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