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Diffusion of Innovations: A Reference Guide

The most widely recognized source for diffusion of innovations (DOI) theory is Everett M.
Rogers seminal work, Diffusion of Innovations, in which he synthesized studies that examined
how innovations diffuse (spread) and become adopted (put into practice). He further refined the
DOI theory through ongoing research. Since the 1950s, other researchers joined him in
developing concepts in the model. DOI is used in many disciplines including sociology,
anthropology, public health, advertising, marketing, education and nursing.

The 5 components of the DOI model

1. Diffusion is the process by which an innovation is communicated through certain
channels over time by members of a social system.
2. An Innovation is an idea, practice, or object perceived as new by an individual or
organization.
3. Innovations are adopted through Communication Channels, a process in which
participants create and share information in order to reach a mutual understanding.
4. Time-an innovation is adopted over a period of time. Some innovations will be adopted
more quickly than others.
5. The Social System is a set of interrelated units engaged in joint problem solving to
accomplish a common goal. Since diffusion of innovations takes place in the social
system, it is influenced by the social structure of the social system.
There are 2 types of innovations: preventive and incremental. A preventive innovation is a
new idea that an individual adopts to lower the probability of some unwanted future event.
Preventive innovations usually have a slow rate of adoption so their relative advantage is more
uncertain. Incremental innovations provide beneficial outcomes that can be seen or measured in
a short time period and tend to be adopted more quickly.
Diffusion of innovations is a social process that relies on different communication
mechanisms. Diffusion is a specific kind of communication and includes these elements: an
innovation, 2 or more people, and communication channels.
There are 2 primary types of communication channels: Mass media channels include
public media (TV, radio, newspapers, magazines, posters, billboards). Interpersonal channels
consist of 2-way communication between individuals and are more influential in change strong
attitudes. Mass media channels are more influential at the knowledge stage (reducing
uncertainty about the innovation, providing specific information about how the innovation works)
and interpersonal channels are more important at the persuasion stage (promoting a positive
opinion about the innovation and a favorable intention to adopt) in the innovation-decision
process.

This Guide will address 4 key Diffusion of Innovation topics:

Part 1:
Part 2:
Part 3:
Part 4:
Part 5:

The Innovation-Decision Process and 5 stages of Adoption

The S-Shaped Curve
Attributes of the Innovation
Adopter Categories
How to use DoI in nursing practice

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References
Part 1: The Innovation-Decision Process and 5 Stages of Adoption
Rogers described the innovation-decision process as an information-seeking and
information-processing activity, where an individual is motivated to reduce uncertainty about the
advantages and disadvantages of an innovation. The innovation-decision process involves 5
steps: (1) knowledge, (2) persuasion, (3) decision, (4) implementation, and (5) confirmation.
These stages typically follow each other in a time-ordered manner.

Figure 1: The 5 Stages in the Innovation-Decision Process (Rogers, 2003)

The Knowledge Stage
The innovation-decision process starts with the knowledge stage where an individual
learns about the existence of innovation and seeks information about the innovation by asking
these questions: what?, how?, and why? The individual attempts to determine what the
innovation is and how and why it works. These questions form 3 types of knowledge: (1)
awareness-knowledge, (2) how-to-knowledge, and (3) principles-knowledge.
Awareness-knowledge: represents the knowledge of the innovation which can motivate
the individual to learn more about the innovation (how and why it works) and, eventually, to
adopt it. How-to-knowledge: contains information about how to use an innovation correctly. This
is as an essential step in the innovation-decision process. To increase the adoption, an
individual should have sufficient how-to-knowledge prior to the trial of the innovation. This
knowledge is more critical for complex innovations.

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Principles-knowledge: describes how and why an innovation works. An innovation can
be adopted without this knowledge, but the misuse of the innovation may cause its
discontinuance. One of the biggest barriers to use of new ideas in practice is a lack of a vision
of why or how to integrate use of the new practice into real life.
To create new knowledge, technology education and practice should provide not only a
how-to experience but also a know-why experience. In fact, an individual may have all the
necessary knowledge, but this does not mean that the individual will adopt the innovation
because the individuals attitudes also shape the adoption or rejection of the innovation.
The Persuasion Stage
The persuasion step occurs when the individual has a negative or positive attitude
toward the innovation, but the formation of a favorable or unfavorable attitude toward an
innovation does not always lead directly or indirectly to an adoption or rejection. The individual
shapes his or her attitude after he or she knows about the innovation, so the persuasion stage
follows the knowledge stage in the innovation-decision process. Rogers states that the
knowledge stage is more cognitive- (or knowing-) centered, and the persuasion stage is more
affective- (or feeling-) centered. The individual is more involved with the innovation at the
persuasion stage.
The degree of uncertainty about the innovations functioning and the social
reinforcement from others (colleagues, peers) affect the individuals opinions and beliefs about
the innovation. Close peers subjective evaluations that reduce uncertainty about the innovation
and its outcomes are usually more credible to the individual. While information about a new
innovation is available from experts and scientific evaluations, people usually seek endorsement
from trusted friends or colleagues whose subjective opinions are more convincing.
The Decision Stage
At the decision stage, the individual chooses to adopt or reject the innovation. If an
innovation has a partial trial basis, it is usually adopted more quickly, since most individuals first
want to try the innovation in their own situation and then come to an adoption decision. The
vicarious trial (you see someone else doing or using the innovation) can speed up the
innovation-decision process. However, rejection is possible in every stage of the innovationdecision process.
Rogers expressed two types of rejection: active rejection and passive rejection. In an
active rejection situation, an individual tries an innovation and thinks about adopting it, but later
he or she decides not to adopt it. A discontinuance decision, which is to reject an innovation
after adopting it earlier, may be considered as an active type of rejection. In a passive rejection
(or non-adoption) position, the individual does not think about adopting the innovation at all.
The Implementation Stage
At the implementation stage, an innovation is put into practice. However, an innovation
brings the newness in which some degree of uncertainty is involved in diffusion. Uncertainty
about the outcomes of the innovation still can be a problem at this stage. Thus, the implementer
may need technical assistance from change agents and others to reduce the degree of

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uncertainty about the consequences. Moreover, the innovation-decision process will end, since
the innovation loses its distinctive quality as the separate identity of the new idea disappears.
Reinvention usually happens at the implementation stage, so it is an important part of this stage.
Reinvention is the degree to which an innovation is changed or modified by a user in the
process of its adoption and implementation. The more reinvention takes place, the more rapidly
an innovation is adopted and becomes institutionalized.
The Confirmation Stage
The innovation-decision already has been made, but at the confirmation stage the
individual looks for confirming support for the decision. This decision can be reversed if the
individual is exposed to conflicting messages about the innovation. Depending on the support
for adoption of the innovation and the attitude of the individual, later adoption or discontinuance
can occur.
Discontinuance may occur in 2 ways: 1) the individual rejects the innovation to adopt
another innovation perceived as better-called replacement discontinuance; or 2) the individual
rejects the innovation because of dissatisfaction with its performance or it does not meet the
individuals needs-called disenchantment discontinuance. In both cases, relative advantage is
not perceived.
Part 2: The S-Shaped Curve
Diffusion theory studies indicate that all innovations result in a S-shaped curve, which
indicates the rate/pattern of adoption of an innovation over time. This curve also illustrates
critical mass or the tipping point for an innovation. Once a critical mass of people decides to
adopt an innovation, further adoption by others takes off more rapidly.
The slope of the curve reflects the speed of adoption: some innovations are more slowly
adopted and the slope will be more gradual and flat. Peaked slopes indicate rapid adoption.
Some innovations of course are not adopted.

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Figure 2: The S-shaped curve for the adoption of innovations

Part 3: The Attributes of the Innovation

Rogers (2003) described the innovation-diffusion process as an uncertainty reduction
process, and he proposes attributes of innovations that help to decrease uncertainty about the
innovation. Attributes of innovations includes five characteristics of innovations: (1) relative
advantage, (2) compatibility, (3) complexity, (4) trialability, and (5) observability. The DOI model
suggests that perceptions of these characteristics predict the rate of adoption of innovations.
Rogers defined the rate of adoption as the relative speed with which an innovation is
adopted by members of a social system. For instance, the number of individuals who adopted
the innovation for a period of time can be measured as the rate of adoption of the innovation.
The perceived attributes of an innovation are significant predictors of the rate of adoption.
Rogers reported that 49-87% of the variance in the rate of adoption of innovations is explained
by these 5 attributes. In addition to these attributes, the innovation-decision type (optional,
collective, or authority), communication channels (mass media or interpersonal channels), social
system (norms or network interconnectedness), and change agents may increase the rate of
adoption.
Relative Advantage
Defined as the degree to which an innovation is perceived as being better than the idea
it supersedes. The cost and social status motivation aspects of innovations are elements of
relative advantage. To increase the rate of adopting innovations and to make relative advantage
more effective, direct or indirect incentives may be used to support or motivate individuals in
adopting an innovation. According to Rogers, relative advantage is the strongest predictor of the
rate of adoption of an innovation.
Compatibility
Compatibility is the degree to which an innovation is perceived as consistent with the
existing values, past experiences, and needs of potential adopters. A lack of compatibility
negatively affects adoption. The naming of the innovation is important and should be meaningful
(and compatible) with its purpose and needs of the adopter, and its meaning should be clear.
Complexity
Defined as the degree to which an innovation is perceived as relatively difficult to
understand and use. Opposite to the other attributes, complexity is negatively correlated with
the rate of adoption. Thus, excessive complexity of an innovation is an important obstacle in its
adoption.
Trialability
Defined as the degree to which an innovation may be experimented with on a limited
basis, and is positively correlated with the rate of adoption. The more an innovation is tried, the
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faster it is adoption is. Reinvention may occur during the trial, where modifications are made to
improve the fit or acceptance of the innovation. Another important factor is the vicarious trial,
where the innovation can be observed by others during a trialthis is especially helpful for later
adopters.
Observability
Defined as the degree to which the results of an innovation are visible to others. Role
modeling (or peer observation) is the key motivational factor in the adoption and diffusion of
technology. Observability also positively correlated with the rate of adoption of an innovation.
In summary, innovations offering more relative advantage, compatibility, simplicity,
trialability, and observability are adopted faster. Rogers cautions that, getting a new idea
adopted, even when it has obvious advantages, is difficult. Often, new ideas or care practices,
even when obviously better than the status quo, may not be adopted even among those likely to
benefit most. The DOI model describes various factors and conditions that are influential in the
adoption process. The characteristics of the innovation are often overlooked in regards to the
extent to which they may have adverse or unfavorable effects or be perceived unfavorably
among certain individuals or groups. A good idea to one person may be the worst idea to
another, for valid or defensible reasons.
Part 4: Adopter Categories
Adopter categories are the classifications of members of a social system on the basis of
innovativeness. This includes innovators, early adopters, early majority, late majority, and
laggards. A persons innovativeness is described as a relatively-stable, socially-constructed,
innovation-dependent characteristic that indicates an individuals willingness to change his or
her familiar practices. This means that a person may be an early adopter for one type of
innovation, and a later adopter for another. It is not an innovativeness personality trait.
Innovators
Innovators are willing to experience new ideas and cope with the uncertainty and
consequences of innovations. Innovators are gatekeepers who bring innovations in from outside
of the system. They may not be respected or trusted by other members of the social system
because of their venturesomeness and relationships outside the social system.
Early Adopters
Early adopters tend to hold leadership roles in the system, others look to them for advice
or information. They play a central role at every stage of the process, particularly in deploying
the resources needed to implement. As role models, early adopters attitudes toward
innovations are important. Their opinions reach others and influence their decisions. Early
adopters reduce uncertainty and put their stamp of approval on the innovation by adopting it.
Early Majority
Early majority tend to have a good interaction with other members of the social system,
but may not have the leadership role that early adopters have. However, their interpersonal
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networks are still important in the innovation-diffusion process. They are more deliberate in
adopting an innovation and are neither the first nor the last to adopt it.
Late Majority
The late majority includes 1/3 of all members of the social system who wait until most of
their peers adopt the innovation. Although they are skeptical about the innovation and its
outcomes, economic necessity and peer pressure may lead them the adoption. To reduce
uncertainty and convince of the safety and effectiveness of an innovation, interpersonal
networks of close peers can be persuasive of the late majority to adopt.
Laggards
Laggards have a more traditional view about change and are more skeptical about
innovations. They are a more localized group and are not in leadership roles -their relationships
are mostly contained within a small peer group. They are conservative and want to be sure an
innovation works before they adopt it. Laggards tend to adopt after seeing others use the
innovation.

Figure 3: The 5 Adopter Categories

The adopter attributes are useful in recognizing and acknowledging the different ways in
which individuals respond to change, however, efforts to pigeon-hole individuals into adopter
categories is not helpful since there can be variability in the extent to which a person may be
more favorable to change or to a new idea or practice depending on what it is. Ones prior
experience, values and beliefs and view of the helpfulness of the new idea or practice may be
influential. A wait and see attitude is not always negative or an indication of resistance or
laggard-type behavior, but is a thoughtful approach to weighing risks/losses and benefits. These
cautionary perspectives can provide some balance to the development and implementation of
new ideas and care practices by providing pressure for a more comprehensive evaluation and
determination of barriers or negative consequences that if resolved, would lead to better ways to
use the idea or implement the new care practice. However, rarely, there are some individuals
who consistently convey dispositions characterized as innovators or laggards and attention to
these ends of the spectrum can prevent over-zealous implementation of new ideas that may not
have a good fit (as advocated by innovators or early adopters), and alternatively, the stalling or
undermining of needed new ideas or care practices (as manifested by laggards).

D.Lekan, Duke University School of Nursing, 2008

Part 5: How to us DOI in nursing practice

The fundamental idea of DOI centers on the conditions which increase or
decrease the likelihood that a new idea, product, or practice will be adopted by members of a
given social system. Diffusion of innovation theory predicts that media as well as interpersonal
contacts provide information and influence opinion and judgment. In summarizing studies of
diffusion, Rogers (1995) proposed four components: the innovation or invention, diffusion (or
communication) through the social system, time and consequences. The information flows
through networks. The nature of the social relationships and communication patterns within and
between networks are influential as are the roles opinion leaders, change agents and
champions. Opinion leaders can determine the likelihood that an innovation or new care
practice will be adopted by endorsing and promoting it. Opinion leaders, change agents and
champions exert influence on others in the social system and their behavior through their
personal contact. Five adopter categories are innovators, early adopters, early majority, late
majority, and laggards, and in the DOI model, these adopter types are normally distributed
suggesting that there are a few innovators and a few laggards, and the majority are early or late
adopters, who can be effectively persuaded if the innovation attributes are favorable (relative
advantage, compatibility, complexity, trialability, observability).
The DOI model provides a framework for evaluating innovations and planning diffusion
strategies that facilitate the adoption of new ideas, practices or technologies/objects. Strengths
of the model include 1) the ability to determine potential barriers and facilitators in the
evaluation, perception, and adoption of new ideas or care practices, 2) the ability to view a
planned change effort through a holistic perspective that takes into consideration the importance
and influence of the individual, system, and communication patterns within the system and the
characteristics of the innovation, 3) the framework relates to other conceptual models of r
change and social science and behavior theories, but is constituted into a coherent model that
can be used easily and effectively in practice for developing strategic initiatives that are
empirically and theoretically based, and 4) it has had successful widespread use across
different disciplines and there are a simple set of core ideas that are easily conveyed, thus
making the model practical, relevant, and useful in clinical practice.

References
Rogers, E.M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.
The Turkish Online Journal of Educational Technology - TOJET April 2006 ISSN: 1303-6521
Volume 5, Issue 2, Article 3. Detailed Review of Rogers Diffusion of Innovations theory
and educational technology-related studies based on Rogers theory. Iowa State
University. Ismail SAHIN isahin@iastate.edu, http://www.tojet.net/articles/523.htm

http://www.ciadvertising.org/studies/student/99_fall/theory/millman/Diffusion.htm

D.Lekan, Duke University School of Nursing, 2008