Diffusion of Innovation (DOI)

Summary

Like fads in fashion, innovative health products and practices can spread like viruses among members of a social system. New things are more apt to be “contagious” if they: (a) are viewed as an improvement over the status quo but compatible with one’s existing lifestyle or setting, (b) are easy to adopt and can be tried out before a permanent commitment is made, (c) have positive consequences that are clear to an observer, (d) are adopted by cool or respected people first, and (e) are publicized through the right channels to the right people at the right points in the change process. For a while, a slowly increasing trickle of people adopts a new practice or product, but then the rate of adoption suddenly skyrockets. In other words, there is a “tipping point” in the rate of adoption of the practice and its penetration beyond opinion leaders into the mass audience. After reaching that point, diffusion is much easier.

Authors

Everett M. Rogers

Seminal references

Rogers, E.M. Diffusion of Innovation, 5th Edition, New York: Free Press.

Major constructs

Innovation (with characteristics of observability, trialability, complexity, relative advantage & ease of use), Social System (homogeneity or “homophily,” network structure, member roles such as opinion leader, member characteristics such as early vs. late adoption tendencies), Communication Channels (mass media vs. interpersonal), & Time

Examples

Kelly JA, Murphy DA, Sikkema KJ, McAuliffe RL, Roffman RA, Solomon LJ, Winett RA, Kalichman SC (1997). Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet, 350(9090), 1500-1505.

Major advantages

• Diffusion theory is a mature explanation of the natural, grassroots spread of new ideas, products and practices.
• It offers numerous points of entry to interventionists by listing the features that make an innovation more likely to spread, segmenting the audience of potential adopters, and specifying the information channels used by early adopters vs. those used by later adopters.
• DOI theory spurred the “Tipping Point” notion popularized by Malcolm Gladwell. This is a rare explanation of the changes in the rate of adoption of a practice over time within a population.

Major Criticisms

• Argues that a practice dies out when it is modified beyond recognition by users, or when something better comes along to replace it, but there has been little research on such “de-adoption.”
• DOI has not been good at predicting adoption of innovations within organizations where decisions about new practices are made by committees or hierarchies and then mandated.

RE-AIM

RE-AIM or a related framework may be a better conceptual fit when an organization or management group makes a conscious effort to spread a practice (e.g., an evidence-based intervention) among other organizations or subordinates. In other words, Re-AIM may be better than DOI at predicting the success of diffusion attempts that are “top-down” instead of “grassroots opinion leaders-out.”

Resources

National Cancer Institute, Theory at a Glance (see pages 27-29)

University of Twente, Diffusion of Innovation