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Results for “Diffusion of Innovation”

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PubMed2003

Gender and educational differences in smoking initiation rates in Spain from 1948 to 1992.

BACKGROUND: The pattern of smoking initiation is of importance in understanding the prevalence of smoking and future trends in tobacco-related diseases. OBJECTIVE: To analyse trends of cigarette smoking initiation rates by sex and educational level in Spain. METHODS: Pooled data from the 1993, 1995 and 1997 Spanish National Health Interview Surveys were used (16,365 males and 17,478 females aged >15 years). The age and smoking status of each subject were reconstructed for five calendar periods (1948-1952, 1958-1962, 1968-1972, 1978-1982, 1988-1992). Age-specific (10 to 24 years old) smoking initiation rates were calculated for males and females, and according to level of education (high education: university and secondary school; low education: primary and less than primary). RESULTS: Among males, there was a trend towards earlier age at start of smoking and higher initiation rates between 1958 and 1982, and a subsequent decline in initiation rates, more apparent in males with a higher level of education. Smoking initiation among females was rare until the 1960s, and from the period 1968-1972 onwards a converging pattern with that of males was observed. Women with a higher level of education started smoking before women with low education, but this pattern changed over the period 1978-1982, with higher initiation rates among less educated women during the last period studied. CONCLUSIONS: These results help to characterize the tobacco epidemic in Spain, now at the end of stage 3. The observations are in agreement with diffusion-of-innovations theory and the social and economic changes from the 1960s onwards in Spain.

Adolescent↗

PubMed2003

Using patient-driven computers to provide cost-effective prevention in primary care: a conceptual framework.

This paper initially presents a rationale for the cost-effectiveness of using patient-driven computers in primary care services. It specifically defines the concepts of prevention and primary care, prior to outlining the advantages of promoting the implementation of prevention practices in primary care. It argues that greater use of computer technology represents one means of cost-effectively optimizing the integration of prevention into routine primary care, and identifies an apparent disjuncture between the potential of computers and the limited success with which attempts to integrate them into routine primary care services have been met, as evidenced in the published international literature. Among several possible explanations for this disjuncture, such as a possible lack of precision with which computers identify at-risk patients, perceived high costs associated with computers and physicians' concerns about the inflexibility and the more impersonal nature of computer interactions, is the apparent failure of researchers to utilize well designed and empirically tested models in the planning, implementation and evaluation of computerized care. An outline for such an approach, utilizing the Precede-Proceed model of health promotion planning and the Diffusion of Innovations theory, is presented.

British Columbia↗

PubMed2004

Improving tuberculosis therapy completion after jail: translation of research to practice.

Inmates have high rates of latent tuberculosis infection (LTBI), but inmates are often released early and do not complete therapy in the community. This study evaluated the translation of results from a randomized trial to improve therapy completion to usual care in a county jail using Rogers' Diffusion of Innovation theory. Inmates who received a single education in the randomized trial in 1998-1999 (study group) were compared to inmates educated by Jail Discharge Planners in 2002-2003 (usual care group). Outcomes were rates of completion of a visit to the TB clinic and completion of therapy. Subjects in the usual care group were significantly less likely to go to clinic in the 30-day period after release (relative risk 0.84, 95% confidence interval 0.75-0.95). The transfer of an educational protocol did not achieve results seen under study conditions, mostly because of implementation fidelity. The educational session in the usual care period for 81.0% of inmates took 5 min, as compared to 10-15 min during the randomized trial. Differences in personnel administering the protocol, training, high turnover and time available may also account for lower rates seen. Practical clinical trials should focus on the context of care as well as the intervention and should have participation by those who will be implementing results.

Adult↗

PubMed1990

High technology in health care.

The structure of the Assistance Publique-Hôpitaux de Paris renders necessary an inhouse centralized technology assessment unit. This unit, named CEDIT (Committee for the Evaluation and the Diffusion of Innovative Technologies), has been functioning since 1982 and has advised the Director General on 70 new technologies, including the lithotriptor and plasma-exchange therapy. A particular feature of the CEDIT is that it is in charge of both the assessment and the implementation of the recommendations following this assessment. We attempt to describe the consequences of the CEDIT's functioning compared to other countries' technology assessment organizations.

Evaluation Studies as Topic↗

PubMed2003

Do peer chart audits improve residents' performance in providing preventive care?

PURPOSE: One recommended method to evaluate residents' competence in practice-based learning and improvement is chart audit. This study determined whether residents improved in providing preventive care after a peer chart audit program was initiated. METHOD: Residents audited 1,005 charts and scored their peers on 12 clinical preventive services. The mean total chart audit scores were compared across five time blocks of the 45-month study. RESULTS: Residents' performance in providing preventive care initially improved significantly but declined in the last ten months. However, their performance remained significantly higher than at the beginning. CONCLUSIONS: By auditing their peers' charts, residents improved their own performance in providing preventive care. The diffusion of innovations theory may explain the prolonged implementation phase and problems in maintaining a chart audit program.

Analysis of Variance↗

PubMed2003

An evidence-based national quality measurement and reporting system.

BACKGROUND: Evidence-based medicine and evidence-based guidelines are widely supported among physicians and other health professionals, although practice may still fall far short of the ideas contained in the concept. Insufficient attention has been given to using the concepts of evidence-based practice in the selection of measures, diffusion of innovations, and adoption of quality improvement (QI) techniques. OBJECTIVES: To describe in greater detail how evidence serves as a foundation for a national quality measurement and reporting system (NQMRS) and to consider the different types of evidence that will be used. The role of the NQMRS in adding to the evidence base is explored. RESEARCH DESIGN: A descriptive, conceptual discussion. RESULTS: Many different types of evidence are available for use in the NQMRS. The NQMRS could add substantial new evidence on how well different approaches to quality measurement, reporting, and improvement work and also expand the evidence base on the effectiveness of clinical interventions for which efficacy has been established. CONCLUSIONS: An evidence-based NQMRS will require substantial leadership from government and private entities. The gains from a greater focus on evidence are expected to be found in accelerating QI. Reliance on evidence-based approaches should not be used to stifle innovation.

Censuses↗

PubMedDate not supplied

Adoption of Thayer-Martin culture medium by physicians in office-based practice.

In the summer of 1972, 26.4% of 900 physicians surveyed in the United States reported that they had performed one or more endocervical cultures for gonorrhea during a week of study. Obstetrician-gynecologists (62.8%) were considerably more likely than others to employ this diagnostic technique. The use of Thayer-Martin cultures was associated with the number of women examined and type of laboratory used (public, private or hospital), but not region of practice (East, Midwest, South, of West), area of practice (urban, suburban, or rural), or month of interview (July, August, or September). Results of this survey are consistent with the diffusion of innovation model proposed by Rogers.

Adult↗

PubMedDate not supplied

Pediatric cardiopulmonary bypass devices: trends in device use for cardiopulmonary bypass and postcardiotomy support.

Cardiopulmonary bypass (CPB) devices and techniques have continuously evolved. We have conducted surveys that chronicle the changes in CPB devices and techniques used at North American pediatric cardiac surgery centers since 1989. The aim of this article is to describe trends in cardiopulmonary bypass device use during cardiac surgery and changes in the devices used for extracorporeal life support (ECLS) following cardiac surgery for pediatric patients. The diffusion of innovation in pediatric cardiovascular surgery has not been solely driven by the availability of scientific evidence to support change but rather it has often been related to other factors that influence clinicians willingness to change including; tradition, ease of use, and cost related pressures. The current CPB systems used for cardiac surgery are more homogenous than in previous years. Most centers use a heparin coated or modified surface system comprised of a "hard shell" open venous reservoir, a roller pump, a hollow fiber membrane oxygenator, and arterial line filter. ECLS systems comprised of hollow fiber oxygenators and centrifugal pumps for are gradually replacing the classical ECLS circuit, servo regulated roller pumps and silicone rubber membranes. Nearly 40% of centers use these alternate components in their ECLS systems. Costs, utility, safety and measurable benefit to the patient should guide decisions related to device selection.

Cardiopulmonary Bypass↗

PubMed2004

Nurses' use of online clinical evidence.

BACKGROUND: The 'information explosion' presents a significant challenge to the nursing profession. One way to assist access to information is to provide electronic information resources at the point of care. A large-scale survey of nurses working in the public health system in New South Wales, Australia, was undertaken as part of a 2-year evaluation of the Clinical Information Access Program (CIAP). This is a website which provides 24 hour, online access to a range of evidence sources at the point of care. AIM: This paper reports a study to investigate factors influencing nurses' use of online evidence available at the point of care and to examine differences between nurses in different roles. METHOD: Nurses from 65 randomly selected hospitals were surveyed. A convenience sample representing 25% of nursing staff at these hospitals was sought. Eighty-four per cent of the survey quota was met and 3128 questionnaires were completed and returned. RESULTS: The results showed that 58% of nurses had heard of the CIAP and, of those, 70% had used the website's resources. Senior nurses had greater awareness and use than others. The most frequent reasons for use were to fill a knowledge gap and for personal education. Lack of training was the most frequently cited reason for not using the website. Use of online evidence, particularly amongst senior staff, was higher than reported in previous studies. CONCLUSION: Use of online evidence was associated with nursing role, and with managerial and organizational support. Diffusion of innovation theory can help to explain some of the patterns observed. The use and impact of online evidence should be interpreted in the context of nursing practice and culture.

Adult↗

PubMed2006

Diagnosis: contemporary medical hubris; Rx: a tincture of humility.

Despite increasing attention to evidence-based medicine, unprecedented advances in medical technology, and rapid diffusion of innovative information, there continues to be disturbing disclosures of widespread iatrogenic illness resulting from harmful medical interventions. The medical community at times displays a lethargic and lackluster response to important scientific and epidemiological data that challenges prevailing conventional wisdom or that elucidates existing medical miscalculations. To ensure that long-term health and well-being for patients and the community remains the primary goal of medicine, it is necessary to revisit the important issues of scientific integrity, health care objectives, and medical professionalism. Furthermore, to be trustworthy advisors for individual patients and credible advocates for the health of populations, the medical community needs to critically evaluate the profound influence of commercial interests on medical research, medical education and clinical practice.

Biomedical Research↗

PubMed1991

Promoting comprehensive school health programs through summer health promotion conferences.

This study reports on the evaluation of the second North Carolina Healthful Living Institute (HLI), a statewide conference to promote comprehensive school health education. A comparison of year one and year two evaluation results is included. Based on a theoretical framework derived from the theory of diffusion of innovations within organizations, the impact of the HLI was assessed by studying characteristics of school districts sending representatives to the HLI and the composition of teams from each school district, and using pretest and posttest measures of participants' perceptions of the importance of health as a content area and participants' perceptions of the importance of the various components of comprehensive school health. Results indicate the effect of school health promotion conferences is linked to characteristics of school district teams, with the Institute needing to attract more varied teams, and teams from smaller, rural districts.

Adult↗

PubMed2001

Start right-eat right award scheme: implementing food and nutrition policy in child care centers.

The Start Right-Eat Right award scheme implemented in Western Australia has been used to provide the incentive to bring about improvement in food service in line with government policy and regulations in the child care industry. Theories of organizational change were used to identify processes and strategies to support the industry in translating policy into practice. A baseline survey of food service management practices, as well as process evaluation, informed action and identified barriers. Impact evaluation demonstrated that the award scheme could bring about improvements in the quality of food service; 80% of centers made changes to their menus as a result of participating. Two years postlaunch, 40% of centers have registered in the scheme. The diffusion of innovation theory is used to explain uptake and discuss results. The success of the scheme was based on four factors: an understanding of the industry, collaboration between the child care industry and government, supporting resources, and incentives.

Certification↗

PubMed2005

Randomized trial testing a worksite sun protection program in an outdoor recreation industry.

Health communication campaigns intended to reduce chronic and severe exposure to ultraviolet radiation in sunlight and prevent skin cancer are a national priority. Outdoor workers represent an unaddressed, high-risk population. Go Sun Smart (GSS), a worksite sun safety program largely based on the diffusion-of-innovations theory, was evaluated in a pair-matched, group-randomized, pretest-posttest controlled design enrolling employees at 26 ski areas in Western North America. Employees at the intervention ski areas were more aware of GSS (odds ratio [OR] = 8.27, p < .05) and reported less sunburning (adjusted OR = 1.63, p < .05) at posttest than employees at the control areas. A dose response was evident (OR = 1.46, p < .05) with greater observed program implementation associated with fewer sunburns among employees. Program awareness per se was not predictive (p > .05) of reduced sunburning in a mediational analysis. Analyses of nonrespondents, including intent-to-treat analyses, further supported the success of GSS.

Adolescent↗

PubMed2003

A framework for evaluating comprehensive community initiatives.

This article describes a model and design for evaluating a comprehensive community health promotion initiative. The theoretically based model was designed by the authors to evaluate a countywide initiative based on developmental assets, a framework for healthy youth development promoted by the Search Institute in Minneapolis, Minnesota. The model includes the components of a typical logic model and incorporates concepts proposed by diffusion of innovations, social cognitive theory, and Search Institute's conceptual model for community change. The model highlights the priorities of local stakeholders and directs evaluation activities in multiple community sectors over time. The evaluation design is presented according to the Centers for Disease Control and Prevention framework for program evaluation in public health.

Academies and Institutes↗

PubMedDate not supplied

Going to scale: re-engineering systems for primary care treatment of depression.

BACKGROUND: Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy. METHODS: In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change. The clinical model is evidence based. The change strategy relies on established quality improvement programs and is informed by diffusion of innovations theory. Evaluation will address patient outcomes, as well as process of care and process of change. RESULTS: Five medical groups and health plans are participating in the trial. The RCT involves 180 clinicians in 60 practices. All practices assigned to the clinical model have implemented it. Participating organizations have the potential to disseminate this clinical model of care to 700 practices and 1,700 clinicians. CONCLUSIONS: It is feasible to implement the clinical model and change strategy in diverse practices. Follow-up evaluation will determine the impact, sustainability, and potential for dissemination. Materials are available through http://www. depression-primarycare.org; more in-depth descriptions of the clinical model and change strategy are available in the online-only appendixes to this article.

Cooperative Behavior↗

PubMed2000

Pattern of smoking initiation in Catalonia, Spain, from 1948 to 1992.

OBJECTIVES: This study analyzed the pattern of smoking initiation by sex and educational level in Catalonia, Spain. METHODS: Data from the 1994 Catalan Health Interview Survey were used (n = 12,245). The age and smoking status of each subject were reconstructed for each calendar period. Age-specific smoking initiation rates were calculated. RESULTS: Smoking initiation among females was rare until the 1960s, but from the period 1968-1972 onward a converging pattern was observed between the genders. Women with higher levels of education started smoking before other women, but the gradient of educational level has changed in recent years, with higher initiation rates among less-educated women. CONCLUSIONS: These results are consistent with diffusion-of-innovations theory and could be related to social and economic changes from the 1960s onward in Spain.

Adolescent↗

PubMed2006

Who's using PDAs? Estimates of PDA use by health care providers: a systematic review of surveys.

BACKGROUND: Personal digital assistants (PDAs) find many uses in health care. Knowing rates of collective PDA use among health care providers is an important guiding step to further understanding those health care contexts that are most suited to PDA use and whether PDAs provide improved health outcomes. OBJECTIVES: The objectives of this study were to estimate current and future PDA use among health care providers and to discuss possible implications of that use on choice of technology in clinical practice and research. METHODS: This study was a systematic review of PDA usage surveys. Surveys were identified as part of an ongoing systematic review on the use of handheld devices. Reports from eight databases covering both biomedical sciences and engineering (1993-2006) were screened against distinct eligibility criteria. Data from included surveys were extracted and verified in a standardized way and were assessed descriptively. RESULTS: We identified 23 relevant surveys, 15 of which were derived from peer-reviewed journals. This cohort of surveys was published between 2000 and 2005. Overall, since 1999, there is clear evidence of an increasing trend in PDA use. The current overall adoption rate for individual professional use ranges between 45% and 85%, indicating high but somewhat variable adoption, primarily among physicians. CONCLUSIONS: Younger physicians and residents and those working in large and hospital-based practices are more likely to use a PDA. The adoption rate is now at its highest rate of increase according to a commonly accepted diffusion of innovations model. A common problem with the evaluation of information technology is that use frequently precedes research. This is the case here, in which PDA adoption rates are already high and projections are for rapid growth in the short term. In general, it appears that professional PDA use in health care settings involves more administrative and organizational tasks than those related to patient care, perhaps signaling where the growth in adoption is most likely to occur. We conclude that physicians are likely accustomed to using a PDA, and, therefore, technology expertise will probably not be a barrier to implementing PDA applications. However, there is an urgent need to evaluate the effectiveness and efficiency of specific tasks using handheld technology to inform those developing and those using PDA applications.

Age Factors↗

PubMedDate not supplied

Mixed blessings: an essay.

It has been 12 years since Robert and Peggy Stinson chronicled the brief life of their prematurely born son in The Long Dying of Baby Andrew. Their story examined the ethical dilemmas involved in providing neonatal intensive care to marginally viable infants. Although much has changed in neonatal intensive care in 12 years time, issues regarding treatment of marginal infants remain unresolved. Further, neonatal intensive care has provided society a window through which to observe the growing fetus, with potentially profound implication for women's reproductive decision-making. The unintended and unanticipated consequences of neonatal intensive care are examined according to Roger's change model, as described in his book Diffusion of Innovations.

Death↗