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Results for “Diffusion of Innovation”

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PubMedDate not supplied

The future of health behavior and prevention research: what will change in the next 25 years?

OBJECTIVE: To review progress in the field of health behavior research and suggest future directions. METHODS: Reviewed the theoretical and methodological underpinnings of research during the past 25 years and identified likely technological changes that will impact research during the next 25 years. RESULTS: In the not-too-distant future, normal science will be transformed by broad-based diffusion of innovations, some of which will include the increased use of automated data collection methods and the widespread adoption of research-based programs. CONCLUSION: Research during the next 25 years will eventually result in a radical transformation of health behavior research.

Forecasting↗

PubMed2003

Diffusion of a developmental asset-building initiative in public schools.

OBJECTIVE: To identify characteristics that distinguish between school personnel who do and do not adopt asset-building behaviors in the formative stage of a countywide initiative. METHODS: An anonymous questionnaire, assessing constructs from diffusion of innovation and social cognitive theories, was administered to 467 adult personnel in 3 school districts. RESULTS: Discriminant analysis revealed that implementation of asset building was most closely related to rating the initiative high on trialability, relative advantage, compatibility, and observability and low on complexity. CONCLUSIONS: Efforts to implement asset-building initiatives need to assess perceptions of adult personnel and should not assume that positive youth development will be widely supported in schools.

Discriminant Analysis↗

PubMed2000

Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south.

Twenty-one 10th graders selected as opinion leaders by their peers in a rural county in a southern state participated in a 36-hour peer-educator training program Students Together Against Negative Decisions (STAND) based on diffusion of innovations theory and the transtheoretical model. Comparison subjects received either a 22-hour leadership training course (n = 20) or no intervention (n = 45). STAND and comparison subjects completed a 154-item written knowledge, attitude, and behavior survey at the beginning of the training (Time 1), at the end of the training (Time 2), and again 8 months later (Time 3). One hundred and sixty-seven other 9th and 10th graders in the intervention county and 74 in the comparison county completed an abbreviated telephone interview at Time 1 and Time 3. At Time 3 STAND-trained peer educators reported significantly greater increases in AIDS Risk Behavior Knowledge (more than 4 times comparison groups), frequency of conversations with peers about birth control/condoms (+180% vs. +12%) and sexually transmitted diseases (STDs; +282% vs. -33%), condom use self efficacy (+16% vs. -1%), and consistent condom use (+28% vs. +15%). STAND teens also reported substantial favorable trends at Time 3, including increased condom use (+213% vs. +31%) and decreased unprotected intercourse (-30% vs. +29%). At Time 3 teens in the intervention county reported significantly greater increases in the number of people who talked with friends in the preceding 3 months about STDs (+39% vs. -19%) or with a parent/adult about sex (+6% vs. -37%). Intervention county teens also reported a substantial but nonsignificant 2.6-fold greater increase in condom use at last intercourse (+64% vs. +25%) but unfavorable changes in other risk behaviors. The STAND peer-educator training program appears to be an effective method for improving selected sexual knowledge, attitudes, and behaviors among participant teenagers in the rural South.

Adolescent↗

PubMed2000

A technology transfer model for effective HIV/AIDS interventions: science and practice.

The widespread use of effective, science-based interventions to motivate and sustain behavior change provides an important approach to reducing the spread of HIV. The process of disseminating information about effective interventions and building capacity for implementing them in field settings must be improved, however. Starting with a review of diffusion of innovations and technology transfer literature, we offer a technology transfer model for HIV interventions. We identify participants and activities directed toward the use of effective interventions by prevention services providers (e.g., health departments and community-based organizations) in each phase of technology transfer: preimplementation, implementation, and maintenance and evolution. Preimplementation activities focus on selecting an intervention and preparing for implementation. Implementation activities include initial implementation and process evaluation. Maintenance and evolution are ongoing with continued support for and evaluation of the intervention. This article takes the perspective of providers. Other perspectives are presented elsewhere in this issue.

HIV Infections↗

PubMedDate not supplied

[Social implications of physician professional and certification quality].

The paper analyzes the social implications of the professional quality of physicians and of their process of certification. The adequate competencies of physicians are especially relevant in countries that have broad social asymmetries and cultural plurality. This diversity of social and epidemiologic conditions demands a profile of physicians able to work in a wide range of environments and able to achieve the best professional practice, making the best use of the available resources for medical care. Medical competencies and quality of care are interrelated. The process of coupling universal knowledge and local conditions creates a synchronic diversity of professional practices. Medical certification must be viewed as part of the process of diffusion of innovations. The development of a variety of abilities to cope with innovations contributes to the production of a diachronic diversity of medical practices. In the light of continuing quality improvement, it is necessary that certification systems be articulated with both continuing medical education and the accreditation and progress of healthcare institutions. Otherwise, there is the risk of increasing inequality in medical practice that, in the last analysis, blames the victim.

Certification↗

PubMed1975

Social factors influencing contraceptive usage in the Black population of Rhodesia.

Adoption of family planning practices involves two decisions--acceptance or rejection of, firstly, the concept of voluntary fertility control, and secondly, of the use of contraceptives. Modern contraceptives are a medical innovation. The diffusion process is influenced by social, economic and political factors in the country.

Black or African American↗

PubMed2002

Knowledge management to support performance-based medicine.

OBJECTIVES: To discuss research issues for medical informatics in order to support the further development of health information systems, exploiting knowledge management and information and communication technology to increase the performance of Health Care Organizations (HCOs). METHODS: Analyze the potential of exploiting knowledge management technology in medicine. RESULTS AND CONCLUSIONS: The increasing pressure on HCOs to ensure efficiency and cost-effectiveness, balance the quality of care, and contain costs will drive them towards more effective management of medical knowledge derived from biomedical research. Knowledge management technology may provide effective methods and tools in speeding up the diffusion of innovative medical procedures. Reviews of the effectiveness of various methods of best practice dissemination show that the greatest impact is achieved when such knowledge is made accessible through the health information system at the moment it is required by care providers at their work sites. There is a need to take a more clinical process view of health care delivery and to identify the appropriate organizational and information infrastructures to support medical work. Thus, the great challenge for medical informatics is represented by the effective exploitation of the astonishing capabilities of new technologies to assure the conditions of knowledge management and organizational learning within HCOs.

Decision Making, Computer-Assisted↗

PubMed1975

Lessons from the Chinese experience: China's planned birth program and its transferability.

This article describes the most salient developments in the planned birth program of the People's Republic of China during the 1970s and discusses the potential for transfer of some features to other countries. Many Chinese activities are of interest because they are designed for a country with scarce resources for development and a low-income population. Some particular program features worth noting are: the encouragement of local initiative and experimentation: specific methods for the diffusion of innovation; and total integration of the health system with other development-political, administrative, economic, and social-at the grass-roots level.

Birth Rate↗

PubMed1994

Spatio-temporal variations in population growth in India since 1901.

"On the basis of census data we analyse population growth since 1901 first for India as a whole, secondly on State level. The spatio-temporal patterns suggest a process of innovation and diffusion with regard to the spatial change of natural increase. The southern States cover more stages of the model of demographic transition than the northern States. Explanations about these spatial differentials come for example [from] sociocultural differences between north and south determining two demographic regions according to Satpura Range." (SUMMARY IN GER AND RUS)

Asia↗

PubMed2003

Education and income: double-edged swords in the epidemiologic transition of cardiovascular disease.

The 2002 World Health Report warns that the allies of poverty and ignorance are joining forces with the new formidable enemies of health. This describes the epidemiologic transition of burden of disease from infectious and parasitic diseases to that of noncommunicable diseases. All parts of the world, with the possible exception of sub-Saharan Africa, have well-established epidemics of coronary heart disease and stroke. Hypertension contributes significantly to mortality everywhere and is a leading global problem. Education and wealth have strong influences on the epidemiologic transition and might serve as a double-edged sword of benefit and risk. While improved education and enhanced resources are necessary to reduce infectious, parasitic, and perinatal diseases, these factors are also associated with adoption of deleterious health behaviors, which lead to the atherosclerotic diseases. The diffusion of innovation theory describes the early adoption of unhealthy lifestyles in the educated and wealthy, who soon recognize the costs to their community and modify these lifestyles. The uneducated poor may adopt these unhealthy lifestyles later, but, once that occurs, are left with higher risk and burden of cardiovascular disease. One possible reason for this is that discretionary income and the desire for modern conveniences quickly attract unhealthy products (tobacco, high fat/high salt foods) and unhealthy behaviors (sedentary entertainment transportation without physical exertion). The commercial interests of these products have been efficient and effective in delivering their messages to developing societies. Heart health organizations must be more aggressive in their assessment of needs for programs, education of people over a broad range of education levels, assurance of access to heart health services, alteration of the environment to facilitate heart health, and the development of policies and laws to limit deleterious products and behaviors. These late-adopter communities are assumed to require additional efforts and services to counterbalance deleterious influences. Sub-Saharan Africa is the only WHO region in which cardiovascular disease is not the leading cause of death. There is no precedent to support the notion that Africa will, without special efforts, avoid progression to later stages of the epidemiologic transition. The goal of improved education and eradication of poverty in Africa should not and need not carry the unhappy consequence of a cardiovascular disease epidemic.

Africa South of the Sahara↗

PubMed2005

Using feedback to raise the quality of primary care computer data: a literature review.

BACKGROUND: Primary care is recognised as a medical specialty and its unique information needs justify the existence of its own health informatics sub-specialty: primary care informatics (PCI). A challenge for PCI is how to raise the standard of computerised medical records so that meaningful conclusions can be drawn from them. In the UK the Primary Care Data Quality (PCDQ) programme has eight years experience of using feedback in an educational context to improve data quality. OBJECTIVE: This literature review set out to define the characteristics of a feedback process most likely to achieve change; the principles of which could be applied to PCDQ or to other data quality initiatives. METHOD: A literature review of the major medical bibliographical databases, and the websites and working groups of the international medical informatics associations. RESULTS: There are generalisable lessons for primary care derived from the literature about implementing best evidence, feedback and the theory of diffusion of innovation. The principles identified are: (1) Engage and support local innovators - i.e. those most likely to adopt change, demonstrate the evidence-base for the intervention and the form of feedback most acceptable to them (2) Model the clinical context in which quality improvement is required; (3) Develop an understanding of the health system, its culture and management system; and, (4) Identify and address technical issues relating to computer use and coding. CONCLUSIONS: Feedback is most effective when: clinically relevant, educationally orientated, given by peers, and sensitive to the socio-technical context.

Feedback↗

PubMed2005

Update on pediatric perfusion practice in North America: 2005 survey.

The devices and techniques used for pediatric cardiopulmonary bypass (CPB) undergo continuous change. New techniques and clinical comparisons of devices are frequently reported in the literature; however, information about the extent to which these techniques and devices are adopted into clinical practice at pediatric heart centers are not well described. We conducted a mail survey of North American pediatric cardiac surgery centers to gain perspective on the extent to which various devices and techniques were used for CPB along with program demographic data. In January 2005, surveys were mailed to 180 North American open heart centers. The survey was nearly identical in format and content to three earlier surveys completed in 1989, 1994, and 1999, with the exception that new questions were added to address new techniques and devices that have emerged over the years. Responses were received from 76 hospitals, for an overall response rate of 42%. Of the responding centers, 53 were performing pediatric open heart surgery and 23 were not. Twenty centers performed only pediatric open heart surgery, and 33 performed both pediatric and adult open heart surgery. The mean pediatric annual caseload of responding centers was 195 procedures/yr (range, 20-650 procedures/yr; median, 154 procedures/yr). A total of 9943 pediatric open heart procedures were performed at responding centers in 2004. Most of the centers surveyed reported use of an open venous reservoir system (88%), use of roller pumps (90%), and use of arterial line filtration (98%). Most centers used circuits that have surface treatments with heparin or some other surface-modifying agent (74%). There has been an increase in the use of all types of safety devices. Modified ultrafiltration is used at 75% of the centers surveyed. Centers reported an increase in the availability of all types of cardiac support devices including extracorporeal membrane oxygenation for postcardiotomy cardiac support (90%). This survey provides an overview of clinical practice in 2004. The series of surveys document the historical progression of clinical practice over the past 16 years. Practice surveys may also be useful for identifying gaps between evidence-based knowledge and clinical practice. These surveys document the diffusion of innovation related to CPB during the past 16 years and areas of variation in practice that need further study.

Adult↗

PubMed2006

Health information Hispanic outreach in the Texas Lower Rio Grande Valley.

PURPOSE: This paper provides an overview of the two-year Texas Lower Rio Grande Valley Health Information Hispanic Outreach (HI HO) project. The project included a needs assessment, four pilot projects, and focus groups on the use of MedlinePlus and MedlinePlus en español. The needs assessment included a survey of physicians' information usage and a review of the circuit librarian program that had been established in 1989. The pilot projects were located at a high school, a rural health clinic, an urban health clinic, and a community center. Diffusion of innovation theory provided a framework for interpreting the results of the pilot projects. METHODS: The survey of physicians' information usage partially replicated a similar 1990 survey. The review of the circuit librarian program included usage statistics, interviews of administrators, and a survey of participants. Pilot project methodology varied by site. At the high school, four students were trained to instruct their peers in the use of MedlinePlus. At the two clinics, a computer workstation was installed for patients to access MedlinePlus. At the community center, staff were trained to use MedlinePlus en español to train community residents. Project evaluation included surveys, focus groups, and interviews. Indicators of success included increased level of consumer use of MedlinePlus, reports by key informants and consumers of how MedlinePlus was used, reports about training, and development of self-sustaining activity. RESULTS: The physician survey documented usage of health information resources in 2002 compared to 1990. The review of the circuit librarian program documented the change in program usage between 1989 and 2003. The pilot project at the high school was the most successful of the four pilot projects in introducing MedlinePlus to a large number of people, followed by the community center project. In the high school and community center projects, the participating institutions had reinforcing educational missions and paid staff who were highly motivated to achieve the project goals. The computer workstations projects at the two clinics were less successful, due in part to limited staff commitment and conflicting priorities. CONCLUSIONS: The HI HO project tested methods of reaching the Hispanic community in the Lower Rio Grande Valley region of Texas. The four HI HO pilot projects varied in achieving their stated objectives. But taken as a whole, the HI HO project significantly contributed to a better understanding of health information outreach to the Hispanic community, knowledge that should be useful to others with similar outreach activities.

Ambulatory Care Facilities↗

PubMed2006

Assessing organizational readiness and change in community intervention research: framework for participatory evaluation.

This paper describes a study currently underway that uses a collaborative approach to assess organizational capacity to form partnerships around mental health and substance abuse care. Employing many of the principles of community-based participatory research, the study's primary objective is to collaboratively develop a conceptual understanding and generalizable, practical measures of organizational capacity. The intent of this collaborative approach is to increase the rigor and relevance of the assessment framework while strengthening the ability of health partnerships and stakeholders to understand and track community organizational capacity. The study investigators developed an initial model of community dissemination based on the research literatures on organizations and the diffusion of innovations. Through the collaborative process, the specific goals of the project shifted substantially to match the partnership interests and concerns of community agencies. One of the benefits of a collaborative approach has been to use researchers' academic knowledge to catalogue potential factors and the wealth of community coinvestigators' experiential knowledge of interagency dynamics to identify specific relevant dimensions of capacity. This initial exploratory study represents a first step toward developing a general approach to conceptualizing and tracking the organizational capacity of communities. The model and measurement framework may have wider applicability to capacities to partner around and implement a variety of health-related interventions within communities.

Black or African American↗

PubMed1991

Population behavior change: a theory-based approach.

Behavioral science provides useful ideas about how programs of mass communication and community participation can produce synergistic influences on the lifestyles and policy decisions of populations and their representatives. Media campaigns featuring real-life behavior models and community networks mobilized to promote behavior change provide a theoretically sound paradigm for community-level activities to accelerate the diffusion of innovation in health. Illustrative case studies demonstrate how behavioral science concepts can be applied to preventing HIV infections and to promoting citizen lobbying against selected nuclear weapons systems.

Health Behavior↗

PubMed1989

Marketing smokeless tobacco in California communities: implications for health education.

In the first phase of a 5-year research project aimed at curtailing smokeless tobacco use among youth, we examined the marketing of smokeless tobacco within California. Observational data were collected from almost 200 retail stores located near high schools and colleges in 14 California counties. Interviews were conducted with over 100 school personnel and youth leaders in 13 counties and with seven retailers from 4 counties. Overall, 81% of the stores in the sample carried smokeless tobacco, and even in urban areas most stores (71%) had these products for sale. Urban stores were more likely to have materials promoting them (e.g., posters, displays, coupon offers). Almost all (98%) stores that carried smokeless tobacco sold moist snuff. Most (78%) school personnel and youth leaders, especially in urban areas, were aware of advertisements for it, particularly on television and in magazines. Rogers' theory regarding the diffusion of innovations was the basis of the discussion of our results. The implications of marketing for the development of health education programs are examined.

Adolescent↗

PubMed1989

Innovation, centralization, and growth. Coronary artery bypass graft surgery in Manitoba.

Innovation and diffusion of new surgical procedures are limited in Manitoba, Canada by restrictions on which hospitals are allowed to perform particular surgical programs. Programs centralizing performance of certain operations in a few hospitals have the potential for controlling costs and quality of care but may limit access for individuals living in other areas. Such issues are highlighted in this analysis of coronary artery bypass graft surgery in Manitoba. Patterns of growth and access are first examined; then regional variations in rates of bypass surgery are compared with rates for coronary angiography and valve surgery. Physician reluctance to refer patients to Winnipeg appears to be responsible for the lower rates of these procedures in Western Manitoba. The implications for studies of centralization/regionalization of medical services, physician decision-making, and diffusion of technology are explored.

Adult↗

PubMed1989

The health sciences communicator as faculty developer.

To determine the content for a model faculty development program for primary care faculty, a combination of the Delphi and Nominal Group Technique was used resulting in a curriculum with five units of instruction: development of curriculum and instruction, teaching methods, evaluation, administration, and academic survival skills. A philosophy for conducting faculty development is presented which includes concepts of andragogy, technology transfer, the diffusion of innovation, and networking. Program types include short-term, long-term, and extended programs such as fellowships.

Communication↗