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

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)

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

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.

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

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

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.

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

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.

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.

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.

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

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

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

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

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)

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

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

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

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: http://www.cbprcurriculum.info/

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?