Using Diffusion of Innovation Theory to Improve Adoption of Evidence Based Practice in Community Settings: A 10-Year Case Study in PRT

Background: Barriers to adoption of evidence-based practice in autism spectrum disorder treatment are numerous and there is a need for research on how better to bridge this gap between science and practice. Diffusion of innovation theory (Rogers, 2003) has been used to understand the adoption and rejection of new practices in a wide range of disciplines, such as agriculture and computing science, though has only rarely been applied to understanding autism treatment (Dingfelder & Mandell, 2011). This case study frames the adoption process of an evidence-based practice (EBP) over a 10-year period - Pivotal Response Treatment [PRT] (Koegel et al., 2006) - currently under dissemination in Western Canada by a large, non-profit autism service provider. This study extends previous research on evaluating EBP in community settings.

Objectives:

1. To summarize five key characteristics of diffusion of innovation theory: relative advantage, compatibility, complexity, trialability, and observability.
2. To apply these key characteristics to the adoption of PRT in a community-based setting, identifying successes and barriers in the adoption process.
3. To share these observations with other treatment providers and researchers to improve the adoption of EBP in community-based settings.

Methods: Using a case study framework, the 10-year adoption process of PRT was summarized, highlighting specific training models and methods of implementation of a large service provider in Western Canada. Diffusion of innovation theory was used to frame key aspects of the adoption process, highlighting successes and areas of difficulty. The primary focus was on the persuasion component of diffusion of innovation theory. Persuasion is associated with increased likelihood of adoption of an EBP, and by identifying key aspects, it is hypothesized this will allow other treatment providers to better understand how to use implementation science as a means of improving EBP adoption.

Results: A timeline of events was provided, including successes and setbacks in PRT adoption, in this practice setting. A clear description of the different implementation models trialed by the service provider were described, as well as training programs, quality control mechanisms, and areas of conflict and success. For each component of the persuasive element of diffusion of innovation theory, contrasting successes and sources of disagreement were identified. Themes emerged identifying agreement as well as challenges with the adoption process by program staff. Even 10 years after the adoption of this technology at a management level, full adoption of PRT at a practice level staff was still only partial, highlighting the challenges in disseminating EBP in existing practice environments.

Conclusions: Bridging the research to practice gap is difficult. This case study summarizes the experience of a large service provider in Western Canada with the adoption process of an EBP in this practice setting. Using diffusion of innovation theory, the adoption process is better understood, highlighting areas of success, as well as past and future challenges. This study demonstrates how difficult the implementation of EBP may be in community-based practice settings, and provides a framework for better understanding how to improve the implementation process of science-based practices in these settings.