Diffusion of Innovation Research in a Community-Based Integrated Screening Cohort
Date Issued
2016
Date
2016
Author(s)
Lien, Angela Shin-Yu
Abstract
Background: Because the risk of cancer and chronic diseases are increasing, early health screening can reduce morbidity and mortality. However, developing strategies to improve the screening coverage rate and increase willingness to adopt screening programmes is challenging for public health nurses. The Keelung Community-based Integrated Screening (KCIS), a new health promotion policy, integrated six cancers and six chronic diseases in a screening programme, which was conducted between 1999 and 2009. The KCIS is an innovative health promotion strategy for community populations because it combines outreach screening, health education, and a direct referral system. Aims: In this study, we applied the diffusion of innovation (DOI) theory, a macro-level human behaviour change theory, and analysed participants who were enrolled in the KCIS programme between 1999 and 2009 to investigate the relationship between time to adoption KCIS programme and demographic characteristics, lifestyle factors, and diabetes- and metabolic syndrome-related factors. Methods: A total of 79,489 participants participated in the KCIS programme between 1999 and 2009. According to the definition of the DOI theory, the ‘S-time shaped’ curve was used to categorise the participants on the basis of their time to adoption. The Kaplan–Meier method was used to plot the curve for the time of enrolment to estimate time in each category. The Cox proportional hazards regression model was used to calculate hazard ratios (HRs) for the time of enrolment in the KCIS with respect to demographic characteristics, lifestyle factors, and diabetes- and metabolic syndrome-related factors. In addition, the Weibull distribution method was used for the accelerated failure time model to estimate the median time of enrolment. Results: The KCIS coverage rate increased from 4.2% in 1999 to 84.3% in 2009. After adjustment for all variables, demographic factors such as age (aHR = 1.012, 95% CI = 1.012, 1.013), sex (aHR = 1.23, 95% CI = 1.21–1.25), low education level (aHR = 1.15, 95% CI = 1.12, 1.18), and early marriage (aHR = 1.32, 95% CI = 1.30, 1.36) as well as lifestyle factors such as not smoking (aHR = 1.16, 95% CI = 1.14–1.17), not consuming alcohol (aHR = 1.10, 95% CI = 1.08–1.12), and regular exercise (aHR = 1.36, 95% CI = 1.34–1.38) were significantly associated with early enrolment in the programme. The rate of early enrolment was higher in the participants without diabetes (aHR = 1.16, 95% CI = 1.12–1.21) and metabolic syndrome (aHR = 1.34, 95% CI = 1.341–1.36) than in those with diabetes and metabolic syndrome. Compared with the participants with metabolic syndrome, the adjusted median time of enrolment of the participants without metabolic syndrome was 0.82 years earlier. Furthermore, compared with the participants with severe metabolic syndrome, the adjusted median time of enrolment of the participants without metabolic syndrome was up to 2.25 years earlier. Conclusions: The innovative KCIS programme had successful diffusion within a decade and improved screening adoption behaviour. Demographic characteristics, unhealthy lifestyle, and chronic disease diagnosis affected the time of enrolment in the programme. The results suggest that nurses should apply the DOI theory to disseminate the health promotion strategy from the individual to the community level. Moreover, nursing intervention should be provided in different time zones and should be disseminated from the personal to the family level rather than the community level, with a focus on the specific screening needs of people in different age groups and of different sexes. The accurate documentation of screening results, early invitation to regular screenings, and health education should be provided for patients with chronic diseases.
Subjects
Diffusion of innovation theory
Keelung Community-based Integrated Screening
lifestyle
diabetes
metabolic syndrome
community nursing
SDGs
Type
thesis
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