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

Area of Science:

• Public Health
• Health Services Research
• Organizational Behavior

Background:

• Limited public health resources necessitate effective program allocation.
• Mis-implementation, including ending effective programs or continuing ineffective ones, strains resources.
• This study examines organizational supports for evidence-based decision-making in U.S. local health departments.

Purpose of the Study:

• To explore the associations between organizational supports for evidence-based decision-making and public health mis-implementation.
• To identify reasons for both inappropriate termination of effective programs and inappropriate continuation of ineffective programs.

Main Methods:

• A cross-sectional study surveyed leaders from a national sample of U.S. local health departments.
• Survey items assessed the frequency and reasons for mis-implementation.
• Participants rated organizational supports for evidence-based decision-making on a 7-point Likert scale.

Main Results:

• 30.0% reported ending effective programs (inappropriate termination), primarily due to ended grant funding.
• Organizational supports were not associated with the frequency of inappropriate termination.
• 16.4% reported continuing ineffective programs (inappropriate continuation).
• Higher perceived organizational supports for evidence-based decision-making were associated with less frequent inappropriate continuation.

Conclusions:

• Organizational supports for evidence-based decision-making can help prevent the continuation of ineffective programs.
• Creative support mechanisms are needed to prevent the inappropriate termination of effective programs.
• Understanding mis-implementation drivers can guide the de-implementation of ineffective programs, optimizing resource allocation for evidence-based initiatives.