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

Autor: Mackenzie V Robinson, Debra Dekker, Stephanie Mazzucca, Renee G Parks, Margaret Padek, Ross C. Brownson, Peg Allen, Maureen Dobbins, Rebekah R. Jacob, Hengrui Hu
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Health departments
Decision Making
Sample (statistics)
Health informatics
Health administration
Odds
Likert scale
Resource Allocation
Evidence-based decision making
03 medical and health sciences
0302 clinical medicine
Nursing
Surveys and Questionnaires
medicine
Odds Ratio
Humans
030212 general & internal medicine
030505 public health
Local Government
business.industry
Mis-implementation
Health Policy
Public health
Nursing research
lcsh:Public aspects of medicine
lcsh:RA1-1270
United States
3. Good health
Leadership
Cross-Sectional Studies
Evidence-Based Practice
Evidence-based public health
Chronic Disease
De-implementation
Implementation science
Female
0305 other medical science
business
Public Health Administration
Health department
Program Evaluation
Research Article
Zdroj: BMC Health Services Research
BMC Health Services Research, Vol 20, Iss 1, Pp 1-11 (2020)
ISSN: 1472-6963
Popis: Background 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. Methods 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). Results 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%). Conclusions 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.
Databáze: OpenAIRE
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