PHOENIX: A new framework for applying psychological theories to the adoption of innovations by healthcare professionals
Fahy N., Greenhalgh T., Shaw S.
<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background </jats:bold>Although implementation science has borrowed concepts from psychology to explain how individuals think and act in relation to innovation adoption, the use of psychology has been limited and not well adapted to the aims and obligations of professionals. We aimed to enrich implementation science with a broader set of psychological theories relevant for professional behaviour, drawing particularly on the diffusion of innovations and stages of change models. <jats:bold>Methods </jats:bold>The study had two parallel components. The first was a hermeneutic review of how psychological theory has and could be used to understand innovation adoption by health professionals. The second component was an empirical case study of the implementation of guidance on routine HIV screening in three sites across two London hospitals. Primary data sources were synthesised and combined with emerging secondary research findings, each feeding into the other. Analysis focused empirically on how the stages of the diffusion of innovations adoption model (prior conditions, knowledge, persuasion, decision, implementation, confirmation) could be enriched by psychological theories. <jats:bold>Results </jats:bold>The hermeneutic review identified at least 20 relevant psychological theories from social, organisational, developmental and sports psychology; many of these were not single theories but contributions from domains of evolving research, making this an underestimate of potentially relevant theory. We developed a model (PHOENIX) to encapsulate how psychological theory can help illuminate each stage of adoption from diffusion of innovations theory: Person and History (prior conditions stage) – individuals’ characteristics and past experiences; Overload avoidance (knowledge stage) – filtering strategies when faced with overwhelming amounts of new knowledge; Evolving attitudes (persuasion stage) – a social process of collectively emerging views within a team; Networked decisions (decision stage) – decisions at two levels of the department combined with individual judgements; Implementation support (implementation stage) to turn an intention to act into actual action, with external supports valuable to reduce the cognitive effort required; uneXceptional (confirmation stage) – sustained effort to turn the new behaviour from a conscious innovation to a habit. <jats:bold>Conclusions </jats:bold>The PHOENIX model, if affirmed in further studies, has potential to enrich the study of innovation adoption by healthcare staff in organisational and professional contexts.</jats:p>