Integration of diffusion of innovation theory into diabetes care

Unravelling clinicians' shared decision-making adoption: a qualitative exploration through the lens of diffusion of innovations theory

OBJECTIVES

This study uses the diffusion of innovations (DOI) theory to comprehensively understand the adoption of shared decision-making (SDM) in clinical practice, specifically focusing on the 'knowledge' and 'persuasion' stages within DOI. We aim to understand the challenges and dynamics associated with SDM adoption, offering insights for more patient-centred decision-making in healthcare.

DESIGN

This qualitative study employs a modified framework analysis approach, integrating ethnographic and interview data from prior research, along with additional interviews. The framework used is based on the DOI theory.

STUDY SETTING AND PARTICIPANTS

This study was conducted in the obstetrics and gynaecology department of a tertiary teaching hospital in the Eastern region of the Netherlands. It included interviews with 20 participants, including gynaecologists, obstetrics registrars and junior doctors currently practising in the department. Additionally, data from prior research conducted within the same department were incorporated, ensuring the maintenance of contextual consistency.

RESULTS

Findings reveal a complex interplay between SDM's benefits and challenges. Clinicians value SDM for upholding patient autonomy and enhancing medical practice, viewing it as valuable for medical decision-making. Decision aids are seen as advantageous in supporting treatment decisions. Challenges include compatibility issues between patient and clinician preferences, perceptions of SDM as time-consuming and difficult and limitations imposed by the rapid pace of healthcare and its swift decisions. Additionally, perceived complexity varies by situation, influenced by colleagues' attitudes, with limited trialability and sparsely observed instances of SDM.

CONCLUSIONS

Clinicians' decision to adopt or reject SDM is multifaceted, shaped by beliefs, cognitive processes and contextual challenges. Cognitive dissonance is critical as clinicians reconcile their existing practices with the adoption of SDM. Practical strategies such as practice assessments, open discussions about SDM's utility and reflective practice through professional development initiatives empower clinicians to make the best informed decision to adopt or reject SDM.

Communities of practice: An alternative approach to bridging the theory-practice gap in radiography?

OBJECTIVES

There is an increasing need to engage with evidence-based practice (EBP) and continuing professional development (CPD) to effectively respond to the current healthcare demands and challenges. This review critically synthesises key knowledge diffusion and implementation theories, with particular emphasis on Communities of Practice (CoPs), a theory as yet unexplored in radiography practice.

KEY FINDINGS

Prominent theories including implementation science, translational science and knowledge diffusion theories have previously been proposed to bridge the theory-practice gap. However, the radiography profession is a fast-paced, complex and a highly regulated profession which makes the application of rigid theories more challenging. CoPs, which have their origins in Social Learning Theory, represents a potentially more viable approach to bridging the theory-practice gap.

CONCLUSION

Cultivating and maintaining CoPs is a more practical approach to improve knowledge dissemination, EBP and CPD, allowing radiographers in practice to share knowledge, best practices, and experiences out with an organisational hierarchy. The collective pool of knowledge, and history created may contribute to further establishing the radiography profession and the radiographer identity as the CoPs connect, expand, and advance over time.

IMPLICATIONS FOR PRACTICE

CoPs may be cultivated and further investigated in radiography practice to improve knowledge dissemination, EBP and CPD, with the ultimate aim of improving individual and organisational performance in radiography practices.

Toolkit for emerging technologies in laboratory medicine

An emerging technology (ET) for laboratory medicine can be defined as an analytical method (including biomarkers) or device (software, applications, and algorithms) that by its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics. Considering the laboratory medicine-specific definition, this document examines eight key tools, encompassing clinical, analytical, operational, and financial aspects, used throughout the life cycle of ET implementation. The tools provide a systematic approach starting with identifying the unmet need or identifying opportunities for improvement (Tool 1), forecasting (Tool 2), technology readiness assessment (Tool 3), health technology assessment (Tool 4), organizational impact map (Tool 5), change management (Tool 6), total pathway to method evaluation checklist (Tool 7), and green procurement (Tool 8). Whilst there are differences in clinical priorities between different settings, the use of this set of tools will help support the overall quality and sustainability of the emerging technology implementation.

Exploring the Challenges and Opportunities of Adopting and Using Telemedicine for Diabetes Care and Management: Qualitative Semistructured Interview Study Among Health Care Providers and Patients With Diabetes

BACKGROUND

Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait.

OBJECTIVE

The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait's health care system for diabetes care and management.

METHODS

The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The "diffusion of innovation" model was used as a perspective to interpret the findings.

RESULTS

A total of 20 participants were included in this study-10 HCPs and 10 patients with diabetes-all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety.

CONCLUSIONS

The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.

Using formative evaluation of a community-based opioid overdose prevention program to inform strategic communication for adoption, implementation, and sustainability

BACKGROUND

Opioid addiction and overdose is a public health problem in the United States and is expected to remain with substance use increasing due to the COVID-19 pandemic. Communities that approach this issue through multi-sector partnerships experience more positive health outcomes. Understanding motivation for stakeholder engagement in these efforts is essential to successful adoption, implementation, and sustainability particularly in the shifting landscape of needs and resources.

METHODS

A formative evaluation was conducted on the C.L.E.A.R. Program in Massachusetts, a state heavily impacted by the opioid epidemic. A stakeholder power analysis identified appropriate stakeholders for the study (n = 9). The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Surveys (n = 8) examined perception and attitudes on the program; motivations and communication for engagement; and, benefits and barriers to collaboration. Stakeholder interviews (n = 6) explored the quantitative findings in more detail. Surveys were analyzed using descriptive statistics and a content analysis with deductive approach was conducted for stakeholder interviews. The Diffusion of Innovation (DOI) Theory guided recommendations for communications to engage stakeholders.

RESULTS

Agencies represented a range of sectors and the majority (n = 5) were familiar with the C.L.E.A.R.

PROGRAM

Despite the many strengths of the program and existing collaboration, based on the coding densities of each CFIR construct stakeholders identified crucial gaps in the services the program provided and noted that the overall infrastructure of the program could be enhanced. Opportunities for strategic communication to address the stages of DOI align with the gaps identified in the CFIR domains to result in increased agency collaboration and expansion of services into the surrounding communities to ensure sustainability of the C.L.E.A.R.

PROGRAM

CONCLUSIONS

This study explored factors necessary for ongoing multi-sector collaboration and sustainability of an existing community-based program especially given the changing context from COVID-19. Findings informed both program revisions and communication strategies to promote the program to new and existing collaborating agencies and the community served, and identify effective communication approaches across sectors. This is essential for successful implementation and sustainability of the program, especially as it is adapted and expanded to address post-pandemic times.

TRIAL REGISTRATION

This study does not report results of a health care intervention on human participants, however it was reviewed and determined an exempt study with the Boston University Institutional Review Board (IRB #H-42107).

Emerging technology: a definition for laboratory medicine

The term "emerging technology" (ET) is used extensively, and there are numerous definitions offered, but to our knowledge, none specifically encompass the field of laboratory medicine. An ET definition that incorporates the overarching IFCC aim of "Advancing excellence in laboratory medicine to support healthcare worldwide" would clarify discussions. We discuss key aspects of the term "emerging technology(ies)" as it applies to laboratory medicine with a view to laying the foundations for a practical definition for the profession and propose the definition of an ET as "An analytical method or device that by virtue of its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics".

Social Marketing Strategy to Promote Traditional Thai Medicines during COVID-19: KAP and DoI Two-Step Theory Application Process

Introduction: Recently, the Thai government has been promoting the innovation of finished forms of traditional Thai medicine (TTM) products (e.g., tablets and capsules). According to the existing literature, most consumers are unaware of the finished forms of TTMs because of conflicting knowledge, information, and communication. Therefore, the consumers have poor perceptions about TTMs and their benefits. Purpose: This qualitative study explores the current perceptions about TTMs and the modes of promotion that are being utilized to develop a strategic communication plan for the finished forms of TTMs. Design/methodology/approach: Utilising thematic analysis, focus groups were conducted with thirty experienced consumers. Findings: Using KAP and DoI theory, the following three themes emerged in this study: (i) the current KAP of Thai consumers toward the finished forms of TTM; (ii) factors influencing the use of finished forms of TTM; and (iii) integrated marketing communication as a promotion strategy to rapidly disseminate knowledge. Research limitations/implications: Given Thailand's large population, the findings of this study are substantially limited and cannot be generalized. Therefore, the findings herein may not reflect the experiences and opinions of the Thai consumers residing in other regions or the opinions of the entire country. Originality/value: This study utilises interdisciplinary methods and two-step theory application to explain the current knowledge and perceptions about the finished forms of TTM and develop proper communication and media strategies that can promote the finished forms of traditional Thai medicines, helping to widen their usage significantly.

Assessing E-Health adoption readiness using diffusion of innovation theory and the role mediated by each adopter's category in a Mauritian context

BACKGROUND

The preparedness of healthcare institutes for the foreseen changes expected to arise through the implementation of E-Health is a significant turning point in determining its success. This should be evaluated through the awareness and readiness of healthcare workers to adopt E-Health technology to reduce health information technology failures.

METHODS

This study investigated the relationship between the perceived attributes of innovation and E-Health adoption decisions of healthcare workers as part of a preimplementation process. Using a cross-sectional quantitative approach, the dimensions of the diffusion of innovation (DOI) theory were used to assess the E-Health readiness of 110 healthcare workers in a Mauritian specialized hospital.

RESULTS

A strong inclination towards E-Health adoption was observed, where the prime stimulators were perceived as modernization of healthcare management (84.1%, ẋ=4.19), increased work efficiency through reduction of duplication (77.6%, ẋ=4.10) and faster generation of results (71.1%, ẋ=4.07). The findings of this study also validated the use of five DOI dimensions (i.e. relative advantage, compatibility, complexity, trialability and observability) in a predictability model (F(5, 101)=17.067, p<0.001) towards E-Health adoption. A significant association between 'adopter category' and 'willingness to recommend E-Health adoption' (χ2(8)=74.89, p<0.001) endorsed the fact that physicians and nursing managers have central roles within a social ecosystem to facilitate the diffusion of technology and influence the adoption of innovation.

CONCLUSION

This is the first study of its kind in Mauritius to successfully characterize each adopter's profile and demonstrate the applicability of the DOI framework to predict the diffusion rate of E-Health platforms, while also highlighting the importance of identifying key opinion leaders who can be primed by innovators regarding the benefits of E-Health platforms, thus ensuring non-disruptive evolutionary innovation in the Mauritian healthcare sector.

Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

Compliance and Attitudes of Critical Care Transport Providers Regarding a Prehospital Rapid Sequence Intubation Checklist

Human factors engineering innovations, such as checklists, have been adopted in various acute care settings to improve safety with reasonable compliance and acceptance. In the air medical industry, checklists have been implemented by different teams for critical clinical procedures such as rapid sequence intubation. However, compliance and attitudes toward these human factors engineering innovations in the critical care transport setting are not well described. In this institutional review board-exempt, retrospective review of checklist usage, we assessed rapid sequence intubation checklist compliance and surveyed providers with 5 questions based on Rogers' theory of diffusion of innovation to examine why or why not there was compliance. Our results indicated that compliance with checklist implementation was excellent. The survey questions were consistent with process improvement factors that enhance the spread and acceptance of innovation.

Determinants of overall knowledge and health behaviours in relation to hepatitis B and C among ever-married women in Pakistan: evidence based on Demographic and Health Survey 2017-18

Background

In 2019, around 5 million and 10 million people were affected by hepatitis B virus (HBV) and hepatitis C virus (HCV) respectively in Pakistan. On World Hepatitis Day 2019, Pakistan’s Government announced the Prime Minister’s Plan to eliminate HBV and HCV from the country by 2030. In order to achieve this goal, adequate knowledge about HBV and HCV regarding mode of transmission, symptoms of the disease, and awareness about available treatments and vaccines is imperative. The present study aims to investigate the determinants related to overall knowledge about and behaviour in relation to HBV and HCV amongst married women in Pakistan.

Methods

Secondary data analysis was carried out using the Pakistan Demographic and Health Survey (PDHS) 2017–18. A series of questions regarding women’s knowledge about how to avoid HBV and HCV and their health behaviour in relation to HBV and HCV were posed to 12,364 ever-married women of reproductive age (15–49 years). Bivariate and multivariable logistic and linear regression was applied to examine the effects of sociodemographic characteristics and covariates on women’s overall knowledge and health behaviour regarding HBV and HCV.

Results

The findings highlight that the majority of women (88.3%) have heard of HBV and HCV. Nonetheless, only 34.8% had comprehensive knowledge about how to avoid HBV and HCV. Few women (11.3%) had been tested for HBV or HCV during the year preceding the survey. Furthermore, the results indicate that women living in urban areas, being older, and having more than 10 years of schooling, reported better knowledge and health behaviours regarding HBV and HCV.

Conclusion

This study provides evidence that women’s sociodemographic characteristics create differences in their overall knowledge about and attitudes towards HBV and HCV. This research emphasized that there is a need to create awareness about the causes and prevention of HBV and HCV in order to achieve the goal of eliminating these diseases in Pakistan by 2030.

Diffusion of innovations: a guiding framework for public health

Exploring the behavior change process has been of interest and importance to public health professionals, to translate research into practice. Diffusion of innovations (DOI) model has been extensively applied in public health to examine the process by which innovation is passively communicated to individuals and groups. It builds on a staged model of awareness, persuasion, decision, implementation, and confirmation; and categorizes communities into innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%). It reflects on the diversity of strategies to be applied for different cadres of the society to bring about a wholistic change. Nonetheless, DOI suffers from 'pro-innovation' and 'individual blame' bias, as it fails to account for the influence of societal, cultural, and extraneous factors affecting individual behavior change. The social networks theory (SNT) in contrast, explains behavior change based on social networks and their influences. It builds on the constructs of homophily, centralization, reciprocity, transitivity, and density; and fills the void in the DOI model. We suggest public health professionals to combine the constructs of DOI and SNT in rolling out behavior change interventions, to yield a comprehensive approach.

Applying a diffusion of innovations framework to the scale-up of direct-acting antiviral therapies for hepatitis C virus infection: Identified challenges for widespread implementation

BACKGROUND AND AIMS

Interferon-free, direct-acting antivirals (DAAs) for hepatitis C virus (HCV) offer much promise to achieve World Health Organization targets by 2030. However, impediments at the practitioner and health-system level will continue to obstruct the scale-up of DAAs worldwide unless identified and acted upon. Applying a diffusion of innovations framework, the aim of this study was to identify structural factors impacting practitioner experiences of managing HCV treatment.

METHODS

In-depth, semi-structured, telephone interviews took place between September 2018 and April 2019 to investigate barriers and facilitators for engaging in HCV management and DAA therapy amongst general practitioners (GPs) who prescribe opioid agonist therapy and drug and alcohol specialists in Australia. Interviews were transcribed verbatim, de-identified, and coded, and data were analysed with iterative categorisation and thematic analysis using Everett Rogers's diffusion of innovation framework.

RESULTS

amongst 30 participants (12 GPs, 18 drug and alcohol specialists), several structural factors were reported to impede practitioner efforts to deliver optimal HCV care. Two primary themes were explored: contextual factors for the diffusion of DAA therapies, including attempts by participants to shift clinic culture and respond to siloed health structures, and adopter factors. Some participants chose to 'rock the boat' by circumventing clinic protocol and HCV guidelines to treat more clients, effectively shifting adopter categories to become greater advocates in HCV care. Also, while a role for GPs as the 'new adopters' in HCV management was discussed, many participants expressed uncertainty as to how much GPs should become involved in the diffusion of DAA therapies more widely.

CONCLUSIONS

Reducing the global burden of HCV infection will not be possible without the widespread delivery of HCV treatment amongst practitioners. Practitioners and health workers require leadership and resources from health authorities so that the individual and population-level benefits of DAA therapy are realised.

Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review

BACKGROUND

In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients.

METHODS

Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review.

RESULTS

Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance.

DISCUSSION/CONCLUSION

Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.

A global perspective on implant education: Cluster analysis of the "first dental implant experience" of dentists from 84 nationalities

OBJECTIVES

The aim of this cross-sectional study was to explore the demographic and educational patterns related to the dentists' first implant dental experience.

MATERIAL AND METHODS

Participants of a Massive Open Online Course in implant dentistry who have placed and restored implants completed a 25-item online questionnaire investigating their pathway of education and assessing their experience with the "first implant placement." Exploratory analysis included hierarchical clustering using 9 demographic categorical factors.

RESULTS

A total of 1015 respondents from 84 countries formed 5 distinct clusters. Age and work experience were dominant clustering traits, decreasing from Cluster 1 to Cluster 5. Clusters 1 and 3 represented "senior" and "younger" general dental practitioners, respectively, whilst Clusters 2 and 4 represented post-graduate educated clinicians. Cluster 5 represented recent graduates. Asia, South America and Africa were over-represented in "younger" clusters. Time in practice was a significant determinant of attitudes, followed by completion of post-graduate education. There were significant differences in reported patterns of challenges and complications depending on dentists' time in practice, age and post-graduate education. Challenge in implant positioning was more frequently identified by "young post-graduate" educated dentists. Recent graduates reported having the fewest complications of all clusters. Obtaining implant education in University settings was most frequently recommended by clusters of dentists with post-graduate education.

CONCLUSIONS

Time in practice is a parameter to be considered when designing implant education. The absence of structured education and mentorship might lead to inability to properly assess treatment outcomes and identify complications. Quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.

Big Data Analytics in Healthcare: Investigating the Diffusion of Innovation

The shortage of data scientists has restricted the implementation of big data analytics in healthcare facilities. This survey study explores big data tool and technology usage, examines the gap between the supply and the demand for data scientists through Diffusion of Innovations theory, proposes engaging academics to accelerate knowledge diffusion, and recommends adoption of curriculum-building models. For this study, data were collected through a national survey of healthcare managers. Results provide practical data on big data tool and technology skills utilized in the workplace. This information is valuable for healthcare organizations, academics, and industry leaders who collaborate to implement the necessary infrastructure for content delivery and for experiential learning. It informs academics working to reengineer their curriculum to focus on big data analytics. The paper presents numerous resources that provide guidance for building knowledge. Future research directions are discussed.