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Article

Jo Holliday, Suzanne Audrey, Rona Campbell, and Laurence Moore

Addictive behaviors with detrimental outcomes can quickly become embedded in daily life. It therefore remains a priority to prevent or modify these health behaviors early in the life course. Diffusion theory suggests that community norms are shaped by credible and influential “opinion leaders” who may be characterized by their values and traits, competence or expertise, and social position. With respect to health behaviors, opinion leaders can assume a variety of roles, including changing social norms and facilitating behavioral change. There is considerable variation in the methods used to identify opinion leaders for behavior change interventions, and these may have differential success. However, despite the potential consequences for intervention success, few studies have documented the processes for identifying, recruiting, and training opinion leaders to promote health, or have discussed the characteristics of those identified. One study that has acknowledged this is the effective UK-based ASSIST smoking-prevention program. The ASSIST Programme is an example of a peer-led intervention that has been shown to be successful in utilizing opinion leaders to influence health behaviors in schools. A “whole community” peer nomination process to identify opinion leaders underwent extensive developmental and piloting work prior to being administered in a randomized trial context. Influential students were identified through the use of three simple questions and trained as “peer supporters” to disseminate smoke-free messages through everyday conversations with their peers. In response to a need to understand the contribution of various elements of the intervention, and the degree to which these achieve their aim, a comprehensive assessment of the nomination process was conducted following intervention implementation. The nomination process was successful in identifying a diverse group of young people who represented a variety of social groups, and whom were predominantly considered suitable by their peers. The successful outcome of this approach demonstrates the importance of paying close attention to the design and development of strategies to identify opinion leaders. Importantly, the involvement of young people during the development phase may be key to increasing the effectiveness of peer education that relies on young people taking the lead role.

Article

Diffusion is the process through which new ideas, technologies, products, or processes are spread through communication among members of a social system via communication channels over time. Diffusion is a specialized form of communication that focuses on disseminating information about new ideas, products, technologies, services, or regulations. It is an especially important form of communication because it promotes social progress in the evaluation and adoption of important new ideas to address social issues. Diffusion helps to reduce uncertainty about how to address difficult issues and provides direction for achieving social goals. A large body of research has been conducted from many disciplines on the diffusion of innovations since the original publication of Everett M. Rogers’ seminal book The Diffusion of Innovations in 1962, which is now in its fifth edition (2003). In this book, he introduced the Diffusion of Innovations (DOI) model, which describes a general process of adopting new ideas across multiple populations, cultures, and applications. This research has examined innovations in fields such as agriculture, engineering, sales, education, architecture, technology, public policy, and health care, and has been applied to a range of different issues, such as the adoption of new technologies, consumer purchasing behaviors, and public support for political issues and candidates, but has been especially influential in guiding strategic health promotion. The DOI model has contributed to a greater understanding of health behavior change, including adoption of health promotion recommendations. The model has led to a broad scope of practical applications for promoting public health.

Article

Behavioral journalism is a term used to describe a theory-based health communication messaging strategy that is based on conveying “role model stories” about real people and how they achieve healthy behavior changes. The aim is to stimulate imitation of these models by audiences of their peers. Theoretical foundations for the strategy itself are in Albert Bandura’s social cognitive theory and Everett Rogers’s model of diffusion of innovations, but it can be used flexibly to convey various kinds of theory-driven message content. Behavioral journalism emerged as an explicit health communication technique in the late 1970s and was developed as a distinct alternative to the social marketing approach and its focus on centrally generated messages devised by experts. It has been used subsequently to promote smoking cessation, improvements in nutrition and physical activity, avoidance of sexually transmitted diseases and unplanned pregnancy, reduced intergroup hostility, advocacy for healthy policy and environmental changes, and many other diverse health promotion objectives. Formats used for behavioral journalism include reality television programs, broadcast and print news media, printed newsletters for special audiences, documentary film and video, digital and mobile communication, and new social media. Behavioral journalism is intended for use in concert with community organization and actions to prompt and reinforce the imitation of role models and to facilitate and enable behavior change, and its use in that context has yielded many reports of significant impact on behavior. With citations of use growing steadily in the past two decades, behavioral journalism has proven to be readily adaptable to new and emerging communication technologies.

Article

Public service announcements (PSAs) emerged after World War II in the United States as a promising strategy for increasing awareness of important social issues and changing beliefs, attitudes, and behavior. Research at that time showed that PSA campaigns had limited success in changing attitudes and behavior. Even so, both in the U.S. and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change. In the 1980s, a more informed view of what PSAs can achieve began to emerge as practitioners of social marketing demonstrated that media campaigns can produce behavior change when they are designed and executed according to the principles and best practices followed by the advertising industry. Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common. Research has shown that such campaigns can play a key role in shaping the public agenda, changing perceptions of social norms, reinforcing school- and community-based programs, and building support for and then publicizing changes in public policy, all of which can foster individual behavior change. PSAs and other media executions are best designed using a planning scheme that is grounded in advertising best practices and behavior change theory and that uses those media executions as part of a broader intervention effort. These various elements can be brought together by using a media planning guide that outlines how the campaign will work in sync with other intervention activities and what its key messages will be. In the United States, federal regulations that outlined broadcasters’ public service obligations were loosened in the 1980s, making it increasingly difficult to get donated time for PSAs and other public service messages. More broadly, the increased focus of broadcasters, cable networks, and print publications on generating revenue has magnified this problem. Faced with strong competition, campaign planners need a strategy for convincing media gatekeepers to give priority to their messaging. The rise of social media (e.g., Facebook, Instagram, Twitter) has opened up a new means of putting PSAs before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups. Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts and that eventually the message will “go viral.” PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.