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This paper utilizes the diffusion of innovation framework to discuss factors affecting adoption of telemedicine. Empirical and anecdotal findings are organized across five attributes affecting innovation adoption rates for the following four adopter groups: physicians, patients, hospital administrators, and payers. A discussion of the implications is included.
Network analysis is an approach to research that is uniquely suited to describing, exploring, and understanding structural and relational aspects of health. It is both a methodological tool and a theoretical paradigm that allows us to pose and answer important ecological questions in public health. In this review we trace the history of network analysis, provide a methodological overview of network techniques, and discuss where and how network analysis has been used in public health. We show how network analysis has its roots in mathematics, statistics, sociology, anthropology, psychology, biology, physics, and computer science. In public health, network analysis has been used to study primarily disease transmission, especially for HIV/AIDS and other sexually transmitted diseases; information transmission, particularly for diffusion of innovations; the role of social support and social capital; the influence of personal and social networks on health behavior; and the interorganizational structure of health systems. We conclude with future directions for network analysis in public health.
Diffusion theory can profitably be applied to a range of health problems and interventions. This paper uses the case of tobacco to illustrate this process. The diffusion of innovations model refers to the spread of new ideas, techniques and behaviours or products throughout populations. Those who adopt at different phases of the process tend to differ in predictable ways, such as age, sex, residence, socioeconomic status and level of access to communications, each of which can be employed to affect the overall rate of adoption. A series of perspectives are employed to examine aspects of the diffusion process for tobacco use. Examples from the tobacco areas are used to illustrate ways in which the diffusion model can be applied in the field. Applications of the model for prevention are presented and discussed.
Small Group Education (SGE) to promote breast cancer screening was implemented in a community-wide program. Based on diffusion of innovations theory, SGE initially was directed toward women at higher occupation and education levels and then progressively shifted toward more vulnerable populations of women at risk of not getting screening. During the four-year intervention, 116 volunteers led SGE presentations, with 8,184 women participating in 740 groups at work sites, organizations, residences, and churches. High participation in SGE and positive participant responses suggest that delivery of SGE using a social diffusion model was an effective method for reaching women throughout the community.
In this exploratory study, Rogers' diffusion of innovation theory was used to identify which factors are likely to contribute to the potential acceptance of transgenic biopharmaceuticals (TG-Bs). These products are not yet available to the general public. A scale was designed to assess three of five core attributes related to the potential adoption rate of innovations (Rogers 1995), as well as to measure potential acceptance characteristics for biotechnology products. These attributes were relative advantage, compatibility with existing values, and complexity. In addition, two other characteristics were included: knowledge (Gartrell and Gartrell 1979) and perceived risks (Bauer 1960). The survey was completed by 74 consumers (78% response rate) using convenience sampling. The research findings show that Rogers' three core attributes are supported, but that knowledge andperceived risks were excluded from the model. The model for transgenic biopharmaceuticals consists of: 1. Consumer-related benefits (positively correlated to potential adoption). 2. New types of animals (negatively correlated to potential 3. Perceived complexity (negatively correlated to potential adoption). All the scaled items developed for this study were highly significant, which indicates that they can be used successfully by other researchers working in this field. As TG-Bs are a discontinuous innovation, biotechnology companies may need to present the benefits of these products, as well as the ease of their use prior to their launch, in order to increase their potential acceptance by consumers.
Recently, health care investment in information technology (IT) has experienced a significant increase. Paralleling this increase has been an increase in IT capabilities. Despite the interest in and promises of IT in the health care setting, there is a paucity of empirical research that has attempted to define an organizational measure of IT capability. The dearth of research has contributed to the traditional belief that IT is perceived as a "black box," whereby organizational resources enter the box as "inputs" and are somehow transformed into positive outcomes for an organization. However, for positive outcomes to be realized, these outcomes must be measurable. This research uses a stakeholder perspective to develop a theoretically specified measure of IT capability. A latent construct, IT munificence, is proposed using tenets from diffusion of innovation theory and strategic contingency theory. The construct is tested using a sample of 1,545 acute care hospitals located in the United States. IT munificence fits the study data well, supporting the hypothesis that IT munificence represents a strategy of hospital IT capability.
The problem of patient safety has been repeatedly identified in the medical literature since the mid 1950s, but regular revelations about patient deaths and injuries resulting from treatment have had almost no effect on the actual practice of medicine. Only very recently has the medical profession made a systematic effort to reduce or eliminate the many preventable deaths and injuries that occur in hospitals each year. This review traces the diffusion of innovation in medical error reduction to the public shaming of the profession that occurred as a result of stories that appeared in the news media. The focus is on the USA, but news stories about patient safety are sparking a similar process throughout the western world.
The Centers for Disease Control and Prevention (CDC) currently promotes an HIV prevention intervention for young adult African American women, known as SISTA, through the Diffusion of Effective Behavioral Interventions (DEBI) program. Nationally, more than 700 agencies have completed a 1-week CDC-funded training to implement SISTA. Agencies that have been trained in SISTA are also eligible to receive training in a newly published HIV prevention intervention for African American adolescent females, known as SiHLE (Sistering, Informing, Healing, Living, and Empowering), as well as to receive training in a newly published prevention intervention for women living with HIV, known as WiLLOW (Women Involved in Life Learning From Other Women). All three of these HIV prevention interventions, target African American females, are designed to reduce HIV sexual risk behaviors and share similar theoretical, core, and methodological elements. The diffusion of innovation paradigm suggests that if potential adopters perceive one innovation as being closely related to another innovation, it may be useful to promote a cluster of innovations, rather than to treat each new innovation separately. This article examines how promotion of a suite of HIV interventions for African American females may facilitate adoption of the three evidence-based HIV interventions for this population.
Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.
OBJECTIVES: To assess the use of the "Core Competencies for Public Health Professionals" standards in practice and academic work settings by public health nurses (PHNs), and to determine differences between practitioners and faculty. DESIGN: Nonexperimental, descriptive study using a cross-sectional survey. SAMPLE: Three public health nursing (PHN) organizations sent invitations to all members. A total of 334 (18.7%) from an estimated 1,786 members completed the survey. MEASUREMENTS: The investigators developed a 17-item web-based survey with open- and closed-ended responses, using Rogers' diffusion of innovations as a theoretical framework. RESULTS: Respondents are equally familiar with the competencies for public health professionals disseminated by the Council on Linkages and for PHNs by the Quad Council of Public Health Nursing Organizations (Quad Council). Two thirds of PHNs are aware of the competencies after only 2 years, primarily from professional PHN organizations. Faculty are adopting and using the competencies at a significantly faster rate than practitioners. CONCLUSIONS: Faculty and practitioners who use the competencies value them, and rarely discontinued their use after adoption. Efforts to promote diffusion among faculty and especially practitioners need to continue. Professional organizations can actively provide and share examples of useable formats and best practices associated with the competencies.
Although evidence-based practice is the current practice approach recommended for use in occupational therapy, practitioners often report difficulties in using research evidence because of its content and presentation. This paper discusses a conceptual model that researchers can use to create research evidence that is easier for practitioners to understand and use. The Diffusion of Innovations Theory is used as a framework to identify desirable characteristics that may facilitate practitioners' adoption and utilization of research evidence. The concepts of social validity, ecological validity, and clinical significance are presented and discussed as ways to create those desirable characteristics that could make research information more usable for evidence-based practice. Examples for implementation of the conceptual model are also discussed.
AIM: Four questions about translation research are considered in this article. (1) Why should there be concern about preparing nurse scientists for translation research? (2) Are current research-intensive doctoral programs in nursing preparing graduates for translation research? (3) Should targeted efforts be made to systematically prepare nurses in translation research? (4) What strategies would be useful? QUESTION 1: It is argued that translation research is needed in order to increase the odds that interventions found to be efficacious can be effectively translated into practices that will produce desired outcomes. Thus, evidence from translation research is a very important component of the science base needed to guide innovation in practice. Another reason of concern in preparing translation researchers is the growing pace of research into the efficacy of interventions, which accelerates the need for translation research. Furthermore, the emergence of clinical doctoral programs in nursing that will be seeking faculty with expertise in translation research supports the need for preparing scientists in translation research. QUESTION 2: To determine whether translation research was visible in current research-intensive doctoral programs, a Web-based review of these programs offered by colleges and universities in the database of the American Association of Colleges of Nursing (AACN) was conducted in the fall of 2003. The search revealed that in the 79 programs surveyed, no school identified an area of emphasis in terms that suggested a component of translation science such as research dissemination or utilization, knowledge transfer, diffusion of innovation, or technology transfer. Less than a dozen courses could be located that focused on topics related to translation research or translation science. QUESTIONS 3 AND 4: The case is made that more attention should be given to preparing translation scientists in research-intensive doctoral programs in nursing, and several strategies were suggested for moving toward that goal.
Social-ecological (SE) models are becoming more widely used in health behavior research. Applying SE models to the design of interventions is challenging because models must be tailor-made for each behavior and population, other theories need to be integrated into multi-level frameworks, and empirical research to guide model development is limited. The purpose of the present paper is to describe a SE framework that guided the intervention and measurement plans for a specific study. The trial of activity for adolescent girls (TAAG) is a multi-center study of interventions to reduce the decline of physical activity in adolescent girls. The TAAG framework incorporates operant learning theory, social cognitive theory, organizational change theory and the diffusion of innovation model in a multi-level model. The explicit and practical model developed for TAAG has already benefited the study and may have elements that can generalize to other health promotion studies.
Patient education activities in pharmacies are receiving much attention. These activities are relatively new and implementation requires individual and organisational change in pharmacies. The aim of this study is to identify barriers and facilitators to the implementation of patient education in community pharmacies and to classify these barriers and facilitators into the diffusion stages of Rogers' 'Innovations in Organisations' model [Rogers, EM. Diffusion of innovations. 4th ed. New York: The Free Press, 1995]. Six focus group interviews, three with pharmacists and three with pharmacy technicians (total n = 38) were carried out. The initiation phase has been dealt with by community pharmacies, whereas the implementation phase has not. The barriers and facilitators in the redefining/restructuring stage were mainly related to the organisation of patient education. In the clarifying and routinizing stages, barriers were related to repetition and knowledge transfer. The facilitators in these stages relate to performing and talking about patient education. Interventions for implementation of patient education should aim at these barriers and facilitating factors.
This article contends that the German social and economic situation is conductive to the rapid diffusion of innovative medical technology. While there is public control over hospital facilities, the pluralistic health care system and decentralized government responsibilities contribute to an essentially laissez faire regulatory environment. There is perfunctory planning and regulation for major medical expenditures, but the essential constraints are financial. This is no comprehensive program for the assessment of diagnostic technologies and the effective imposition of guidelines depends on the cooperative effort of various financing organizations, professional interests, and public pressure groups.
There is increasing programme focus on the impact of HIV and AIDS and the advances in biomedical research that are taking central stage even in sub-Saharan Africa. Perhaps out of frustration, communication and behaviour change efforts are receiving lesser attention. But as long as heterosexual intercourse remains the predominant means of transmission of HIV in sub-Saharan Africa, there is the inherent danger of more people getting infected thus mopping up the gains from other approaches. This paper therefore argues for evidence based behaviour change interventions in sub-Saharan Africa, revisits the behaviour change theories and their relevance to the African situation. It proposes an integration of models based on the convergence of three existing theories of social learning, diffusion of innovation and social networks and the author's understanding of some African culture. The beauty of the model is based on the fact that 'social norms are best understood and influenced at the level of social networks'; existing chains of communication and the naturalness of exchange of information. A case is made for application of the 'model' to precipitate sexual behaviour change and HIV reduction in sub-Saharan Africa.
It is estimated that employers spend more than 75 billion dollars annually on obesity-attributable health care. Interventions to reduce or prevent the risk of obesity are increasingly common at worksites and include health fairs, weight loss and nutrition classes, and fitness programs. However, many companies lack the resources to plan and implement these types of programs. Environmental approaches offer companies a low-cost option. A community-based participatory research model was used to bring academic researchers, human resources personnel, and health department educators together to plan and implement an environmental program aimed at increasing healthy eating and physical activity at four small manufacturing companies. The Diffusion of Innovations Theory guided the development of focus group questions. A focus group study was then conducted to gather information from employees and managers at these four companies. The questions identified workplace strategies that would aid in reducing barriers and developing appropriate communication channels to enhance employee participation in the program. The researchers identified themes from manager and employee focus groups regarding the following five environmental components: signs, walking paths, food changes, educational strategies, and advisory groups.
Regulation strategies for controlling hospital costs are widely discussed today and medical technology assessment is one of these strategies. A Committee for Evaluation of the Diffusion of Innovative Technologies (CEDIT) was created in 1982 at the 'Assistance Publique de Paris', the most important health care institution in France. The CEDIT makes recommendations to the Director General on the use of new technologies. Since 1982, more than 50 medical technologies have been studied by the CEDIT: procedures such as plasmapheresis, bone marrow transplantation and percutaneous transluminal angioplasty; equipment such as lasers and the lithotriptor. The CEDIT helps planners who have to make difficult choices.