Diffusion of innovations theory for alcohol, tobacco, and drugs.
The applications of the diffusion of innovations theory in public health, health promotion, and health education began with immunization campaigns and family planning programs. Its application in alcohol, tobacco, and drugs can be seen at two levels. The first level pertains to adoption and diffusion of the habit of using alcohol, tobacco, and drugs. The second level pertains to diffusion of successful interventions pertaining to prevention and control of alcohol, tobacco, and drugs. Ferrence (2001) calls these two levels "natural" or spontaneous as in the unplanned diffusion of drugs in a given population and "planned" as in the case of interventions. It is the latter level that our readers would be especially interested. Ebrahim and colleagues (2007) advocate in present times the need for faster diffusion of interventions at a global level with regard to five modifiable risk behaviors of alcohol consumption, tobacco use, overweight and obesity, low fruit and vegetable consumption, and physical inactivity.
Simons-Morton and colleagues (1997) have advocated the use of diffusion of innovations theory in prevention of alcohol, tobacco and drug use. Several interventions in the area of alcohol, tobacco, and drugs have used diffusion of innovations theory for their dissemination. One intervention is the Smart Choices, a school-based tobacco prevention program (Brink, Basen-Engquist, O'Hara-Tompkins, Parcel, Gottlieb, Lovato, 1995; Parcel et al., 1995). It was found that adoption of the program was increased in the intervention districts, and teacher attitudes and organizational factors were responsible for adoption. A unique feature of this study is that it combined social cognitive theory (Bandura, 1986) with diffusion of innovations theory.
Another example of application of diffusion of innovations theory is the dissemination of Centers for Disease Control and Prevention's school guidelines to prevent tobacco use and addiction to state education agencies (McCormick & Tompkins, 1998). It was found that diffusion process requires planned change over time through several communication channels.
In North Carolina an experimental study was done in 22 school districts to ascertain the extent of implementation of school-based tobacco prevention curricula being disseminated based on diffusion of innovations model (McCormick, Steckler, & McLeroy, 1995). The study found that larger organizational size and teacher training were strongest predictors of curricula implementation.
Ferrence (1996) notes several applications of diffusion of innovations theory in tobacco prevention such as limiting exposure to environmental tobacco smoke, diffusion of smoking cessation programs among physicians, and diffusion of policies regarding tobacco control among public health agencies. Rohrbach and colleagues (1996) also advocate use of diffusion of innovations theory to adoption and implementation of alcohol, tobacco, and drugs prevention programs in schools
However, there are some limitations to the diffusion of innovations theory that researchers must consider. First, public health interventions are preventive in nature where the individual has to adopt the new idea today to avoid the likelihood of a negative consequence at a later date. For example, a smoker would need to quit smoking today to prevent development of lung cancer 20 or so years later. Such a long interval poses special challenges and diffusion occurs more slowly (Rogers, 2002). It needs to be kept in mind that diffusion of innovations in health is a complex process that occurs at multiple levels, across many different settings, and utilizes different strategies (Parcel, Perry, & Taylor, 1990).
Second, oftentimes in health promotion and health education the interventions have to be designed for lower socio-economic groups, people with low literacy levels and other vulnerable sections of the community. The adoption and diffusion process occurs easier and smoother in the wealthier and highly educated while in the vulnerable sections it is not as smooth and offers a number of challenges and barriers. As a consequence the gap between those who have and those who do not have widens even farther.
Finally, an issue with the diffusion of innovations theory is what is called pro-innovation bias (Rogers, 2003). This refers to the connotation that an innovation should be diffused and adopted by all members and in a rapid manner without rejection or reinvention. This is often not possible with many of the health promotion and education objectives. For example, with quitting smoking it is virtually impossible at present to think that no one will smoke. Rogers (2003) suggests conducting research while the innovation is still being adopted rather than waiting for it to be completely adopted, studying unsuccessful innovations, and examining the broader context in which an innovation diffuses.
On the whole the diffusion of innovations is a robust theory. More researchers must utilize it in prevention of alcohol, tobacco and drug use.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.
Brink, S. G., Basen-Engquist, K. M., O'Hara-Tompkins, N. M., Parcel, G. S., Gottlieb, N. H., Lovato, C. Y. (1995). Diffusion of an effective tobacco prevention program. Part I: Evaluation of the dissemination phase. Health Education Research, 10(3), 283-295.
Ebrahim, S., Garcia, J., Sujudi, A., & Atrash, H. (2007). Globalization of behavioral risks needs faster diffusion of interventions. Preventing Chronic Disease. Retrieved September 4, 2007, from http://www.cdc.gov/pcd/issues/2007/apr/06_0099.htm
Ferrence, R. (2001). Diffusion theory and drug use. Addiction, 96(1), 165-173.
Ferrence, R. (1996). Using diffusion theory in health promotion: The case of tobacco. Canadian Journal of Public Health, 87 (Suppl. 2), S24-27.
McCormick, L. K., Steckler, A. B., McLeroy, K. R. (1995). Diffusion of innovations in schools: A study of adoption and implementation of school-based tobacco prevention curricula. American Journal of Health Promotion, 9(3), 210-219.
McCormick, L., & Tompkins, N. O. (1998). Diffusion of CDC's guidelines to prevent tobacco use and addiction. Journal of School Health, 68(2), 43-45.
Parcel, G. S., O'Hara-Tompkins, N. M., Harrist, R. B., Basen-Engquist, K.M., McCormick, L. K., Gottlieb, N. H., & Eriksen, M. P. (1995). Diffusion of an effective tobacco prevention program. Part II: Evaluation of the adoption phase. Health Education Research, 10(3), 297-307.
Parcel, G. S., Perry, C. L., & Taylor, W.C. (1990). Beyond demonstration: Diffusion of health promotion interventions. In N. Bracht (ed.), Health promotion at the community level. Thousand Oaks, CA: Sage Publishers.
Rohrbach, L. A. D'Onofrio, C. N., Backer, T. E., & Montgomery, S. B. (1996). Diffusion of school-based substance abuse prevention programs. American Behavioral Scientist, 39, 919-934.
Rogers, E. M. (2002). Diffusion of preventive interventions. Addictive Behaviors, 27, 989-993.
Rogers, E. M. (2003). Diffusion of innovations. (5th ed.). New York: Free Press.
Simons-Morton, B. G., Donohew, L., & Crump, A. D. (1997). Health communication in the prevention of alcohol, tobacco, and drug use. Health Education & Behavior, 24(5), 544-554.
Manoj Sharma, MBBS, CHES, Ph.D.
Editor, Journal of Alcohol & Drug Education & Amar Kanekar, MBBS, MPH
University of Cincinnati
526 Teachers College
PO Box 210068
Cincinnati, OH 45221-0068
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|Author:||Sharma, Manoj; Kanekar, Amar|
|Publication:||Journal of Alcohol & Drug Education|
|Date:||Apr 1, 2008|
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