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Results for “Diffusion of Innovation”

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At least 217 records · Page 12Linked to original sources

PubMed2006

An evaluation of how well research reports facilitate the use of findings in practice.

PURPOSE: To analyze how research is reported in journal publications as a potential barrier to use of research findings in practice. DESIGN: Content analysis of 46 reports of diabetes self-management interventions published between 1993 and 2004. METHODS: Data were extracted from the publications using a coding scheme based on concepts from Rogers' theory of the diffusion of innovations. FINDINGS: Authors provided only some of the information potential users need to progress through Roger's stages of adopting an intervention and implementing it in practice. Authors provided only limited information on the target population; frequency, number, and duration of patient contacts; expertise and training required to deliver the intervention; intervention protocol; and the process of adapting and implementing interventions in practice settings. CONCLUSIONS: To close the gap between research and practice, authors should offer more information to help readers decide whether and how to adopt and implement interventions.

Diffusion of Innovation↗

PubMed2001

Translating research into practice. Considerations for critical care investigators.

Experimental multisite studies are needed to test adoption interventions that promote use of evidence-based guidelines in critical care practice. A research model (see Fig. 2) based on Rogers' diffusion of innovation model provides a conceptual guide for selecting interventions to test in translational research studies. Studies should address the four major areas of innovation adoption: (1) characteristics of the guideline, (2) users of the guideline, (3) methods of communicating the guideline, and (4) the social system in which it is being adopted. It is imperative that researchers study which interventions are most effective in promoting use of critical care evidence-based practices by nurses and physicians and how the social system of critical care environments affects adoption of such practices. Without this empiric knowledge, health care systems have little guidance in how to most effectively promote adoption of scientific evidence to improve care of critically ill patients.

Clinical Nursing Research↗

PubMedDate not supplied

Heart health promotion: predisposition, capacity and implementation in Ontario Public Health Units, 1994-96.

The Canadian Heart Health Initiative-Ontario Project (CHHIOP) investigates predisposition and capacity in Ontario public health departments to implement community-based heart health promotion activities. The research draws upon diffusion of innovations theory and recent work on ecological approaches to health promotion within which public health agencies are seen to play a central role. Mail-back surveys were completed by heart health staff in all 42 health departments in 1994 and 1996. Predisposition and capacity were measured as the importance and effectiveness ascribed to 18 organizational practices supportive of community heart health activities. Level of implementation was reported for 74 activities spanning a range of risk factors and settings. Predisposition, capacity and implementation scores increased between 1994 and 1996. The findings confirm positive correlations between predisposition and capacity and between capacity and implementation.

Attitude of Health Personnel↗

PubMed1992

The uses of theory in health advocacy: policies and programs.

This paper illustrates the utility of theory for health educators who advocate for health promotion policies and programs. It describes how diffusion of innovation and other social science theories were employed by a statewide coalition called the Health Promotion and Education Council of Virginia in its effort to reduce premature and preventable death and disability in the state. To this end the Council sought legislative action to accelerate the diffusion of health promotion throughout the state. Discussing elements of diffusion theory such as working through opinion leaders, creating information-exchange relationships, and tailoring the attributes of the innovation to achieve its objectives, the paper reviews the process through which the Council became an effective advocate, and the strategies it devised to communicate the innovation of health promotion to legislators. The legislation that was generated by the work of the legislative study committee and future uses of theory are also discussed.

Diffusion of Innovation↗

PubMed1992

Patient cards: storage and input for medical data.

The literature concerning the diffusion of innovations reveals that it is not surprising that a promising technology is confronting obstacles in its development and implementation. Alternative technologies also often appear that address the same or similar problems. Better information enables physicians to provide medical care that is less expensive and less error prone. The prescription of medications is reduced in number and cost when the prescribing physician knows the current and previous medications of the patient. The ordering of clinical tests is reduced in number and cost, and the ordering of timely retesting is more likely when physicians have before them information about previous testing of their patient. The challenge is in how the portability of the patient card and its ability to be self-contained can enhance medical practice.

Data Collection↗

PubMed1999

Monitoring the dissemination of an educational protocol on pediatric asthma in family practice: a test of associations between dissemination variables.

Many asthma education programs aim at reducing morbidity. Now that effective programs are available, the next step is the nationwide dissemination to achieve morbidity reduction. A dissemination of a tested program has been undertaken in Dutch primary care, guided by the Diffusion of Innovation theory. It was hypothesized that greater awareness and concern and/or receptivity about asthma self-management would make it more likely that family physicians would adopt the program. Family physicians were considered more likely to adopt the program if they saw it as an improvement on their current way of providing education, as easy to use, and as having observable outcomes. It was expected that once the program had been adopted, and as it was being implemented, it would increasingly be perceived by its users as successful. Finally, more perceived success of performance was expected to be related to continued use. Both longitudinal and cross-sectional data largely confirmed the hypotheses.

Adult↗

PubMed1983

Implementing asthma self-management education in medical care settings--issues and strategies.

Asthma self-management education has the potential to improve the health and quality of life for children and to reduce use of acute care services. The preparation of parents and children to prevent asthma attacks and to ameliorate acute episodes when they do occur can best be accomplished with the support of medical care providers. This analysis addresses policy issues relevant to that acceptance: the degree of integration into medical practice that is desirable; the most hospitable clinical settings; and the incentives for providers, consumers, and payers that would result in appropriate supply and use of ASME:. The analysis commences with a discussion of the costs and benefits of making ASME a part of medical care. It then turns to a description of the trends that led to the current array of institutions, services, and incentives within the health care sector. Future changes in family context, financing, and other determinants of the use of medical services by children and youth are forecast. The framework for the analysis of incentives is diffusion of innovation. ASME is analyzed according to the attributes that generally facilitate the acceptance of a new procedure. In its current form and with current incentives, ASME is fairly complex and difficult to communicate, has little relative advantage, and is not necessarily compatible with the usual provider goals. The motivating factors for three interrelated groups-providers, consumers, and third-party payers-and leverage points for the application of incentives are identified. The latter include reimbursement, standards of practice, information generation and flow, insurance regulation, institutional development, and research funding. Important information to potential adopters includes the definition of the service, its optimal intensity and mix of providers, and its effects on net costs and quality of life.

Asthma↗

PubMedDate not supplied

Use of interdisciplinary simulation to understand perceptions of team members' roles.

The aim of this study was to examine the effectiveness of an interdisciplinary approach to learning in helping care providers understand their overlapping roles in the clinical management of asthma. In addition, the perceived usefulness of an interdisciplinary approach for students in the health-care disciplines of nursing, medicine, pharmacy, and respiratory therapy to learn about the clinical management of asthma was explored. The diffusion of innovation framework was used to guide the process of development of CD-ROMs. An interpretative approach was selected for this research because of the emphasis on how a phenomenon is perceived and how meaning is constructed in situations. This approach assumes that multiple ways of interpreting experiences are available through interaction. A convenience sample of health-care practitioners from two rural campuses was selected to participate in this study. The cohort of participants represented students from the population of a large midwestern moderate-sized university that has four geographically distinct campuses. Preliminary results indicate that the use of interdisciplinary learning helps clarify the roles of each discipline and that learning from one another is enhanced.

Adult↗

PubMedDate not supplied

A staged model of communication effects: evidence from an entertainment-education radio soap opera in Tanzania.

The authors draw on (1) the hierarchy-of-effects (HOE) model, (2) the stages-of-change (SOC) model, (3) social learning theory (SLT), and (4) the diffusion of innovations (DOI) to synthesize a staged model through which communication messages have effects on individual behavior change by stimulating (1) involvement with media characters and role modeling of their actions, and (2) interpersonal communication. Data from a field experiment in Tanzania on the effects of an entertainment-education radio soap opera, Twende na Wakati (Let's Go With the Times), on the adoption of family planning, are analyzed in light of a six-staged model of communication effects. It is found that (1) the model provides a useful framework for understanding the effects of an entertainment-education program, and (2) the radio soap opera promoted progress through the stages for family planning adoption in the treatment area in three of the four years of broadcast, and in the comparison area after broadcasts of the radio program began there.

Adult↗

PubMed2006

Prescribing antiepileptics for the elderly: differences between guideline recommendations and clinical practice.

The incidence of epilepsy in patients aged >60 years is higher than in any other period of life. Yet, until recently, what was known about the treatment of older patients with epilepsy has been inferred from studies in younger patients. A growing body of clinical evidence focused exclusively on the elderly suggests that, while some issues are similar for older and younger adults, older patients with epilepsy may require even more attention regarding antiepileptic drug (AED) selection than younger patients. This article reviews published guidelines and recommendations to identify explicit recommendations for use of specific AEDs in the elderly, and assesses the extent to which those recommendations have been adopted in clinical practice. We found that while one systematically derived guideline stated that lamotrigine may be a good choice for older patients because of its favourable adverse effect profile, only clinical recommendations based on expert opinion explicitly identified AEDs that are more and less appropriate for use in the elderly. Examination of published studies describing recent AED-prescribing patterns suggests that clinical recommendations have been, at best, slowly adopted. This observation is exemplified by the fact that older patients newly diagnosed with epilepsy are still prescribed phenobarbital--a drug identified as suboptimal in 1985. In order to better understand the delay in adopting clinical recommendations, we examine these findings in light of diffusion of innovations theory, a theory that has been used to understand dissemination of other new medical technologies. According to this theory, while it is too early to suggest that use of second-generation AEDs in the elderly has been delayed, the continued use of phenobarbital in older patients newly diagnosed with epilepsy represents a serious delay in adoption of recent guidelines. Delays may be related to lack of knowledge by primary care clinicians and emergency room physicians (who frequently treat older patients with epilepsy), lack of 'opinion leaders' in primary care and perhaps general neurology, clinicians' focus on seizure control as the primary endpoint in treating patients with epilepsy, and difficulties in changing long-standing prescribing patterns. Research targeting barriers to more appropriate prescribing is needed to determine appropriate strategies for changing AED prescribing practices in the elderly.

Aged↗

PubMed1996

Training of opinion leaders in family planning in India: does it serve any purpose?

Community leaders are known to play a crucial role in the diffusion of innovations. The government of India started an ambitious programme for the training of opinion leaders in family planning, so as to provide a boost to its National Family Planning (Welfare) Programme. The present study attempts to analyse the knowledge, attitudes and practices of opinion leaders who had been trained in such Orientation Training Camps, vis a vis their untrained counterparts from the same geopolitical region. There was a highly significant difference between the knowledge of the two groups (p < 0.001) and a minor difference in their attitudes towards family planning (p = 0.18), but the practices of opinion leaders from both the groups were identical, thus pointing to a significant KAP-gap in the trained group. Opinion leaders from both the groups were engaged in minimal or negligible motivational work among their followers for acceptance of contraception, and only a very limited few from both the groups had themselves adopted any method of modern contraception.

Community Health Workers↗

PubMed2002

Will the 'principles of effectiveness' improve prevention practice? Early findings from a diffusion study.

This study examines adoption and implementation of the US Department of Education's new policy, the 'Principles of Effectiveness', from a diffusion of innovations theoretical framework. In this report, we evaluate adoption in relation to Principle 3: the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation is low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons and teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the Principles of Effectiveness. We conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance have contributed to the slow progress in improving school-based prevention.

Curriculum↗

PubMedDate not supplied

Information-seeking, research utilization, and barriers to research utilization of pediatric nurse educators.

This study used Roger's diffusion of innovations model to examine information-seeking, research utilization, and perceived barriers to research utilization of pediatric nurse educators in National League for Nursing accredited baccalaureate degree nursing (BSN) programs. A four instrument survey was mailed to 409 pediatric nurse educators. The response rate was 52 per cent. The most frequently selected sources of information for updating instruction of BSN students were nursing journals, educational activities by specialty groups, and nursing texts. The level of research utilization was estimated using the Nursing Practice Questionnaire-Education (NPQ-E). The level of research utilization for the eight nursing practices related to pediatric pain assessment and management was at the implementation stage. The highest perceived barriers to research utilization in clinical settings using the Barriers instrument were characteristics of the nurse followed by characteristics of the setting, the presentation, and the research. Pediatric nurse educators who selected nursing journals among their top three sources of information had significantly higher research utilization scores than those who did not select nursing journals among their top three sources of information.

Communication Barriers↗

PubMed1999

A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines.

Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies.

Diffusion of Innovation↗

PubMed2004

Stakeholder readiness for telehomecare: implications for implementation.

Numerous pilot studies have demonstrated that telehomecare technology may improve client outcomes through timely intervention and health crises prevention, thereby reducing return visits to hospitals and physician offices. Although the potential of telehomecare to increase access to services and improve quality of care and health outcomes is recognized, expectations for its widespread adoption have not been realized. Factors affecting diffusion of innovations include, among other things, perceptions of the technology, organizational characteristics, and communication. These require further exploration for telehealth applications because evidence alone will not automatically produce large-scale conversions in practice. This 12-month study was designed to assess the readiness of clients, health care professionals, and organizations to adopt telehomecare services for adult diabetic clients within the Calgary Health Region. A qualitative approach was used to collect data through focus groups with clients and home care nurses along with interviews with family physicians and key informants responsible for planning and resource allocation in diabetic homecare and telehealth programs. The transcripts of these interviews were analyzed for themes, which were categorized with respect to their effect on quality of care (including structure, process or outcome of care), including those related to the individual client, the health care provider, and the organization as a whole. The study findings identified differences in stakeholder conceptions of the technology, including common themes among clients, providers, and organizations. Implications of study results for developing a strategy to incorporate telehomecare into routine community care are discussed.

Adult↗

PubMed2005

Physician adoption of hyperbaric oxygen therapy in the treatment of chronic wounds.

Hyperbaric oxygen therapy, a treatment alternative for chronic wounds, has been used for several decades yet little is known about factors that influence physicians to incorporate this therapy into practice. To assess wound care physician knowledge of, attitudes toward, and adoption of hyperbaric oxygen therapy and to identify factors associated with physician adoption of this therapy, a 23-item questionnaire, based on Rogers' diffusion of innovation model, was developed by the authors and distributed to 653 American Academy of Wound Management Board-certified physicians. Of the 246 (43%) physicians in the study population who responded to the study survey, 167 (68%) reported they had used or referred patients for hyperbaric oxygen therapy during the past 12 months. More than half of the respondents reported a relatively high level of familiarity with and a positive attitude toward the effects of hyperbaric oxygen therapy on wound healing. Physician adoption of hyperbaric oxygen therapy was significantly associated with a community of >100,000 residents (adjusted odds ratio = 2.29, 95% confidence interval = 1.05 to 5.04); patient request for hyperbaric oxygen therapy (adjusted odds ratio = 5.38, 95% confidence interval = 2.50 to 11.56); positive attitude toward (adjusted odds ratio = 3.38, 95% confidence interval = 1.49 to 7.66) and high level of familiarity with hyperbaric oxygen therapy (adjusted odds ratio = 5.33, 95% confidence interval = 1.72 to 6.49); and practice location in either Florida or Texas (adjusted odds ratio = 3.44, 95% confidence interval = 1.24 to 9.54). Although the majority of the respondents reported adoption of hyperbaric oxygen therapy, most adopters are concentrated only in a few geographic areas. Despite the limitations of this study, especially the potential effects of sampling and response bias, the results help explain factors that have facilitated and hindered the adoption of this technology into practice.

Adult↗

PubMed2005

The contextual influence of professional culture: certified nurse-midwives' knowledge of and reliance on evidence-based practice.

This paper reports research undertaken to assess US certified nurse-midwives' (CNMs) knowledge of, access to, and use of evidence-based medicine (EBM). Findings are presented in the context of interprofessional, institutional, and popular culture. The descriptive study follows concepts of diffusion of innovation, evidence-based patient choice, and authoritative knowledge to analyse incentives and barriers to the implementation of evidence-based midwifery care. Structured interviews were conducted with practicing CNMs in an urban practice site and a regional teaching centre. The analysis of responses explored congruence between practitioner knowledge, professed practice, and published professional as well as hospital-based internal practice guidelines, for two specific interventions for which there is ample systematic review, epidural and episiotomy. The CNMs demonstrated enthusiasm for their own individual understanding of EBM, but responses to specific questions about EBM-supported practice indicate that many had an incomplete understanding of the concept. Furthermore, in those cases where CNMs demonstrated accurate knowledge of EBM, practice protocols followed subspecialty dictates, thereby preventing their knowledge from translating into adherence to EBM-guided clinical practice guidelines. Finally, patient expectations for technological intervention appeared to influence CNMs' care decisions, even when those expectations lacked sound supporting evidence. If, as conceived by its originators and champions, EBM is to be widely adopted, then practitioners such as CNMs need to accurately understand its concepts and also to be afforded the opportunity to exercise professional control over its implementation. Central to an epistemically balanced EBM is the need to ensure that midwifery knowledge contributes in a robust and ongoing fashion to EBM's scientific research base. Lastly, EBM advocates must identify balanced strategies to both rationally and fairly address consumerist pressures for aggressive health care consumption.

Access to Information↗

PubMed2003

Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use.

Many interventions to improve the success of information technology (IT) implementations are grounded in behavioral science, using theories, and models to identify conditions and determinants of successful use. However, each model in the IT literature has evolved to address specific theoretical problems of particular disciplinary concerns, and each model has been tested and has evolved using, in most cases, a more or less restricted set of IT implementation procedures. Functionally, this limits the perspective for taking into account the multiple factors at the individual, group, and organizational levels that influence use behavior. While a rich body of literature has emerged, employing prominent models such as the Technology Adoption Model, Social-Cognitive Theory, and Diffusion of Innovation Theory, the complexity of defining a suitable multi-level intervention has largely been overlooked. A gap exists between the implementation of IT and the integration of theories and models that can be utilized to develop multi-level approaches to identify factors that impede usage behavior. We present a novel framework that is intended to guide synthesis of more than one theoretical perspective for the purpose of planning multi-level interventions to enhance IT use. This integrative framework is adapted from PRECEDE/PROCEDE, a conceptual framework used by health planners in hundreds of published studies to direct interventions that account for the multiple determinants of behavior. Since we claim that the literature on IT use behavior does not now include a multi-level approach, we undertook a systematic literature analysis to confirm this assertion. Our framework facilitated organizing this literature synthesis and our analysis was aimed at determining if the IT implementation approaches in the published literature were characterized by an approach that considered at least two levels of IT usage determinants. We found that while 61% of studies mentioned or referred to theory, none considered two or more levels. In other words, although the researchers employ behavioral theory, they omit two fundamental propositions: (1) IT usage is influenced by multiple factors and (2) interventions must be multi-dimensional. Our literature synthesis may provide additional insight into the reason for high failure rates associated with underutilized systems, and underscores the need to move beyond the current dominant approach that employs a single model to guide IT implementation plans that aim to address factors associated with IT acceptance and subsequent positive use behavior.

Attitude to Computers↗