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Table 2 Diffusion of innovation: organization and individual patient level processes

From: On-site bundled rapid HIV/HCV testing in substance use disorder treatment programs: study protocol for a hybrid design randomized controlled trial

Diffusion of innovation (on-site bundled rapid HIV/HCV testing strategy) process in substance use disorders treatment programs Innovation-decision process at the individual patient level
Stages Description Sample of questions guiding each stage Steps Description Sample of factors guiding each step
Agenda setting Identifying organizational challenges that create a need to increase HIV/HCV testing and receipt of test results among patients What is the primary motivation to adopt a bundled rapid testing strategy? Knowledge Patients are introduced to a bundled rapid testing strategy but do not have detailed information about it Patient knowledge of what bundled rapid testing is, how it works, and why it is beneficial.
Matching Identifying how the bundled HIV/HCV testing strategy addresses the organizational challenge What problem or need in the program matches a bundled rapid testing strategy? Persuasion To what extent are patients interested in bundled rapid testing, linkage to care, and further information? Concerns of positive results for one or both HIV/HCV, timing and readiness to test, apathy, and risk perceptions
Redefine/restructure Modifying a new testing and linkage strategy to fit the organization and reconfigure organizational structures How would the program operationalize the decision to adopt bundled rapid testing? How would structures be modified to fit the strategy? Decision Patients consider advantages and disadvantages and decide to accept bundled rapid testing or not Discovery of results on engagement in drug treatment. Concerns about confidentiality, access to treatment if HIV- and/or HCV-positive
Clarifying Stabilizing of the relations among the testing, post-test counseling, and linkage strategies and the organization What infrastructures would support diffusion? How would the testing strategy be reinvented, if at all? Implementation Patients accept bundled rapid testing and determine usefulness of the strategy. Preferred testing method, concerns about test accuracy, wait time for results, and counseling
Routinizing Making bundled rapid HIV/HCV testing, post-test counseling, and linkage services a normal part of the organization’s activity. Could bundled rapid testing become part of a program’s routine? What are the indicators that support the potential for routinizing? Confirmation Patients finalize decision to continue to use bundled rapid testing strategy, initiate, and continue care. Additional information that may influence the decision to use or not use the strategy in the future