1. H571 – Week 8 Diffusion of Innovations Theory Community-Based Research
Tara
Community-Based Research
Intro (NCI)
Alexandra
Israel et al paper
Coral, Kathryn and Alexandra
Parker et al paper
Connie and Jennifer
Discussion Questions

2. Diffusion of Innovations Theory
DSC: Chapter 10
Diffusion of Innovations Theory
“The process by which an innovation is communicated through certain channels over time among members of a social system” (Rogers, 1995, p. 10)

3. Adopter categories and the cumulative rate of adoption: With successive groups of consumers adopting the new technology (blue), market share (yellow) will eventually reach the saturation level

4. Diffusion of Innovations
Diffusion of Innovations Theory (DIT) suggests that behavior change is essentially contagious!
DIT is a highly developed and structured system of describing and facilitating behavior change in large populations.
The eloquence of DIT: Diffusion becomes self-sustaining after a sufficient number of people have initially adopted the innovation.
It is important to note that an innovation may be a product or a behavior but it must be perceived as being “new” –the first step in using DIT.

5. Communication Channels Time The Social System
Four Key Elements
Innovation
Communication Channels
Time
The Social System

6. Element One: Innovation
12 Key Characteristics – but main 5 are:
Three that apply before adoption:
Relative Advantage
Compatibility
Trialability
One that applies during adoption:
Complexity
One that applies after adoption:
Observability

7. 2nd Element: Communication Channels
These may be formal (media) or informal (interpersonal)
With interpersonal communication, think social learning and homophily (share values)
Shared values between change agents (i.e., those who actively attempt to promote adoption of an innovation) and members of the target population increases likelihood of adoption of the innovation (new behavior)
A construct is a theoretical or psychological concept.

8. Third Element: Time The innovation-decision process:
Five phases of change:
Knowledge
Persuasion
Decision
Implementation
Confirmation/reinforcement

9. Fourth Element: Social System
The social system sets the boundaries for diffusion and the communication structures spread information about the innovation.
Communication structures can be formal or informal – it is vital to know the difference between the two.

10. Application
DIT works best when the adoption of the innovation can be publicly communicated to others.
DIT works best when the innovation or behavior does not require daily repetition.
DIT is an intervention approach that can efficiently produce population-level health behavior change.

11. Community-Level Theory of Change
Community, as one level embedded in the social ecological model, is a complex and dynamic system.
While we have multiple theories of individual change and organizational change, we have very few theories of community change.
This is one of the least understood processes in public health, but perhaps the one with greatest potential to impact population health.

14. PNRC framework for Creating Nurturing Environments
DISTAL INFLUENCES
PROXIMAL INFLUENCES
PRIMARY OUTCOMES
Poverty
Neighborhood poverty
Family poverty
Access to dental and health care
Relative deprivation and inequality
Family
Involved in learning-related activities
Involved monitoring
Non-harsh limit setting
Reinforcing interactions
Positive role modeling
Health maintenance, hygiene
Involvement in positive activities
Cognitive Development
Social/
Emotional Competence
Social Cohesion
Pro-social norms, informal social control
Connectedness, social capital
Healthy community norms
Social exclusion, discrimination
School
High-quality early childhood education
Effective instruction
Positive school climate
Positive behavior support
School attendance
Health education and prevention
After-school education and activities
Absence of Psychological and Behavioral Problems
Physical Environment
Decay: abandoned buildings, substandard housing
Neighborhood design, land use
Access to alcohol, tobacco, other drugs, firearms
Access to nutritious foods
Toxic exposures
Media
Peer
Pro-social peers, role models
Exposure to alcohol, tobacco and other drug use, violence and crime
Social networking technology
Physical Health

15. Community-based Participatory Research (CBPR)
Collaborative approach to research
Conducting research with a community vs. conducting research in a community
Equitable participation and shared control over all phases of research
Each community member or representative contributing their strengths

16. Key Principles Recognizes community as a unit of identity
Builds on community’s strengths/assets
Facilitates collaboration in all research phases
Integrates research results with community change efforts for benefit of all partners
Emphasizes a co-learning and empowering process
Cyclical and iterative
Applies both positive and ecological perspectives
Disseminates findings to all partners
Involves long-term commitment

17. Benefits of Community-based Research Partnerships
Enhances relevance of research data
Brings together partners with diverse skill sets and expertise
Local knowledge and perspectives may improve quality and validity of research
Attempts to address social and health inequities among marginalized communities
Creates theory grounded in social experience
Bridges gaps between researchers & practitioners
Involves marginalized communities, reduces discrepancies
Not an exhaustive list

18. Partnership Issues/ Challenges
Lack of trust and perceived lack of respect
Inequities in power and control
Different values, beliefs, perspectives, etc.
Conflict regarding funding
Definition and representation of community
It takes time
Who represents the community (& definition)

19. Methodological Issues/Challenges
Questions raised regarding scientific quality
Difficulty with proving success
Inability to define everything up front
Balance between research & community action
Time required
to collect, analyze and interpret data
Integrating and interpreting data from multiple sources

20. Broader Issues
Broader social, political, economic, institutional, and cultural issues. E.g.:
Competing demands on time and resources across partner institutions
High-risk approach for achieving tenure
Expectations by funding agencies and other institutions that do not allow sufficient time
Political and social dynamics within the community
Deterrents to institutional, community and social change

21. Community Capacity
Community capacity is defined as “characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems” (Speers et al., 1996).
Community capacity is an important input and outcome of community-based health interventions.
Skills, knowledge and resources
Nature of social relationships
Structures for community dialogue
Quality of leadership
Civic participation
Value system
Learning culture

22. Implications of Community-Based Approaches for Health Promotion Practice
Communities are increasingly key settings for health promotion
Building community capacity is increasingly a focal outcome of health promotion
Different approaches to community-based health promotion interventions reflect differing conceptualizations of community (e.g., worksites, media, schools, neighborhoods)
A whole CBPR course online:

23. Discussion Questions
What concepts are common between DIT and CBPR? How do the principles of CBPR relate to the elements of DIT?
2. What is the role of community-based action in diffusion of an innovative intervention? Under what conditions is reinvention of an intervention appropriate?
3. How can interventions be both disseminated through multiple communities and community-developed?
4. How can the conflicting roles (and power) of researchers and community members be reconciled? Does CBPR bias researchers’ objectivity? Does this matter? How can it be avoided or minimized?
5. How can CBPR help professionals facilitate the diffusion of appropriate, effective innovations through already existing or strengthened social systems and communication channels?
6. How could you integrate the DIT and principles of CBPR to address the varying agendas of groups involved in childhood obesity prevention?
7. What barriers do outsiders (researchers or public health practitioners) face when entering a new community? How can they be overcome?
8. How can DIT and CBPR be used together to build coalitions, and then disseminate interventions -- among underserved populations?