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Table 1 Overview of themes

From: “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

Theme

Theme description

Major theme 1: Why a program is considered ineffective

 Lack of program fit

Program was ill-suited to the populations served by the state health department.

 No measured benefits

Local data demonstrated no or little positive outcomes, despite the program being evidence-based in other populations or settings.

 Unknown effectiveness

Lack of evaluation data or the right type of evaluation data led to practitioner views that a program was ineffective.

 Staffing constraints

Lack of sufficient staff or dedicated time to support successful program implementation or scale-up.

Major theme 2: Why ineffective programs are continued

 Inertia and sunk costs

Complex, grant-funded public health programs may be difficult to modify after implementation begins, and losing the money and time spent on initial implementation may decrease practitioners’ incentives to modify an ineffective program.

 Information gaps

Agencies may not have adequate information to decide whether to continue a program, e.g., if evaluation was not built into the initial plan.

 Desire to act

Public health staff may feel good that they are doing something to address a community concern, regardless of the effectiveness of the action.

 Agency capacity

Agencies may lack the money, time, and personnel needed to identify, decide on, and implement changes to an existing program.

 Program champions

The presence of someone in the SHD or community who is vocal about wanting a program to continue may challenge efforts to modify or discontinue an ineffective program.

 Partnership maintenance

Ineffective programs may be continued to support strong relationships with community partners who are invested in a program.