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Implement Sci. 2018 Mar 23;13(1):49. doi: 10.1186/s13012-018-0742-9.

Toward optimal implementation of cancer prevention and control programs in public health: a study protocol on mis-implementation.

Author information

1
Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA. mpadek@wustl.edu.
2
Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
3
Department of Public Health, University of Tennessee, Knoxville, TN, USA.
4
Center on Social Dynamics and Policy, The Brookings Institution, Washington DC, USA.
5
Center for Public Health System Science, Brown School at Washington University in St Louis, St. Louis, MO, USA.
6
Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA.

Abstract

BACKGROUND:

Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes.

METHODS:

This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation.

DISCUSSION:

This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas.

KEYWORDS:

Agent-based models; Cancer control; Mis-implementation

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