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PubMedDate not supplied

Diffusion of innovations theory and work-site AIDS programs.

Four case studies of the adoption of work-site AIDS programs are investigated, two of which were modifications of the Centers for Disease Control and Prevention's Business Responds to AIDS (BRTA) program. AIDS work-site programs were mainly initiated by the four study companies as a result of the efforts of a champion (defined as an individual who gains attention and resources for an issue in a system) or the occurrence of a tragic event, such as a company employee contracting AIDS. The BRTA program is an innovation that has not yet reached critical mass, which is the point after which further rates of adoption occur rapidly in a self-sustaining process.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Coaching and leadership for the diffusion of innovation in health care: a different type of multi-organization improvement collaborative.

BACKGROUND: Health care organizations have suffered a steady decrease in operating margins in recent years while facing increased competition and pressure to provide ever-higher levels of customer service, quality of care, and innovation in delivery methodologies. The ability to rapidly find and implement changes that will lead to strategic improvement is critical. To assist member organizations in dealing with these issues, VHA Upper Midwest launched the Coaching and Leadership Initiative (VHA-CLI) in January 1999. The initiative was intended to develop new methods of collaborating for organizational learning of best practices, with a focus on generalizable change and deliberate leadership supports for deployment, diffusion, and sustainability. The emphasis was on the spread of ideas for improvement into all relevant corners of the organization. STRUCTURE AND PROCESS OF THE COLLABORATIVE: The structure of the VHA-CLI collaborative involved four waves of demonstration teams during 2 years. Each meeting of the collaborative included an executive session, team learning sessions (concepts applied to their improvement projects), and planning for the 6-month action period following the meeting. An important feature of the collaborative is the way in which teams in the various waves overlapped. For example, the Wave 1 team for a given organization came to a learning session in January 1999. At the second collaborative meeting in June 1999, the Wave 1 teams reported on the progress in their pilot sites. This meeting was also the kick-off session for the Wave 2 teams, which could learn about organizational culture and the improvement model from the efforts of their colleagues on Wave 1. Wave 1 teams also learned about and planned for spreading their efforts to other sites beyond the pilot. The pattern of multiple teams stretching across two waves of activity was repeated at every meeting of the collaborative. SUCCESS: Each organization in the collaborative has achieved improved outcomes around its selected clinical topics. In total, 26 teams have made significant improvement in 17 different topic areas. In addition, each organization has been able to successfully spread tested improvements to other individuals, teams, or locations, and the improvement work has become easier and more rapid with each successive cycle. CONCLUSIONS: The learning process initiated by this project will continue for at least another year in the VHA Upper Midwest region and will be expanded as participating organizations in other regions enroll in the VHA's national effort.

Cooperative Behavior↗
PubMed2004

Diffusion of innovations and HIV/AIDS.

As the HIV/AIDS epidemic continues its relentless spread in many parts of the world, DOI provides a useful framework for analyzing the difficulties in achieving behavior change necessary to reduce HIV rates. The DOI concepts most relevant to this question include communication channels, the innovation-decision process, homophily, the attributes of the innovation, adopter categories, and opinion leaders. The preventive measures needed to halt the transmission of HIV constitute a "preventive innovation." This article describes the attributes of this preventive innovation in terms of relative advantage, compatibility, complexity, trialability, and observability. It reviews studies that incorporated DOI into HIV/AIDS behavior change interventions, both in Western countries and in the developing world. Finally, it discusses possible reasons that the use of DOI has been fairly limited to date in HIV/AIDS prevention interventions in developing countries.

Developing Countries↗
PubMed1997

Influence of interpersonal and mass-mediated interventions on injection drug and crack users: diffusion of innovations and HIV risk behaviors.

Evaluation research of public health media campaigns to influence behavior change often bemoans the lack of relevance to target audience and an absence of integrated interpersonal and mass-mediated communication channels. The assumption that illegal drug users are disconnected from mass-mediated communication may account for this absence of media interventions. The authors used cross-tabulation, chi-square, and regression analyses to demonstrate that many out-of-treatment drug users in an HIV-prevention research project are media consumers and that participants who recalled seeing or hearing media interventions reported greater levels of positive behavior change than participants who did not recall such messages. Results suggest coordination of human and mass-mediated public health messages relevant to this population to facilitate behavior changes.

Adolescent↗
PubMed1995

The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts.

OBJECTIVE: This study investigates patterns of utilization of zidovudine (ZDV) by gender, race, risk group, and other respondent characteristics following approval of this treatment. STUDY POPULATION: Longitudinal observational data were used on a demographically diverse population participating in New Jersey's Medicaid waiver program for persons with symptomatic HIV disease. DATA EXTRACTION METHODS: Claims data were merged with administrative data on demographic characteristics, risk group, and functional status. Periods of ZDV utilization were determined by analysis of pharmacy claims. DESIGN: The proportion of respondents ever using ZDV (treatment incidence) and the proportion of time on ZDV among users (treatment persistence) were analyzed for a cohort enrolling in 1987 and 1988, and for a cohort enrolling in 1989 and 1990, with follow-up of utilization through August 1992. For each cohort, bivariate analyses were used to compare incidence and persistence by patient subgroup; logistic regression was used to investigate the predictors of incidence in a multivariate model; and OLS regression was used to analyze proportion of time on ZDV among those with any ZDV use. PRINCIPAL FINDINGS: For the 1987-1988 cohort, substantial race, gender, and risk group differences in utilization were observed, even though all participants in this Medicaid population had financial coverage for ZDV treatment. Treatment incidence was significantly lower for blacks than for others in bivariate comparison (45 percent versus 63 percent had any use of ZDV) and in a logistic regression controlling for a variety of demographic and health status indicators (relative risk .46, CI .31 a variety of demographic and health status indicators (relative risk .46, CI .31 to .69). Treatment persistence differences were also substantial in the 1987-1988 cohort: among ZDV users, women, blacks, and injection drug users (IDUs) had significantly less persistence in use, and the gender and risk group differences were significantly in a multivariate model. In the 1989-1990 cohort, however, both incidence and persistence of treatment converged: no significant differences were observed across demographic groups. CONCLUSIONS: Less-advantaged subgroups lagged in access to this new therapy, suggesting the presence of nonfinancial barriers to care. However, these initial differences subsequently converged. RELEVANCE/IMPACT: Socioeconomic differences have been observed in access to newly introduced treatments for a variety of diseases, reflecting nonfinancial as well as financial barriers to care. Such differences may or may not disappear as use of therapies becomes institutionalized. Monitoring patterns of treatment initiation as well as persistence of treatment over time, using merged data from claims and administrative files, can provide important information on the diffusion of treatments and the extent to which initial disparities are or are not reduced over time.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics.

BACKGROUND: In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later. METHODS: In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8). RESULTS: Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p < .05), women's health training programs (p < .01), separate women's mental health clinics (p < .001), separate space (p < .05), or adequate privacy (p < .05); however, they were less likely to have experienced educational program closures (p < .001) and staffing losses (p < .05) compared to CWHCs. CONCLUSIONS: Diffusion of comprehensive women's health care is as yet incomplete. More research is needed to examine the quality of care associated with these models and to establish the business case for managers faced with small female patient caseloads.

Diffusion of Innovation↗
PubMed2004

Impediments to the diffusion of innovative medicines in Europe.

The pharmaceutical industry has developed many innovative medicines, which are able to extend the life expectancy of patients to increase their quality of life and often to reduce expenditures in the health care sector as a whole. Although these medicines are available in principle for all eligible patients throughout Europe, not everyone receives adequate treatment. There is a huge difference between a possible optimal treatment and the treatment delivered to the patient. In some cases patients are not treated at all; in some cases they only receive outdated medicines (e.g. with lower effectiveness and/or more severe side effects); and in some cases the prescribed dosages of the innovative drugs are too low to be effective. This study gives an overview of the shortfalls in provision of state-of-the-art medicines in selected European countries for about 20 of the most relevant diseases. The following five different groups of factors can be identified as leading to this insufficient diffusion of medicines and are discussed in this text: (i) patient-related factors; (ii) healthcare professional-related factors; (iii) industry-related factors; (iv) system-related (long-term) factors; and (v) policy-related (short-term) factors. It must be clear that these shortages are not isolated cases but general trends in Europe, which have to be discussed in public.

Communication Barriers↗
PubMed2004

Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987-2000).

BACKGROUND: Barriers to cancer screening may change over time as screening becomes more widespread. METHODS: Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal screening (n =66,452). RESULTS: Lack of awareness was the most common barrier for all screening tests; it decreased by 13.5 percentage points for mammography and by 4.6 percentage points for colorectal screening, but increased by 3.0 percentage points for Pap test from 1987 to 2000. Decreases in not recommended by a doctor were observed for mammography (from 20.5% to 3.7%) and colorectal screening (from 22.3% to 14.2%). Examination of trends in barriers among sociodemographic and health care access subgroups revealed disparities for each screening test. CONCLUSIONS: Although population-wide progress has been made in reducing barriers to screening, lack of awareness, and not recommended by a doctor remain important barriers, especially among traditionally underserved populations.

Adult↗
PubMedDate not supplied

Diffusion of innovation: the leaders' role in creating the organizational context for evidence-based practice.

Successfully leading change represents one of the most, if not the most, challenging aspects of a leader's role. The traditional top-down command and control structures and processes present in healthcare institutions and nursing are the enemies of effective change. Transitioning from traditional structures to structures that are more of a partnership between point-of-service staff and administrators is the foundation for creating an evidence-based practice culture.

Attitude of Health Personnel↗
PubMed2000

The relation of communication to risk judgment and preventive behavior related to lead in tap water.

More and more communities are becoming concerned about health risks posed by lead and other health hazards in their drinking water. Our study, applying the model of innovation diffusion to the adoption of preventive health behaviors, found that reliance on health professionals for information about lead in tap water was associated with residents perceiving risk from this hazard, their sense of efficacy in dealing with it, and their adoption of preventive behaviors. Mass media and pamphlets mailed directly to residents were relatively ineffective. Results suggest that interpersonal channels may be the best way to reach individuals who live in areas of highest risk from tap water lead.

Communication↗
PubMedDate not supplied

A review of five major community-based cardiovascular disease prevention programs. Part II: Intervention strategies, evaluation methods, and results.

Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. The main hypothesis is that community intervention will reduce the prevalence of cardiovascular disease risk factors and consequently reduce cardiovascular disease incidence, morbidity, and mortality. Intervention strategies include community mobilization, social marketing, school-based health education, worksite health promotion, screening and referral of those at high risk, education of health professionals, direct education of adults, and modification of physical environments. Formative evaluation provides short-term feedback to program managers about immediate effects of intervention strategies. Outcome evaluation examines the effects of intervention on longitudinally sampled cohorts and compares cardiovascular risk status and morbidity and mortality in intervention and comparison communities. Results from North Karelia and the Stanford Three Community Study indicate that this model is efficacious and cost-effective. The National Heart, Lung, and Blood Institute biomedical research spectrum envisions research in knowledge transfer and innovation diffusion as the last link in the causal chain whereby research affects the health of the population, but research in this area remains undeveloped compared to other aspects of cardiovascular disease prevention. This is Part II of a two part article; Part I appeared in Volume 4, Number 3.

California↗
PubMed1995

[Managing of an innovation in health care: the case of polyvalent intravenous immunoglobulins at the Assistance-Publique-Hôpitaux de Paris].

Managing new innovations in medicine is a particularly timely subject. There is an abundant history concerning over expectations resulting from the development of new treatments or diagnostic procedures, some shown to be less effective than promised, others even found to be dangerous. A new aspect to the question is the importance of economic pressures which require rational investment decisions when diffusing innovating technologies. In 1991, the Commission for the evaluation and diffusion of innovating technologies (CEDIT) at the University Hospitals of Paris (Assistance Publique-Hôpitaux de Paris) developed a programme aimed at better managing the distribution and use of polyvalent intravenous immunoglobulins (IgIV), a new promising therapeutic tool with both a high cost and a certain number of risks. The programme was designed to assist prescribers in elaborating better therapeutic strategies and to help hospital managers rationalize expenditures for IgIV. The results of this experience are presented here together with certain conclusions concerning the way management decisions can be applied to the diffusion of an innovation in health care.

Diffusion of Innovation↗