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.

There is a movement to promote naloxone adoption by law enforcement and other stakeholders in the state of Mississippi. The purpose of this study is to understand how local media are framing the conversation about naloxone products, and to better understand how it might affect naloxone adoption among law enforcement. We searched for news articles published in Mississippi from January 2012 to July 2018 mentioning the words Narcan® and/or naloxone. Four main themes emerged from 25 articles: (a) positive and informative discussion of naloxone, (b) full articles persuading readers to use and/or advocate the use of naloxone, (c) government or organizational effort to increase the availability and use of naloxone products, and (d) negative or misleading information about naloxone. Better efforts to disseminate correct and persuasive information about the drug will have a profound and positive effect on the opioid epidemic in Mississippi and in the United States.

No description available.

No description available.

No description available.

Development discourse emerged from the implicit assumption that the technological achievements and societal organizations of western civilization represent successes of humankind in inhabiting the planet, and should therefore be promoted among other cultures. The ecological threats of this time suggest the contrary, forcing us to reconsider the positiveness of over exploitations of natural resources and to recognize the paradox of the economical growth model. A new urgent meaning for development is that of rediscussing what characterizes an ideal society and enabling the transformation toward sustainability and justice. Among the many challenges that the planet is facing deforestation well represents the reach of the problems since it affects humans at several levels: from the smallest scale of family economy with the products they can directly offer; to the national size through the effect they have on the environmental conditions of countries; and to the global level for the influence over the planet’s climate. In this era of tremendous transformations, demanding the reduction of consumptions for developed countries and appropriate planning of future consumption for developing ones, communication plays a central role. Exchange of information without preferential directions and between different levels (global-local, local-local) is at the base of this process. This study analyses the communication dynamics of a reforestation campaign in Haiti operated by the NGO AMURT. Assuming that the idea of planting trees rather then cutting them can be seen as an innovation, I adopted as a theoretical framework the findings of “Diffusion of Innovation” research. In particular I used the field work to critically assess some of the diffusion model’s findings, especially concerning the characterization of early adopters which I perceived as pro-innovation biased.An analysis of the NGO communication strategy according to diffusion of innovation parameters revealed several positive points, such as the use of homophile change agents, the adaptation of messages to the audience and the characterization of the meaning of the innovation from a receiver’s perspective. Nevertheless, the most important reasons for the success of the program rather seemed to sit in the NGO approach: the relationship of trust, the stability of its presence in the area and the intimate contact and cooperation with the local social structures.

Recently, technology and its impact on aging has become an expanding field of inquiry among marketers, designers, and housing professionals. A major reason for this interest is that the use of technology can help older people who experience deteriorating health to live independently. Another reason stems from an increase in the elderly population. The purpose of this study was to investigate older people's attitudes toward adopting technology as it relates to homes that could improve the quality of life and assist in aging in place. Attitudes were examined in terms of perception and acceptance of residential technology. Data for this study were gathered by an online survey. Online questionnaires were distributed to the potential sample of 9,789 e-mail addresses through the Virginia Tech alumni list serve on February 2004. The response rate was 15.8% with 1,546 eligible responses returned by February 27. The majority of the sample for this study can be described as Caucasian, married men, age 55 to 64 with good or excellent health and a post graduate college education living in owned single-family detached homes. Chi-square, ANOVA, Pearson's correlations, and path analysis were employed to test hypothesized relationships. Nine hypotheses were proposed to examine the relationships of variables based on the research framework. Results from this study cannot be generalized to a national population because of the limitations of the sampling frame. Results, however, are significant in terms of the investigation of early computer adopters who are age 55 and older living independently. Their desire to age in place was not very different from the national population. Findings about the attitudes toward computer and Internet technology indicated that respondents had surprisingly similar attitudes. Age was revealed as an important factor for both the desire to age in place and attitudes toward residential technology as a direct effect. Future research should include people with various demographic backgrounds. In addition, the results of this study imply that differentiated marketing strategies should be recommended to reach older consumers. / Ph. D.

An experiential forest and wildlife management training program, based on the adoption-diffusion model, was conducted for 49 nonindustrial private forestland (NIPF) owners. Participant-owners were surveyed 6 months after their training to monitor adoption and diffusion activity. Owners who were nominated by local natural resources professionals adopted significantly more management innovations than those owners not nominated. Farmers demonstrated the most adoption and diffusion activity, business people the least. Farmers and business people were more oriented towards timber production objectives than others, professionals were more oriented towards wildlife management objectives. An a priori developed predictive opinion-leadership model was not correlated with either adoption or diffusion activity. Owners living less than 8 km from their tract spent significantly more time in dissemination efforts than others, as did those who had voluntarily stated an intrinsic motivation to "share what they learned" upon application to the project. Those owners who had gained extensive knowledge from past contact with natural resource professionals were significantly more active in adoption-diffusion activity than others, and those with self-perceived high interpersonal skills engaged significantly more peer owners in diffusion efforts than did others. Size of forest ownership, time residing in a community, primary objectives for owning forestland, and number of local leadership positions held had no significant effect upon adoption diffusion activity by NIPF owners. A significant and negative correlation was found between an owner's self-perceived level of education and one-onone diffusion outreach activity. NIPF owners were generally ambivalent about involvement in informal resource management clubs. It is suggested that future educational projects conducted for NIPF owners be scheduled for late winter or spring versus the fall season, particularly if a short (6 mo.) monitoring of adoption and diffusion activity is a constraint. This investigator hypothesizes that the same methodology used in this study of adoption-diffusion behavior of NIPF owners would be effective in instructing opinion-leading, professional change agents about adoption diffusion theory and techniques. / Master of Science

The present study used regression procedures to investigate the relationships between selected communication variables and innate innovativeness. The three general types of variables examined in this study were communication anxiety, communicator style, and selfdisclosiveness. Ten hypotheses were tested together with a descriptive model which was based on the communication variables and their ability to predict innate innovativeness. Results of the tests of the model were confirmed as were the ten hypothesized relationships. The results of the regression analyses performed on the data indicated that receiver apprehension and honesty of self-disclosiveness were negatively and positively associated with innate innovativeness respectively, and were the variables which most significantly impacted the variance of innate innovativeness scores.