Thesis (Ph. D.)--University of Missouri-Columbia, 1996. / Typescript. Vita. Includes bibliographical references (leaves 78-84). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1996. / Typescript. Vita. Includes bibliographical references (leaves 78-84). Also available on the Internet.

Thesis (Ph. D.)--University of Utah, 2003. / Includes bibliographical references (leaves [134]-153).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1993. / Includes bibliographical references (leaves 132-137).

Thesis (Ph. D.)--University of California, Irvine, 1989. / Vita. Includes bibliographical references (leaves 366-371).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1959. / Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Evidence-based medicine calls for the use of current best evidence (together with individual clinical expertise). Guidelines aim to distil such evidence, yet clinical practice often fails to follow guidelines, for multiple reasons that are still not well understood. One under-researched aspect of the gap between guidelines and practice is psychology. My literature review found that the application of psychology to implementation research has been limited, and such research is not well integrated into wider implementation research. In this study, I sought to a) systematically apply psychological theory to understand the different psychological processes in the stages of adoption described in the diffusion of innovations model; b) collect and analyse data to explore and test this new, psychologically-enhanced model of guideline adoption; and c) improve and extend my model in the light of my empirical data. Having populated my proposed framework with potentially relevant psychological theories based on my literature review, I undertook a first assessment of the validity and added value of this proposed theoretical framework through a case study of the implementation of guidance on universal offering of HIV testing in hospitals serving populations meeting the criteria for high HIV prevalence in the catchment population, interviewing 20 healthcare professionals across two sites. My findings broadly supported my proposed theoretical approach, and illustrated relevant psychological theories for different stages of adoption. My findings support two provisional conclusions. First, that there is potential to improve the effectiveness of efforts to implement guidelines by augmenting the widely-used innovation adoption model with specific psychological theories. Second, that policymakers would do well to shift from viewing the health system as a complicated entity that policy can control and direct is misconceived; I recommend shifting to a perspective of the health system as a complex system, and rethinking the role of policy from that perspective.

The use of tobacco has been a known contributing factor in the development of disease and death since the 1960s. Unfortunately, evidence-based tobacco cessation protocol is still not effectively being taught in healthcare curriculum as evidenced by the lack of clinical competencies in many institutions. The purpose of this study was to gain an in-depth understanding of the process dental hygiene program directors use to adopt and implement tobacco dependence information into their curricula. Gaining a clearer idea of how and why dental hygiene faculty diffuse tobacco curriculum may inform future dissemination efforts leading to improved adoption and implementation of evidence-based information in healthcare education. A total of ten, one hour interview data sets of US dental hygiene program directors were chosen for this study. They were selected from a possible 14 interviews collected from a larger research project consisting of 32 one hour interview data sets. A case study research methodology was used to guide the collection of interviews. The Diffusion of Innovation, Five Stages in the Innovation Process in Organizations (Rogers, 2003) was used as the theoretical framework to inform the extraction of themes and patterns. The analysis of interview data revealed that all ten program directors reported a similar process of: learning about tobacco cessation, discussing the topic in a faculty meeting, deciding what class the topic should be taught, and that cessation should be a part of the clinical experience. What was not evident from these interviews was how and why the evidence-based tobacco cessation guideline was reduced from five essential elements to minimal implementation by most of the ten schools. Though the process of how dental hygiene programs learn of and implement tobacco cessation into their curriculum, further research is needed to explore how faculty make decisions on content and level of clinical competencies when new innovations are introduced into their program.

The Supplemental Nutrition Assistance Program (SNAP, previously ‘food stamps’), is the nation’s largest federal entitlement nutritional assistance program which assists individuals and households living below the federal poverty level in order to reduce the amount of money they spend on food. With the conversion of food stamps coupons to Electronic Benefit Transfer (EBT), vendors at farmers markets are unable to accept SNAP benefits due to lack of necessary technology adoption. The number of farmers markets has increased 39 percent since 2010 yet only 21 percent of the nation’s farmers markets are equipped to accept EBT (USDA AMS, 2015a). The purpose of this cross-sectional study was to apply the theory of Diffusion of Innovations (DOI) to explain EBT technology adoption at mid-west farmers markets (Illinois, Michigan, and Wisconsin). This study intended to identify the socio-demographic characteristics and levels of communication of farmers market managers, market compatibilities, and perceived EBT attributes that might influence EBT adoption at farmers markets. A survey was administered electronically to market managers of three mid-west states to collect the necessary information to answer the research objectives. A total of 181 managers completed the survey. Logistic regression analyses were used to identify effects of several variables on EBT adoption. Analysis of Variance and Chi-square test were utilized to compare the states and adopter groups. Results of logistic regression showed significant effects of specific variables on EBT adoption. Market managers’ level of communication (Farmers Market Association membership and having partnerships with other organizations), market characteristics (availability of public transports to the market and number of SNAP recipients living in the area), and market managers’ perceptions of EBT attributes (perceived usefulness, ability to try-out, and acceptability) were statistically significant predictors of EBT adoption. For market managers and organizers who are seeking resources and considering EBT adoption assessment of compatibility and level of communication prior to adoption should be considered. In conclusion, the theory of DOI was able to explain effects of market characteristics, market managers’ level of communication, and perceived attributes of EBT on its adoption among the respondents of mid-west farmers markets. Findings of the study can be useful for policymakers in navigating through financial, human, organizational, and political constraints to develop a reachable goal in providing EBT to farmers markets across the nation. Improving the rate of EBT adoption will ultimately have a positive impact on the health of low-income population and sustainability of local agriculture.

This study explored some of the critical success factors at the individual level for usage of PWS (Personal Web Server) systems. I tested core assumptions from Diffusion of Innovations theory for willingness to use new technology, and use some key concepts from the Technology Acceptance Model to reinforce DOI. I employed concepts of an empirically tested, valid, and reliable scale to measure willingness to use. The literature seems to indicate that information technologies are nearly always crucial to corporate strategy and performance. But there are still great chasms between the recognition of problems and the successful implementation of solutions. Therefore discovering what determines successful attitudes toward usage of such technologies at the individual level is critical to firm performance. There already exists an abundance of literature regarding information technology and various aspects of organizational performance. What was lacking was an analysis of how IT innovations are most productively adopted at the individual level, and how recognition of the critical success factors to usage of these technologies affects attitudes toward using them prior to adoption. In a global and increasingly fast-paced business environment, willingness to use IT innovations and the speed with which they are adopted can significantly affect competitive advantage. This was a theory building and explanatory study with the expressed intent to better understand the individual determinants of the success or failure of an IT innovation at the individual level. I studied PWS systems by employing independent variables of complexity, relative advantage, and trialability from Rogers, and using Davis's behavioral intent to predict willingness to use. The three attributes from Rogers were selected as the most face valid constructs, and Roger's rate of adoption outcome variable was excluded because it was deemed too time sensitive. Rogers's constructs of relative advantage and complexity have been demonstrated to be theoretically the same as Davis's perceived usefulness and perceived ease of use. I believe that the use of these variables effectively explained willingness to use at the individual level in a new way, which in turn is instructive toward organizational attitudes toward innovation. My findings showed that Relative Advantage, Complexity, and Trialability were all predictors of Willingness to Use a new technology. These findings as well as the interesting interactions of some of the independent variables should prove useful to those who seek to understand these phenomena within the crucial context of pre-acquisition of information systems. The intent was to explain Willingness to Use at the individual level in a new way, which in turn is instructive toward organizational attitudes toward innovation. It is my hope that the results of this research will be instructive to researchers, empiricists, and practitioners who are interested in pre-adoptive intents and behaviors.