BACKGROUND: Through application of existing knowledge, much of the cancer burden is preventable. State-
level practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-
implementation refers to ending effective programs and policies 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 positive cancer outcomes.
GOAL: This proposal seeks to describe the extent of cancer control mis-implementation and to identify
leverage points for addressing mis-implementation in the United States.
AIMS AND METHODS: This is a three-phase study that takes a comprehensive approach, leading to the
elucidation of tactics for addressing mis-implementation. Phase 1: The first aim seeks to 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 prevention to survivorship). Phase 2: Using data from Phase 1 to identify
organizations in which mis-implementation is high or low, we will conduct eight comparative case studies to
understand contextual differences. These case studies will highlight lessons learned about mis-implementation
and identify hypothesized drivers. Phase 3: The 3rd aim seeks to build agent-based models to identify dynamic
interactions between individual, organizational, and contextual (external) factors driving mis-implementation.
Agent-based modeling will be used to determine the most effective potential approaches for reducing mis-
implementation. We will translate and disseminate findings from Phases 1-3 to practitioners and practice-
related stakeholders in order to support the reduction of mis-implementation. All study phases will rely on an
Advisory Group of public health practitioners and close collaboration with key practice partners.
INNOVATIONS AND IMPACT: This study is innovative and impactful 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 result in a replicable model that can significantly
impact mis-implementation in cancer control and can be applied to other health areas.
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