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PubMed2006

Combining evidence and diffusion of innovation theory to enhance influenza immunization.

BACKGROUND: Children and adolescents with chronic conditions such as asthma, diabetes, and HIV are at high risk of influenza-related morbidity, and there are recommendations to immunize these populations annually. At Cincinnati Children's Hospital Medical Center, the influenza immunization rate increased to 90.4% (5% declined) among 200 patients with cystic fibrosis (CF). Diffusion of innovation theory was used to guide the design and implementation of spread to other clinics. METHOD: The main intervention strategies were: (1) engagement of interested, nurse-led teams, (2) A collaborative learning session, (3) A tool kit including literature, sample goals, reminder postcards, communication strategies, and team member roles and processes, (4) open-access scheduling and standing orders (5) A simple Web-based registry, (6) facilitated vaccine ordering, (7) recall phone calls, and (8) weekly results posting. RESULTS: Clinic-specific immunization rates ranged from 32.7% to 92.8%, with the highest rate reported in the CF clinic. All teams used multiple strategies; with six of the seven using four or more. Overall, 60.0% (762/1,269) of the population was immunized. Barriers included vaccine shortages, lack of time for reminder calls, and lack of physician support in one clinic. DISCUSSION: A combination of interventions, guided by evidence and diffusion of innovation theory, led to immunization rates higher than those reported in the literature.

Adolescent↗
PubMed2005

Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review.

Producing literature reviews of complex evidence for policymaking questions is a challenging methodological area. There are several established and emerging approaches to such reviews, but unanswered questions remain, especially around how to begin to make sense of large data sets drawn from heterogeneous sources. Drawing on Kuhn's notion of scientific paradigms, we developed a new method-meta-narrative review-for sorting and interpreting the 1024 sources identified in our exploratory searches. We took as our initial unit of analysis the unfolding 'storyline' of a research tradition over time. We mapped these storylines by using both electronic and manual tracking to trace the influence of seminal theoretical and empirical work on subsequent research within a tradition. We then drew variously on the different storylines to build up a rich picture of our field of study. We identified 13 key meta-narratives from literatures as disparate as rural sociology, clinical epidemiology, marketing and organisational studies. Researchers in different traditions had conceptualised, explained and investigated diffusion of innovations differently and had used different criteria for judging the quality of empirical work. Moreover, they told very different over-arching stories of the progress of their research. Within each tradition, accounts of research depicted human characters emplotted in a story of (in the early stages) pioneering endeavour and (later) systematic puzzle-solving, variously embellished with scientific dramas, surprises and 'twists in the plot'. By first separating out, and then drawing together, these different meta-narratives, we produced a synthesis that embraced the many complexities and ambiguities of 'diffusion of innovations' in an organisational setting. We were able to make sense of seemingly contradictory data by systematically exposing and exploring tensions between research paradigms as set out in their over-arching storylines. In some traditions, scientific revolutions were identifiable in which breakaway researchers had abandoned the prevailing paradigm and introduced a new set of concepts, theories and empirical methods. We concluded that meta-narrative review adds value to the synthesis of heterogeneous bodies of literature, in which different groups of scientists have conceptualised and investigated the 'same' problem in different ways and produced seemingly contradictory findings. Its contribution to the mixed economy of methods for the systematic review of complex evidence should be explored further.

Diffusion of Innovation↗
PubMed2005

A diffusion of innovations approach to gerontological curriculum enrichment: institutionalizing and sustaining curricula change.

This article describes a gerontological enrichment model for institutionalizing and sustaining curricular change utilizing Rogers' (1995, 2003) diffusion of innovations approach to organizational change. The goal of the project, funded by the John A. Hartford Foundation, is to transform the social work curriculum at a major state university so that age and intergenerational connections are important organizing principles in the diversity emphasis of the program. Components of the model include: (1) increasing faculty competence; (2) infusing gerontological/ geriatric competencies into all foundation courses; (3) community partner involvement; (4) intergenerational service-learning; (5) developing field and practicum sites; and (6) evaluation. Implications for gerontological/ geriatric education are discussed.

Community Participation↗
PubMed2006

Diffusion of innovations: anatomical informatics and iPods.

Over the course of many centuries, evolving scientific methods and technologies have advanced the study of anatomy. More recently, such dissemination of innovations has been formally studied in multidisciplinary psychosocial contexts, yielding useful knowledge about underlying principles and processes. We review these precepts and show how diffusion of innovations theory and principles apply to the development and dissemination of anatomical information methods and resources. We consider the factors affecting the late-20th-century dissemination of personal computers and World Wide Web hypermedia into widespread use in anatomical research and instruction. We report on the results of a small experiment in applied diffusion, the development and Internet-based distribution of learning resources for a popular, widely distributed personal media player. With these wearable microcomputer devices already in use by a variety of students, new opportunities exist for widespread dissemination of anatomical information. The continuing evolution of wearable computing devices underscores the need for maintaining anatomical information transportability via standardized data formats.

Anatomy↗
PubMed2005

The smoking epidemic in Switzerland--an empirical examination of the theory of diffusion of innovations.

OBJECTIVES: Cultural and sex differences in smoking rates among countries indicate different phases of the smoking epidemic. Their background is summarized in a four-stage model based on the Rogers Theory of Diffusion of Innovations. First, to test predictions of the Rogers theory and, second, to test whether, according to the theory, today's innovative process is smoking cessation, predicted by higher rates of cessation among the more highly educated and among men of all educational levels. METHODS: Data covered respondents older than 24 years from two Swiss Health Surveys (1997 and 2002). Logistic regression models were on lifetime smoking versus never-smoking, and on former smoking versus current smoking. RESULTS: Declining smoking rates in both sexes over time, measured by birth cohorts, indicate that the epidemic has peaked, but women of all educational levels and men of lower education still show high prevalence rates. The gap between higher-educated and lower-educated individuals is widening. CONCLUSION: Smoking prevalence is expected to decline further, particularly among women and little educated men. The incidence of tobacco-related diseases in women is predicted to exceed that of men, owing to their lower cessation rates.

Adult↗
PubMed2000

Diffusion and innovation rates for multidimensional neuronal data with large spatial covariances.

The diffusion model has been introduced as a statistical model for processing multidimensional neuronal data. This paper extends estimation procedures for the parameters of this model when spatial covariances are large. The new method is based upon linear regression techniques. It is applied to an optical recording of the auditory cortex of a guinea pig stimulated with pure tone bursts (frequency 14 kHz).

Algorithms↗
PubMedDate not supplied

Using diffusion of innovation concepts to enhance implementation of an electronic health record to support evidence-based practice.

The article identifies the explosion of clinical data that are available and how difficult it is for clinicians to find answers to clinical questions. Electronic healthcare records (EHRs) are increasingly used to assist clinicians in this process; however, resistance to the implementation of technology-assisted care is not uncommon. The article reviews the diffusion of innovation research and provides the nurse manager with suggestions for applying these concepts to enhance the implementation of an EHR that can support evidence-based practice. Five characteristics of innovations, as perceived by individuals, are discussed as they help explain different rates of adoption. The innovation-decision process is studied as it relates to EHR implementations.

Attitude of Health Personnel↗
PubMed2002

The diffusion of innovation: factors influencing the uptake of telehealth.

The actual use of telehealth, particularly for clinical consultations, has in many cases been less than anticipated. The literature identifies a number of factors or barriers. These include legal issues, technical difficulties, time and convenience, cost and training/familiarity with the equipment. No single factor has been identified as being consistently present. Rogers' diffusion of innovation theory suggests that organizational structures and cultures will affect health professionals' perceptions of telehealth. The introduction of telehealth services affects existing work practices and workflows. We believe that it is necessary to develop strategies for the introduction of telehealth applications which take into account the idiosyncrasies of the health service sector, and the particular structures and cultures of individual organizations within that sector.

Diffusion of Innovation↗
PubMed2005

The diffusion of innovation in dentistry: a review using rotary nickel-titanium technology as an example.

Technological innovations are crucial for the advancement of the art and science of clinical dentistry. While some innovations suffer a lack of support, resulting in general nonacceptance, others are gradually adopted and supersede previous techniques and/or materials. Very little has been published in the dental literature concerning the reasons for the adoption, nonadoption, or rejection of new technology in dentistry. This paper reviews the diffusion of innovation in dentistry, with an emphasis on the adoption of rotary nickel-titanium endodontic instruments. Factors affecting adoption of new technology include a complex interplay of perceived benefits and advantages, and psychosocial and behavioral factors, in decision making. The importance of both dental school teaching and continuing education in dentistry is highlighted, emphasizing that such courses must be of a very high caliber.

Attitude of Health Personnel↗
PubMedDate not supplied

Organizational learning, diffusion of innovation, and international collaboration in telemedicine.

The authors analyze competing forces affecting the diffusion of telemedicine practices across organizations, potential learning effects from telemedicine practice, and their implications for the development of telemedicine-based networks. They also speculate on the learning, diffusion, and institutional effects that telemedical collaboration may trigger; five sets of propositions are advanced to explain these effects.

Cooperative Behavior↗
PubMed2026

What influenced the use of embedded genetic expertise by non-genetic clinicians: a qualitative study using the diffusion of innovations theory and theoretical domains framework.

BACKGROUND: While employing change agents is a widely used strategy to support implementation of evidence-based practices in healthcare, the perspectives of the target users of this intervention are under-explored. Within a genomic care setting in Australia, we examined non-genetic clinicians' views of and experience with embedded genetic counsellors employed as external change agents to support the adoption of genomics in clinical care. METHODS: We conducted qualitative interviews with 16 non-genetic healthcare professionals involved in different models of genomic care, all of which employed genetic counsellors as external change agents to provide embedded genetic expertise and support in non-genetic specialty clinics. The Diffusion of Innovations (DOI) theory and the Theoretical Domains Framework (TDF) were drawn upon to guide the study design and data analysis to explore the enablers/barriers to non-genetic clinicians' use of genetic expertise and the wider implementation context of the change agent approach. RESULTS: The TDF domain 'Belief about Consequences' was a positive influence on non-genetic specialists' view of the embedded change agents, when they believed that the change agents positively impacted patient outcomes and the clinicians' knowledge and practice of using genomics in routine care. Meanwhile, major barriers were related to 'Environmental Context & Resources,' e.g. time constraints and logistic hurdles of involving change agents. Perceived attributes related to 'complexity' and 'observability' of genetic expertise were critical factors influencing the decision to put the support to actual use, impacting the diffusion of the genomic innovation. CONCLUSIONS: Our study offers insights into behavioural influences and contextual conditions shaping clinicians' decisions to interact with genetic counsellor change agents and incorporate (or not) their expertise into their routine care. Such understandings can inform future design and implementation of interventions that use change agents to support the adoption of innovations, such as genomics, effectively and sustainably.

Journal Article↗
PubMed2003

Clinical team functioning and IT innovation: a study of the diffusion of a point-of-care online evidence system.

OBJECTIVES: To investigate the association between clinical team functioning and diffusion (awareness, use, and impact) of a 24-hour online evidence retrieval system. To examine the relationships between clinical team characteristics and the adoption of the online evidence system. DESIGN: 18 clinical teams, consisting of 180 clinicians from three Australian hospitals, were identified and studied. Teams were categorized as small ( 15). MEASUREMENTS: Clinical team functioning was assessed using the Team Climate Inventory (TCI). Awareness, use, and impact of an online evidence retrieval system were measured using a self-administered questionnaire. The relationships between TCI scores and awareness, use, and impact were examined using t-tests and one-way ANOVAs. Chi square analyses were used to examine differences between small and large teams. RESULTS were interpreted within a diffusion of innovations framework. RESULTS: Clinical team functioning was not related to awareness or use of the online evidence retrieval system. However, clinical team functioning was significantly associated with the impact of online evidence in terms of reported experience of improved patient care following system use. Clinicians in small teams ( 15) teams. CONCLUSIONS: Team functioning had the greatest impact on the fourth stage of innovation diffusion, the effective use of online evidence for clinical care. This supports Rogers' diffusion of innovation theory, to the effect that different types of communication about an innovation are important at different stages in the diffusion process. Members of small teams were more aware of the system than members of large teams. Team functioning is amenable to improvement through interventions. The findings suggest that the role of team climate in the diffusion of information systems is a promising area for future research.

Analysis of Variance↗
PubMed1996

Using the diffusion of innovation model to influence practice: a case study.

There continue to be suggestions within the nursing literature that research findings are not being utilized in clinical practice. The reasons for this are well documented. However, less emphasis is given to ways to facilitate utilization. It seemed possible that non-utilization could be due not only to lack of knowledge, but also to the method of implementing change towards research-based practice. The "top-down', authoritarian, approach to dissemination of information within the NHS may have been a block to research use. Could staff be motivated to consider research-based change through use of a different approach? An "action research' approach seemed a possible way to attempt to facilitate research-based practice. Within this study one ward was used with all staff as the participants. The staff identified the area to be studied (devising a protocol for preoperative information-giving). The instruments used were semi-structured interviews and informal discussions and field notes. Rogers' diffusion of innovation model was used to organize data collection and to analyse results. Although the results may not be generalizable, the use of this model provides a useful framework for others interested in an alternative approach to achieving research-based practice.

Clinical Nursing Research↗
PubMed1989

Innovation and diffusion of health-related technologies. A conceptual framework.

The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.

Communication↗
PubMed2000

Information technology adoption in health care: when organisations and technology collide.

The implementation of advanced information systems is enabling great social and organisational changes. However, health care has been one of the slowest sectors to adopt and implement information technology (IT). This paper investigates why this is so, reviewing innovation diffusion theory and its application to both health organisations and information technology. Innovation diffusion theory identifies variables that influence the 'innovativeness' of organisations and the rate at which a technology diffuses. When analysed, these variables show why IT implementation has progressed at a slower rate in health compared with other industry sectors. The complexity of health organisations and their fragmented internal structure constrain their ability to adopt organisation wide IT. This is further impacted upon by the relative immaturity of strategic health IT which is complicated and unable to show quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT. On the other hand, localised IT solutions and those providing measurable cost reductions have diffused well.

Diffusion of Innovation↗
PubMed1977

Advances in the study of diffusion of innovation in health care organizations.

Federal government programs of the 1960s to rapidly diffuse technologies have been displaced on the '70s by efforts to constrain costly technological growth. As a guide to action, the understanding of reasons for adoption of innovation is essential; but the utility of available diffusion theory is limited by its focus on the speed of diffusion rather than any reasons for its adoption by organizations. In a practical sense, more is known about the administrator as decision maker than about those increasing situatiions in which physicians play a more central part. Until coherent, empirically grounded theories of organizational innovation are available, large-scale "tests" are premature and wasteful.

Creativity↗
PubMed2003

Assessing or predicting adoption of telehealth using the diffusion of innovations theory: a practical example from a rural program in New Mexico.

In New Mexico, a large rural state, it was anticipated that telehealth would bring significant value to health care delivery, improve local capacity for patient care, decrease the need for patient travel, diminish professional isolation, provide an avenue for enhanced professional education and information sharing, increase access to care, and ultimately improve health status. During the course of an evaluation of the University of New Mexico Center for Telehealth's rural telemedicine program, we used a grounded theory approach to assess barriers to the adoption of telemedicine and components of successful adoption. We then turned to the diffusion of innovations theory to better understand the dynamic interactions between the characteristics of telehealth and the social system in which it is applied. In doing so, we learned that the type of innovation decision involved in the adoption of telehealth appears to be particularly important in determining adoption. In this article we demonstrate that diffusion theory can be a useful framework for evaluating telehealth programs. We also suggest that the development of a predictive tool for prospective assessment would be useful, and could be applied when new telehealth programs are being planned.

Delivery of Health Care↗