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The Potential Adopter

The Potential Adopter. The Intersection of Dissemination, Implementation, and Behavior Change Theory. By Ginger Mckay. Dissemination and Implementation. Dissemination of Evidence Based Interventions Used in a variety of areas within health promotion

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The Potential Adopter

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  1. The Potential Adopter The Intersection of Dissemination, Implementation, and Behavior Change Theory By Ginger Mckay

  2. Dissemination and Implementation • Dissemination of Evidence Based Interventions • Used in a variety of areas within health promotion • Example: DEBI project by the CDC for HIV prevention.

  3. Dominant Theories in D and I • Diffusion of Innovation (Rogers, 2003) • Systems Theories • Rogers-Rütten Framework (Bowen et al., 2010) • Interactive Systems Framework (Wandersman et al., 2008 • ADAPT-ITT (Wingood and DiClemente, 2008)

  4. Diffusion of Innovation Theory • 4 components: • The innovation • Communication channel • Time • The social system

  5. Innovations • Advantage • Compatibility • Complexity • Ability to try • Observability *Innovations are assessed by potential adopters.

  6. Interactive Systems Framework • Focus on institutional structures • Focus on agency level capacity Figure 2. The interactive systems framework for implementation and dissemination Wandersman et al. (2008) Bridging the Gap Between Prevention Research and Practice: The interactive systems framework for Dissemination and Implementation. Am J Community Psychol 41:171-181.

  7. ADAPT-ITT • Adaptation of EBIs through the following steps: • Assessment • Decision • Administration • Production • Topical experts • Integration • Training • Testing Adapted from from: Table 1. The ADAPT-ITT Model: Phases and Methodology in Wingood & DiClemente (2008) THE ADAPT-ITT Model. J Acquir Immune DeficSyndr. 47(Supp. 1):40-46.

  8. Short Comings • Focus on structure and context in systems theory • Missing focus on individual factors • Individuals make up the structures and the agencies • Dissemination also requires behavior change as predicted by diffusion theory • Individuals must choose to adopt EBIs • Ignores evidence of individual factors

  9. Incorporating the TTI • In compliment to diffusion theory • Overlap in individual and intra-personal as predicted by diffusion theory • Overlap with other systems theories • Emphasizes the role of multiple streams and levels of influence on the individual.

  10. THE THEORY OF TRIADIC INFLUENCE CULTURAL SOCIAL BIOLOGY/ ENVIRONMENT SITUATION PERSONALITY Interactions w/ Social Instit’s ATTITUDES SOCIAL SELF-EFFICACY TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Levels of Causation Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural Ultimate Underlying Causes 1 2 3 4 5 6 a f Social/ Personal Nexus c d e b Sense of Information/ Interpersonal Others’ Social Self/Control Opportunities Bonding Beh & Atts Competence Distal Predisposing Influences 7 8 9 10 11 12 g r p i q h k n Expectancies & Evaluations m l j o Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies 13 14 15 16 17 18 s x Affect and Cognitions u w v t Proximal Immediate Predictors 19 20 21 Decisions DECISIONS/INTENTIONS A G B H C I D E F 22 Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Experiences K 23 Note: 1. control/affective and cognitive substreams 2. feedback loops 3. Interactions between streams Related Behaviors J

  11. Innovations • Advantage • Compatibility • Complexity • Ability to try • Observability *Innovations are assessed by potential adopters.

  12. Evidence for Individual Factors • Particularly when focusing on training • Hitt et al., 2006 • Misunderstanding of purpose of intervention (Knowledge) • Changes in skills • Changes in perception of the intervention • Desirous of supportive staff (interpersonal bonding  motivation to comply)

  13. Implications • Trainings that involve behavior change principles. • Individual “interventions” for health providers appropriate?

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