scholarly journals “It’s good to feel like you’re doing something”: a qualitative study examining state health department employees’ views on why ineffective programs continue to be implemented in the USA

2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Stephanie Mazzucca ◽  
Louise Farah Saliba ◽  
Romario Smith ◽  
Emily Rodriguez Weno ◽  
Peg Allen ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Population Health ◽  
Health Department ◽  
Evidence Based ◽  
State Health ◽  
Improve Population Health ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Evidence Based Programs

Abstract Background Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners’ perspectives about what makes programs ineffective and the reasons why ineffective programs continue. Methods Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. Results Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. Conclusions The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies’ ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health.

The Relationships Between State Health Department Practitioners’ Perceptions of Organizational Supports and Evidence-Based Decision-Making Skills

2021 ◽  
pp. 003335492098415
Author(s):  
Stephanie Mazzucca ◽  
Rebekah R. Jacob ◽  
Cheryl A. Valko ◽  
Marti Macchi ◽  
Ross C. Brownson
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Online Survey ◽  
Organizational Capacity ◽  
Health Department ◽  
Evidence Based ◽  
State Health ◽  
State Health Department ◽  
Longitudinal Associations ◽  
Evidence Based Decision Making

Objectives Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. Methods An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents’ skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). Results Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (β estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. Conclusions Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.

scholarly journals A survey tool for measuring evidence-based decision making capacity in public health agencies

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Julie A Jacobs ◽  
Paula F Clayton ◽  
Cassandra Dove ◽  
Tanya Funchess ◽  
Ellen Jones ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based ◽  
Survey Tool ◽  
Public Health Agencies ◽  
Decision Making Capacity ◽  
Health Agencies ◽  
Evidence Based Decision Making

scholarly journals Approaches for Ending Ineffective Programs: Strategies From State Public Health Practitioners

2021 ◽  
Vol 9 ◽  
Author(s):  
Emily Rodriguez Weno ◽  
Peg Allen ◽  
Stephanie Mazzucca ◽  
Louise Farah Saliba ◽  
Margaret Padek ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Disease ◽  
Qualitative Interviews ◽  
Population Level ◽  
Health Department ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Health Practitioners ◽  
Evidence Based Programs ◽  
Public Health Practitioners

Background: Public health agencies are increasingly concerned with ensuring they are maximizing limited resources by delivering evidence-based programs to enhance population-level chronic disease outcomes. Yet, there is little guidance on how to end ineffective programs that continue in communities. The purpose of this analysis is to identify what strategies public health practitioners perceive to be effective in de-implementing, or reducing the use of, ineffective programs.Methods: From March to July 2019, eight states were selected to participate in qualitative interviews from our previous national survey of US state health department (SHD) chronic disease practitioners on program decision making. This analysis examined responses to a question about “…advice for others who want to end an ineffective program.” Forty-five SHD employees were interviewed via phone. Interviews were audio-recorded, and the conversations were transcribed verbatim. All transcripts were consensus coded, and themes were identified and summarized.Results: Participants were program managers or section directors who had on average worked 11 years at their agency and 15 years in public health. SHD employees provided several strategies they perceived as effective for de-implementation. The major themes were: (1) collect and rely on evaluation data; (2) consider if any of the programs can be saved; (3) transparently communicate and discuss program adjustments; (4) be tactful and respectful of partner relationships; (5) communicate in a way that is meaningful to your audience.Conclusions: This analysis provides insight into how experienced SHD practitioners recommend ending ineffective programs which may be useful for others working at public health agencies. As de-implementation research is limited in public health settings, this work provides a guiding point for future researchers to systematically assess these strategies and their effects on public health programming.

scholarly journals Rugged landscapes: complexity and implementation science

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Joseph T. Ornstein ◽  
Ross A. Hammond ◽  
Margaret Padek ◽  
Stephanie Mazzucca ◽  
Ross C. Brownson
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Quality Improvement ◽  
Evolutionary Biology ◽  
Public Health Practice ◽  
Evidence Based ◽  
Health Practice ◽  
Context Specific ◽  
Evidence Based Programs ◽  
Evidence Based Decision Making

Abstract 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.

Using Public Health Legal Counsel Effectively: Beliefs, Barriers and Opportunities for Training

2013 ◽  
Vol 41 (S1) ◽  
pp. 61-64 ◽  
Author(s):  
Nancy Kaufman ◽  
Susan Allan ◽  
Jennifer Ibrahim
Keyword(s):  
Public Health ◽  
The State ◽  
Clear Understanding ◽  
Local Health ◽  
Health Departments ◽  
Legal Counsel ◽  
State Health ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Legal Staff

Laws, ordinances, regulations, and executive orders create the powers and duties of public health agencies and modify the complex community conditions that affect health. Appropriately trained legal counsel serving as legal advisors on the health officer's team facilitate clear understanding of the legal basis for public health interventions and access to legal tools for carrying them out.Legal counsel serve public health agencies via different organizational arrangements — e.g., internal staff counsel, external counsel from the state attorney general's (AG) office, state health department, county or city, or private counsel under contract, or in combination. As of 2011, most state health departments (63%) employ their own counsel, and 56% use AG counsel, while 17% contract with independent attorneys; most local health departments (66%) work with attorneys and legal staff assigned by local government, by the state health agency (23%), or contract with outside attorneys and legal staff (15%).

The Perils of Partnership

2019 ◽  
Author(s):  
Jonathan H. Marks
Keyword(s):  
Public Health ◽  
Multinational Corporations ◽  
Separation Of Powers ◽  
Public Health Research ◽  
Noncommunicable Diseases ◽  
New Paradigm ◽  
Public Health Agencies ◽  
Ethical Implications ◽  
Health Agencies ◽  
Public Bodies

Collaboration with industry has become the paradigm in public health. Governments commonly develop close relationships with companies that are creating or exacerbating the very problems public health agencies are trying to solve. Nowhere is this more evident than in partnerships with food and soda companies to address obesity and diet-related noncommunicable diseases. The author argues that public-private partnerships and multistakeholder initiatives create webs of influence that undermine the integrity of public health agencies; distort public health research and policy; and reinforce the framing of public health problems and their solutions in ways that are least threatening to the commercial interests of corporate “partners.” We should expect multinational corporations to develop strategies of influence. But public bodies need to develop counter-strategies to insulate themselves from corporate influence in all its forms. The author reviews the ways in which we regulate public-public interactions (separation of powers) and private-private interactions (antitrust and competition laws), and argues for an analogous set of norms to govern public-private interactions. The book also offers a novel framework that is designed to help public bodies identify the systemic ethical implications of their existing or proposed relationships with industry actors. The book makes a compelling case that, in public health, the paradigm public-private interaction should be at arm’s length: separation, not collaboration. The author calls for a new paradigm to protect and promote public health while avoiding the ethical perils of partnership with industry.

scholarly journals International Perspectives on COVID-19 Communication Ecologies: Public Health Agencies’ Online Communication in Italy, Sweden, and the United States

2021 ◽  
pp. 000276422199283
Author(s):  
Serena Tagliacozzo ◽  
Frederike Albrecht ◽  
N. Emel Ganapati
Keyword(s):  
Public Health ◽  
United States ◽  
Social Groups ◽  
Online Communication ◽  
The United States ◽  
Negative Consequences ◽  
Public Health Agencies ◽  
Communication Ecology ◽  
Health Agencies ◽  
National Public Health

Communicating during a crisis can be challenging for public agencies as their communication ecology becomes increasingly complex while the need for fast and reliable public communication remains high. Using the lens of communication ecology, this study examines the online communication of national public health agencies during the COVID-19 pandemic in Italy, Sweden, and the United States. Based on content analysis of Twitter data ( n = 856) and agency press releases ( n = 95), this article investigates two main questions: (1) How, and to what extent, did national public health agencies coordinate their online communication with other agencies and organizations? (2) How was online communication from the agencies diversified in terms of targeting specific organizations and social groups? Our findings indicate that public health agencies relied heavily on internal scientific expertise and predominately coordinated their communication efforts with national government agencies. Furthermore, our analysis reveals that agencies in each country differed in how they diversify information; however, all agencies provided tailored information to at least some organizations and social groups. Across the three countries, information tailored for several vulnerable groups (e.g., pregnant women, people with disabilities, immigrants, and homeless populations) was largely absent, which may contribute to negative consequences for these groups.

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