Cover: Mis-implementation of Evidence-Based Behavioural Health Practices in Primary Care

Mis-implementation of Evidence-Based Behavioural Health Practices in Primary Care

Lessons from Randomised Trials in Federally Qualified Health Centers

Published in: Evidence & Policy, Volume 20, Issue 1, pages 15-35 (2024). DOI: 10.1332/17442648Y2023D000000016

Posted on Feb 23, 2024

by Alex R. Dopp, Grace Hindmarch, Karen Chan Osilla, Lisa S. Meredith, Jennifer K. Manuel, Kirsten Becker, Lina Tarhuni, Michael Schoenbaum, Miriam Komaromy, Andrea Cassells, et al.


Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements, but also challenging, especially for complex behavioural health interventions in low-resource settings. 'Mis-implementation' refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange.

Aims and Objectives

We present mis-implementation cases from three pragmatic trials of behavioural health EBPs in US Federally Qualified Health Centers (FQHCs).


We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors.


Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic.

Discussion and Conclusion

Multilevel determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimise mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors, and should be tailored to relevant audiences such as providers, patients, and/or leadership.

Research conducted by

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