The adoption and implementation of the fluoride mouthrinse program: descriptive results from school districts

Heart Partners: a strategy for promoting effective diffusion of school health promotion programs

Heart Partners uses a straightforward, interpersonal approach to increase acceptance and use of innovations in school health promotion. In accord with the linkage model of innovation diffusion, developers of a new program or technology (i.e., resource system) simply designate and train selected members to be recruiters and allies of individual advocates at the campus-level (i.e., user system). Linkage is supported by supplying advocates and allies with guidelines and materials that encourage ongoing, interactive, interpersonal partnerships to promote effective implementation of the new technology at the school. Empirical assessment of this simple strategy implemented by the Texas Affiliate of the American Heart Association showed a twofold to fourfold increase in actual use and reach of school health promotion packages, with an average reported volunteer time of less than three hours per month.

Diffusion of innovations in schools: a study of adoption and implementation of school-based tobacco prevention curricula

PURPOSE

The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process.

DESIGN

The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions.

SETTING

The study was conducted in North Carolina.

SUBJECTS

All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample.

INTERVENTION

An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted.

MEASURES

Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%.

RESULTS

Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation.

CONCLUSIONS

While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.

Time to adoption of an innovation by dentists in private practice: sealant utilization

Dentists can be divided into five adoption categories based upon their time of adoption of pit and fissure sealants: innovators, early adopters, early majority, late majority, and laggards. The differences among dentists in the five adoption categories were examined for four classes of variables: practice characteristics, dentist characteristics, communication of information, and practice environment. Questionnaires were mailed in September 1984 to a random sample (N = 521) of Washington State dentists in general practices. A total of 376 completed questionnaires were returned, for a response rate of 72 percent. Adoption of sealants proceeded as follows: 5 percent of dentists through 1973, 24 percent through 1979, 50 percent through 1982, and 75 percent through 1984. Adoption category was related to percent of assistants who were certified, delegation to assistants and hygienists, magnitude of the fees charged by the practice, number of staff meetings per month, the dentist having been an officer in a dental organization, year the dentist adopted other new technologies, dentist's self-rating of willingness to try new things, percent of patients who are children, and percent of the dentist's colleagues who used sealants. These data lend some support to the two-stage or opinion-leader model of diffusion and suggest that new technologies can be promoted by first influencing dentists who consistently adopt early.

Oral health promotion in the schools: a historical analysis and case study

This article discusses the historical shifts between the treatment-oriented, instructional and primary preventive approaches to oral health promotion, especially in school-based programs in New Zealand and Australia. While in the past much effort has been put into treatment-oriented and instructional programs, their impact has been limited. Among those primary preventive activities that have demonstrated clear benefits are various types of fluoridation and adhesive sealants for the occlusal surfaces of teeth. Further emphasis on primary prevention over treatment is needed to better insure the success of school-based oral health promotion programs. In addition, more effort needs to be put into policy direction, linkages within the educational system, planning, and evaluation.

The role of linking agents in the diffusion of health promotion programs

This article examines the role of state health department dental offices as linking agents in the diffusion of an effective preventive health program, the fluoride mouthrinse program (FMRP) in public schools. The aim of this program is to prevent dental caries by a weekly mouthrinsing by elementary school students. In contrast to the traditional focus of diffusion research on characteristics of the innovation and characteristics of the adopter, this study emphasizes an ecological approach, i.e., the transmittal mechanisms for diffusion. The state dental offices are examined as linking agents, which serve as program advocates or champions for diffusing the FMRP from the national level, where it was developed, to the thousands of local school districts and schools for adoption and continued delivery. Using data from interviews with state dental directors and archival sources, a multivariate model was developed and used to explain the percent of a state's elementary schools using the mouthrinse program. The results support the key role of linking agents in disseminating effective health promotion programs into actual use. Implications are discussed for both research and practice.