, social media use, mobile devices, information handling, and incident reporting. In practice, employees will be required to answer questions formulated under these focus areas to the evaluate their cyber security awareness (CSA) level. The model proposed in this paper was developed to test cybersecurity awareness in the water sector, but can be utilised in other sectors for cybersecurity awareness testing.

Adherence to a Pediatric Continuous Infusion Propofol Policy for Sedation in Mechanically Ventilated Patients: Opportunities for Change and Improvement.

To evaluate adherence to an institutional continuous infusion propofol policy for sedation in mechanically ventilated patients, investigate the rate of propofol-related infusion syndrome (PRIS), and explore areas of improvement to enhance policy compliance and safety. This was a single center, retrospective chart review of patients admitted to a pediatric or cardiac intensive care unit within a large free-standing quaternary care pediatric hospital who received continuous propofol for non-procedural continuous sedation for at least 6 hours between 2014 and 2019. Propofol exposure (dose and duration), laboratory data, and hemodynamic outcomes of patients were evaluated. A total of 104 patients (108 admissions and 133 treatment courses) met inclusion criteria. Policy adherence to propofol dosing and duration limitations were 70% (93/133 courses) and 68% (91/133 courses), respectively. Adherence to all elements of laboratory and hemodynamic monitoring was 23%. Hypotension and bradycardia were common among patients during propofol treatment courses. Except for hypertriglyceridemia, no significant difference in specific laboratory values were detected between patients exposed to greater than 66 mcg/kg/min (4 mg/kg/hr), compared with those exposed to less than 66 mcg/kg/min of propofol. Patients receiving therapy for longer than 48 hours had the highest rates of laboratory values associated with PRIS. No patient in the study cohort met full criteria for PRIS. Adherence to elements of an institutional propofol policy was variable. Improvements in policy adherence may be enhanced by updating policy features, leveraging the electronic medical record order-set, and gaining consensus among key stakeholders.

MASCUP! Mask Policy Adherence in Tatum Arts Center on Hood College’s Campus

The purpose of this research was to evaluate mask adherence in Hood College’s Tatum Arts Center. Across the United States, other colleges participated in concurrent studies to evaluate the overall effectiveness of mask use in higher education. Without proper infection prevention strategies, such as mask use, Covid-19 could have greatly impacted the feasibility of in-person higher education. Student researchers across campus recorded if individuals were wearing a mask, what type of mask, and if they were wearing it correctly. The target population of this research was college campus community members. In Tatum Arts Center, researchers systematically sampled 395 participants to observe in this observational cohort study. The goal of the research was to investigate what type of face mask was worn incorrectly most often. The researcher hypothesized that the results would show that cloth face masks were worn incorrectly most often. The three pieces of data were collected on every third individual who exited Tatum Arts Center, and the data was evaluated using Excel. The results found that there was 100% mask usage in Tatum Arts Center, and masks were worn correctly 93.16% of the time. The results revealed that surgical masks were worn incorrectly the most often, 12.94% of the time. This research helped colleges to evaluate the effectiveness of their Covid-19 mitigation plan, with the hope that it would lessen the spread of Covid-19. It is believed that these results can be generalized to other colleges of similar size.

Real-world implementation of a vaginal preparation policy prior to cesarean delivery

Objective Surgical site infections (SSIs) are a major source of morbidity and mortality for women who undergo cesarean section (c-section). SSIs following c-section include wound infection, infection of the endometrium (endometritis) and intra-abdominal infections. Perioperative interventions to prevent these infections continue to be studied, including the use of vaginal preparation prior to c-section. Although literature has shown that the use of vaginal preparation prior to c-section decreases the rate of SSI, real-world clinical data regarding effective implementation of these policies are lacking. The objectives of this study were to determine (1) if a vaginal preparation policy could be implemented in a real-world setting with a high compliance rate and (2) to identify factors led to differences in compliance with policy. Study design This was a secondary analysis of a retrospective cohort study designed to examine the incidence of SSI after c-section before and after the implementation of vaginal preparation policy. The primary outcomes included implementation rates of the vaginal preparation for the post policy cohort. Secondary outcomes included subgroup analysis of policy adherence based on time of day, urgency of delivery, membrane status, labor status, and maternal factors. Results Overall adherence to the vaginal preparation policy was 87.2% of patients. Maternal factors did not impact the rate of policy adherence. 81.4% of patients undergoing c-section at night had vaginal prep completed compared to 89.9% of patients undergoing c-section during the day (p = .016). 63.8% of patients undergoing emergent c-section had vaginal prep completed, compared to 90.1% of patients undergoing non-emergent c-section (p < .001). Laboring patients were more likely to have vaginal preparation completed (143 (95.3%) vs. 225 (82.7%), p = .009). Conclusions Compliance with vaginal preparation policy was high. Patients who are undergoing evening deliveries and emergent deliveries are less likely to have vaginal preparation completed. Some of these differences are likely attributable to perceived urgency of the c-section. It is important that interventions are identified such as staff education and standardization of documentation to improve rates of policy adherence.

Policy adherence and clinical effect of early infant diagnosis of HIV exposed children: impact on Elimination of mother to child transmission (EMTCT

BackgroundWorld Health Organizations aims to eliminate mother to child transmission of HIV by 2030. Timely HIV infant diagnostics are required to save the lives of HIV-infected babies which fits into Sustainable development goal 3 (Good health and wellbeing). This study reviews early infant diagnosis (EID) practices at Komfo Anokye Teaching Hospital from January 2020 to August 2021 to assess how this aligns with national policy and its impact on infected infants.MethodsEarly Infant diagnosis tests done on KATH samples were extracted focusing on age, gender, dates sample was drawn/ PCR test was done, and results of tests. Dates were converted to days since birth. Descriptive and inferential statistics were used with statistical significance at p&lt; 0.05&#x0D; ResultsA total of 400 infants had samples within study period. Test results were available for 98% (392). Data on gender was available for 37% (148) only. Positive results were 8.9% (35/392). By the time infants were sampled for storage, 24.5% (96/392) were within 6 weeks and 8.7% (34/392) were 9 months. The rest, 66.8% (262/392) deviated from protocol. By the time PCR test was done on stored samples, 5.6% (22/392) were within 6 weeks and 3.1% (12/392) were 9 months. The rest, 91.3% (358/392) deviated from protocol. Positive PCR results for deviated protocol was 8.9% (32/358)The median duration from birth to getting samples taken for positive EID case was 97 days compared to 52 days for negative results, p&lt; 0.002. The median duration from birth to getting test results for positive EID case was 186 days compared to 88 days for negative results, p&lt; 0.0002.&#x0D; ConclusionProtocol deviations from EMTCT policy due to delay in reporting contributes to positive EID results. Delay in testing affects start in treatment and negatively impacts neurodevelopment. Positive EID should be fully audited to identify risks.

With theater, you have to be ready for anything: university response, expert testimony, and sample influence jurors’ decisions and counterfactual endorsement in a crime control theater case

ABSTRACT Crime control theater (CCT) policies are adopted in response to public outcry for action and are widely accepted, but ineffective at reducing crime (e.g. Sex Offender Registration and Notification; SORN). The study examined the influence of a university’s SORN policy adherence (no/minimum/above & beyond), expert testimony on policy effectiveness (absent/present), and sample (student/community) on jurors’ decisions, counterfactual endorsement, and anger. Participants (N = 674) read a vignette in which parents sued a university for the wrongful death of their daughter by a registered sex offender. Greater counterfactual thinking (if the university had done more than different outcome) and likelihood of a liable verdict were expected when expert testimony was absent (greater belief SORN policy effectiveness), or university failed to adhere to the policy. University response and expert testimony had the expected effects on liability measures and counterfactual endorsement. Additionally, counterfactual endorsement was influenced by sample (greater community endorsement). Also, the community sample was less calibrated and more punitive in their decisions – increased liability judgments and damages. Counterfactual endorsement and/or anger mediated the effects of university response, expert testimony, and sample on liability measures and damages. These findings suggest that anger and counterfactual thinking are important mechanisms driving public support for CCT policies.

Death by Neurological Criteria/Brain Death Policy Checklist Implementation and Policy Adherence

Death by Neurological Criteria/Brain Death Policy Checklist Implementation and Policy Adherence

Políticas Nudge no Contexto da COVID-19: Uma Ação Necessária ou Dilema Ético?

ABSTRACT Objective: the aim of this study is to discuss nudges in the SARS-CoV-2 pandemic context, bringing back some reflections on ethics and revising them in the light of the new setting imposed by the pandemic. Theoretical approach: the theoretical framework of Behavioral Economics was the basis for nudges’ analysis, while utilitarianism, deontology, and virtue ethics were the classic moral theories used to reflect on ethical aspects. Methods: we undertook a literature review about nudges searched through the latest studies about this subject applied to COVID-19 mitigation. In the ethical discussion section, we used classical references to articulate the nudge theory with the following moral theories: utilitarianism, deontology, and virtue ethics. Results: our findings indicate that the trend intervention during the pandemic is ‘nudging messages’ and ‘increase people’s commitment,’ mainly to nudge people toward the desired behavior and increase policy adherence. Many experiments did not show significant results, and some drawbacks in policies’ applications indicate that nudges might be revised in crisis scenarios, such as a pandemic outbreak. The ethical discussion section relates three moral theories that justify some of the nudge’s aspects. Conclusions: this paper showed some flaws and inconsistencies in nudge theory and its application during the pandemic that can be solved by discussing ethical aspects. We suggest that connecting these problems with moral views might be a solution for some deadlocks found in the nudge theory.

Practice Patterns and Assessment of Needs for Pediatric Pain Management in Alberta Emergency Departments.

PurposeMany rural and community emergency departments (EDs) experience barriers to providing optimal pain care to children. In preparation for a quality improvement initiative, our team conducted a provincial pediatric pain management practice and needs assessment.MethodsAn online survey was sent to ED administrators and educators from March to May 2017. Themes included pain assessment, pain and distress management strategies, available resources, education, barriers to care, and opportunities for improvement.ResultsForty-five respondents, from 31 EDs representing all five geographic health zones in Alberta, completed the survey. Use of a pain assessment tool was reported at 93.5% (29/31 sites) of the sites. Topical anesthesia was employed “most of the time” before suturing at 67% (18/27) of sites, versus 15% (4/27) before blood work or IV insertion. Eighty-one percent (22/27) of sites reported physically restraining children for procedures “often”, while 37% (10/27) reported use of comfort positioning “often”. Digital distraction devices were available at 37% (10/27) of sites. Reported challenges included lack of resources (33.3%, 12/36), staff education/knowledge (33.3%, 12/36), and absent policies/poor policy adherence (25.0%, 9/36). Opportunities for improvement included staff member education (73.5%, 25/34) and more resources (58.8%, 20/34). Respondents rated their site’s overall ability to manage children’s pain as 50/100 [IQR:21,61].ConclusionGeneral EDs report providing suboptimal children’s pain care, with use of physical restraint for medical procedures, and under-utilization of evidence-based, inexpensive treatment options. There are many gaps in children’s pain care in rural and community EDs which could be addressed through collaborative quality improvement initiatives.

Living in a pandemic: changes in mobility routines, social activity and adherence to COVID-19 protective measures

Non-Pharmaceutical Interventions (NPIs), aimed at reducing the diffusion of the COVID-19 pandemic, have dramatically influenced our everyday behaviour. In this work, we study how individuals adapted their daily movements and person-to-person contact patterns over time in response to the NPIs. We leverage longitudinal GPS mobility data of hundreds of thousands of anonymous individuals to empirically show and quantify the dramatic disruption in people’s mobility habits and social behaviour. We find that local interventions did not just impact the number of visits to different venues but also how people experience them. Individuals spend less time in venues, preferring simpler and more predictable routines, also reducing person-to-person contacts. Moreover, we find that the individual patterns of visits are influenced by the strength of the NPIs policies, the local severity of the pandemic and a risk adaptation factor, which increases the people’s mobility regardless of the stringency of interventions. Finally, despite the gradual recovery in visit patterns, we find that individuals continue to keep person-to-person contacts low. This apparent conflict hints that the evolution of policy adherence should be carefully addressed by policymakers, epidemiologists and mobility experts.

Household visitation during the COVID-19 pandemic

The COVID-19 pandemic has posed novel risks related to the indoor mixing of individuals from different households and challenged policymakers to adequately regulate this behaviour. While in many cases household visits are necessary for the purpose of social care, they have been linked to broadening community transmission of the virus. In this study we propose a novel, privacy-preserving framework for the measurement of household visitation at national and regional scales, making use of passively collected mobility data. We implement this approach in England from January 2020 to May 2021. The measures expose significant spatial and temporal variation in household visitation patterns, impacted by both national and regional lockdown policies, and the rollout of the vaccination programme. The findings point to complex social processes unfolding differently over space and time, likely informed by variations in policy adherence, vaccine relaxation, and regional interventions.

Training and development methods and organizational performance: A case of the local government organization in Central Region, Ghana

Abstract Purpose: Is to investigate the relationship between training and development (T&amp;D) methods and organizational performance in the local government sector, as well as contribute to knowledge. Research Methodology: The study employed a quantitative approach and correlation design, a census sampling method to sample 215 employees, a structured questionnaire to collect data, multiple linear regression to test hypotheses, and the Statistical Package for Social Science (SPSS) version 20 to input, transform and analyze the data. Result: The result shows that training and development (T &amp; D) methods (job orientation, job rotation, workshop &amp; conference, and classroom lectures) had a significant relationship with organizational performance. The findings also revealed that training and development (T &amp; D) methods (job orientation, workshop &amp; conference, and classroom lectures) have a significant relationship with the quality of service delivery. However, job rotation has no relationship with quality service delivery. Limitation: The study's main weakness is that it only looked at four different training and development methods and their impact on organizational performance and service quality. Another flaw in the study is that it only looked at one metropolitan assembly. Contribution: In this regard, metropolitan and municipal assembly executives and managers should consider employing training and development methods that provide stronger predictions to boost the organization’s performance and delivery of quality services to communities. They should train and develop employees within the organization as soon as political power changes hands to enhance organization performance because policy adherence is critical to the organization's performance.

Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital.

To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. Observational point prevalence study. Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.

Heterogeneity in Response to India's Initial COVID‐19 Nationwide‐Lockdown: A Quasi‐Experimental Study Using Aggregate Mobility Data

Research ObjectiveIndia's March 2020 nationwide lockdown garnered early support from the World Health Organization, but has also been the subject of criticism due to strict enforcement and the inaccessibility of basic supplies for those under lockdown. Given the scale of the policy and relevant concerns, there is an urgent need to better understand the impact of this policy on its intended outcome: slowing covid case growth.Study DesignWe assessed state‐level variation in response to the nation‐wide lockdown. Using a public dataset of differentially privatized aggregate mobility data, we assessed the combined impact of the Janta Curfew and lockdown using a Single Interrupted Time Series (SITS) design. Our primary outcomes were change in relative mobility and change in state‐level COVID‐19 case growth. We first looked at variation in mobility between states and then used the results from state‐level SITS to assess the relationship with COVID‐19 case growth. To do so, we used a model with rate of increase in COVID‐19 cases over time as our dependent variable and change in aggregate mobility as our predictor, controlling for population demographics, such as: size, urbanicity and poverty as well as known COVID‐19 cases (cumulative as of March 25th). For COVID‐19, we used “Covid19India” which aggregated statistics from the Ministry of Health and Family Welfare (MoHFW), each state or union territory and the Indian Council of Medical Research (ICMR).Population StudiedOur analytic sample included 10,512 state‐day observations, representing 1.21 billion individuals across 36 states and union territories in India.Principal FindingsWe observed an immediate and pronounced decrease in mobility following the policy's implementation. Overall the lockdown was associated with an 86% decrease in mobility as compared to a location‐specific pre‐lockdown baseline. However, these effects were not homogeneous by mobility type, nor were they homogeneously sustained in the post‐policy period. Visits to grocery stores and pharmacies (slope = 0.62% increase in visits per day) and transit stations (slope = 0.24%) began to recover relatively quickly whereas visits to retail and recreation (slope = −0.41%), and parks (slope − 0.47%) continued to decline during the post period. We observed significant state‐level variation in mobility responses (71% to 95% decrease in visits to retail and recreation sites). States with the largest decreases in aggregate mobility to retail and recreational sites had a relatively slow (7.2%) rate of increase in COVID‐19 case growth in contrast to states with the lowest decreases in mobility, who saw a 53% rate increase in COVID‐19 cases (p = 0.03) over the same time period.ConclusionsStates that were most effective in responding to the lockdown policy, as measured by decreased mobility, were also most effective in slowing covid case growth (controlling for state wealth, size, and urbanicity).Implications for Policy or PracticeWhile our findings suggest India's nationwide lockdown may have been effective in achieving its primary goal, we require a better understanding of what drives sub‐national variation in policy adherence over time as well as careful tracking of unintended economic and wellbeing costs.