Diffusion of Innovations Theory
by Malyse Uwase
The Diffusion of Innovation (DOI) Theory explains the adoption process of a new idea, product, or practice by a community (1). Diffusion, in particular, defines the process through which members of a society communicate an innovation using specific channels over a certain period of time (2). According to this theory there are multiple steps that occur before a new product, practice, or idea is accepted by the critical mass of the population. The degree of acceptance is based on five adoption categories: innovators, early adopters, early majority, late majority, and laggards (3). Initially only a few people (innovators) accept the innovation and they gradually spread word on the product, idea, or practice until the other adoption categories accept it. The diffusion process is complete when the laggards have accepted the innovation (Figure 1) (3).
Figure 1. Adoption Categories in the Diffusion of Innovations Theory (Image from Boston University School of Public Health [Internet]. Behavioral Change Models Diffusion of Innovation Theory. 2013 [cited 2015 Apr 26]. Available from: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models4.html).
With DOI, in order for a new product, practice, or idea to be successful and become accepted by the population it has to respond to the needs of the five categories of adopters (1). Consequently understanding the various characteristics of the adoption categories in a community and how these might hinder or encourage an innovation is crucial in the DOI model (3). Additionally, it is important to pay attention to five steps that happen at the individual level before a person adopts a new product or idea: knowledge, persuasion, decision, implementation, and confirmation (2). It is at the implementation level that behavior change occurs as the individual decides to practice or not practice the new idea having gone through the knowledge, persuasion, and decision stages. As a result the model is also connected to behavior change and in particularly to three steps: commencement, cessation, and adoption (2).
Figure 2. Change Process at the Individual Level.
Research on the Diffusion of Innovation Theory began with the German-Austrian and British schools of diffusionism in anthropology (4). Then Gabriel Tarde, a French sociologist, extended the research by introducing the s-shaped curve and the concept of opinion leaders (trend setters) in 1903 to illustrate the gradual diffusion process (Figure 3) (1). In 1943, Bryce Ryan and Neal Gross added to the theory the concept of adopter categories, the role of information sources, and emphasized the importance of awareness in order for the adoption of a new idea to occur (1, 4). Their findings were based on a study on the introduction of hybrid corn among Iowa farmers (1). Today the theory is a combination of these findings and Everett Rogers’ Innovation-Decision process that introduced the previously discussed five steps of change at the individual level.
Figure 3. Diffusion Process (Image from Kaminski, J. Diffusion of Innovation Theory. J Can Nursing Info [Internet]. 2011 [cited 2015 Mar 17]; 6(2). Available from: http://cjni.net/journal/?p=1444)
Application in Global Health:
Public health relies on the successful communication of health messages and behavioral change to improve the wellness of populations (2). Globally, the DOI model facilitates the customization of public health innovations to meet the needs of various communities. The model is very useful in understanding the differences in the reception (positive or negative) of crucial health innovations such as the practice of drinking boiled water in places where there is no access to clean water (3). Recently, applications of DOI in global health have included the study of HIV/AIDS prevention programs, the use of antibiotic drugs and the implementation of family planning programs (3, 5).
There are some challenges associated with the DOI model and its applicability in public health. First although DOI is used in public health it does not have its foundation in this sector (3). Second it does not emphasize a participatory approach because the theory’s intrinsic goal (to achieve the adoption of an innovation) often takes precedence over this approach (3). Third it is uniquely tailored towards adoption and it is not suitable for cessation or prevention of behaviors (3). Fourth it has a strong pro-innovation bias as it is based on the assumption that everyone should adopt an innovation regardless of the ability to do so (3, 4). These are common challenges that for example were noted with the use of DOI to promote family planning services globally (6). Limitations identified--in this public health campaign--included the abuse of power to get women to use family planning services, a lack of understanding of the role of gender and economic class in access to family planning services, and a vertical implementation that ignored other reproductive health needs for women (6). These are challenges that were a result of the lack of participatory approaches, a pro-innovation bias, and a focus on adoption.
(1) Kaminski, J. Diffusion of Innovation Theory. J Can Nursing Info [Internet]. 2011 [cited 2015 Mar 17]; 6(2).Available from: http://cjni.net/journal/?p=1444
(2) Muhiuddin H., Kreps GL. Forty Years of Diffusion of Innovations: Utility and Value in Public Health. J Heal Comm [Internet]. 2004 [cited 2015 Mar 17];9:3-11. Available from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/14960400
(3) Boston University School of Public Health [Internet]. Behavioral Change Models Diffusion of Innovation Theory. 2013 [cited 2015 Apr 26]. Available from: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models4.html
(4) Valente TW, Rogers EM. The Origins and Development of the Diffusion of Innovations Paradigm as an Example of Scientific Growth. Sci Comm [Internet]. 1995 [cited 2015 Mar 17]; 16(3):242-243. Available from Sage Journals: http://scx.sagepub.com/content/16/3/242.short
(5) Rogers EM. New Product Adoption and Diffusion. J of Consum Research [Internet]. 1976 [cited 2015 Mar 17]; 2 (4). Available from JStor: http://www.jstor.org/stable/pdf/2488658.pdf
(6) Murphy, E. Diffusion of Innovations: Family Planning in Developing Countries. J Health Commun [Internet]. 2004 [cited 2015 Apr 26]; 9 123-129. Available from: http://web.b.ebscohost.com.ezproxy.bu.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=36cee57e-08a9-49bf-8d6e-c5400d3231b0%40sessionmgr113&hid=115