A cross-country study of mis-implementation in public health practice

Furtado, Karishma; Budd, Elizabeth L.; Armstrong, Rebecca; Pettman, Tahna; Reis, Rodrigo Siqueira; Sung-Chan, Pauline; Wang, Zhaoxin; Brownson, Ross C.

doi:10.1186/s12889-019-6591-x

Cited by 8 publications

(13 citation statements)

References 45 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to previous pilot work, perceived frequency of mis-implementation in SHD was higher in this study (36.5% vs 50.7% for inappropriate termination and 24.7% vs 48.5% for inappropriate continuation), although some of this difference may be attributable in part to updates to the mis-implementation survey item de nitions and changes in the approach to categorization of responses (9,10,21). In earlier studies, the recoded dichotomized mis-implementation variables only included the often/always response.…”

Section: Limitationscontrasting

confidence: 91%

See 1 more Smart Citation

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

Padek¹,

Mazzucca²,

Allen³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones.Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation.Results: Half (50.7%) of respondents were program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40).Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

show abstract

Section: Limitationscontrasting

confidence: 91%

“…Mis-implementation is an emerging area of interest for public health practitioners and researchers (8)(9)(10). The term refers to the inappropriate termination of evidence-based programs or the inappropriate continuation of non-evidence based programs (8).…”

Section: Introductionmentioning

confidence: 99%

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

Padek¹,

Mazzucca²,

Allen³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Management support for EBDM in public health agencies is associated with improved public health performance [ 37 , 38 ]. In a cross-country comparison of mis-implementation, leadership support and political contexts were all common factors in whether programs continued or ended [ 2 ]. Preliminary data indicate that organizational supports for EBDM may be protective against mis-implementation (e.g., leadership support for EBDM, having a work unit with the necessary EBDM skills) and, more specifically, a leader’s ability to persevere in implementation of EBIs, ability and willingness to manage change, and use of quality improvement processes [ 1 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mis-implementation is an emerging area of interest for public health researchers and practitioners [1][2][3]. The term refers to the premature termination of evidencebased programs or the failure to de-implement nonevidence-based programs [1], and recent evidence suggests that it is a widespread problem in public health practice.…”

Section: Introductionmentioning

confidence: 99%

Rugged landscapes: complexity and implementation science

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Mis-implementation—defined as failure to successfully implement and continue evidence-based programs—is widespread in public health practice. Yet the causes of this phenomenon are poorly understood. Methods We develop an agent-based computational model to explore how complexity hinders effective implementation. The model is adapted from the evolutionary biology literature and incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches—Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM). Results The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM. Conclusions The model’s results emphasize the importance of adapting one’s approach to the characteristics of the problem at hand. Evidence-based decision-making (EBDM), which combines evidence from multiple independent sources with on-the-ground local knowledge, is a particularly potent strategy for implementation and quality improvement.

show abstract

“…The mechanisms behind mis-implementation are an important area of inquiry for public health practitioners and researchers [8][9][10]. The term mis-implementation refers to the inappropriate termination of evidence-based programs or the inappropriate continuation of non-evidence based programs [8].…”

Section: Introductionmentioning

confidence: 99%

Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

Padek

Mazzucca

Allen

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results: Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

show abstract

A cross-country study of mis-implementation in public health practice

Cited by 8 publications

References 45 publications

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

Patterns and Correlates of Mis-implementation in State Public Health Practice in the United States

Rugged landscapes: complexity and implementation science

Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

Contact Info

Product

Resources

About